COMPARISON OF THE INFLUENCE OF TWICE DAILY NPH INSULIN VERSUS ONCE DAILY GLARGINE INSULIN ON THE FREQUENCY OF NOCTURNAL HYPOGLYCEMIA IN TYPE 2 DIABETIC PATIENTS WITH CONGESTIVE HEART FAILURE

Objective: The probability of developing nocturnal hypoglycemia is high in type 2 diabetic patients with existing heart failure. We intended to compare applying single dose of glargine insulin by bedtime against twice daily NPH insulin in terms of creating nocturnal hypoglycemia in such patients. Material and method: The patients demonstrating similar characteristics with respect to age, body mass index, duration of diabetes and heart failure and metabolism were randomized into two groups as insulin glargine (n:19) and NPH (n: 11). The subjects have been prospectively followed up for 12 weeks. Results: The maintenance of metabolic control was found to be markedly better in glargine insulin group than those being applied NPH (p<0.001). The frequency of nocturnal hypoglycemia was observed to be 10.5 % in the insulin glargine group, compared to 9.1 % in the NPH group, which was not a statistically significant difference. The frequency of overall hypoglycemia was higher in patients taking glargine insulin (p=0.029). Conclusions: While the use of insulin glargine provided a better metabolic control in our study group compared to NPH insulin, it failed to decrease the frequency of nocturnal hypoglycemia. Caution should be taken for nocturnal hypoglycemia when using insulin in type 2 diabetics with concurrent heart failure.