[Intensified conventional insulin therapy. The long-term successes and reasons for failure of this therapeutic concept].

Insulin treatment in 34 type I diabetics (17 women and 17 men; mean age 30.6 [13-72] years) was changed from a conventional to an intensified conventional treatment schedule (ICIT). However, optimal metabolic control was possible in the long term in only 16 patients. A "dawn phenomenon" occurred in 18 patients, compliance was unsatisfactory in five despite intensive instruction, in three the basal insulin requirements could not be determined on an out-patient basis, and two developed marked gastroparesis. Ultratard, used at first as a retard-insulin, proved inadequate in eight patients. In the 16 patients in whom it was possible to continue ICIT, the HbA1c value decreased after 18.0 +/- 7.2 months from 8.4 +/- 1.4% to 7.1 +/- 1.1% (P less than 0.01), fasting blood sugar levels fell from 185.6 +/- 118 mg/dl to 123.2 +/- 11.8 mg/dl. Thus ICIT may significantly contribute to improving the metabolic state of type I diabetics. But factors which may interfere with a satisfactory control of the diabetes must first be excluded. In particular, if the "dawn phenomenon" occurs, other forms of treatment should be attempted.