We investigated the use, in a short period, of HumalogMix25 (Mix25) in a twice-daily administration regimen comparedto a twice-daily injection therapy with Humulin 30/70 (30/70) indiabetic patients with Italian dietary habits. We studied 33type 2 diabetic patients aged 59.1±8.1 years, BMI 29.8±2.7kg/m2, duration of diabetes andinsulin therapy of 14.4±9.8 and 4.2±4.6 years, respectively.After a 4-day leadin period of twice-daily human insulin 30/70treatment, patients were randomized to one of two treatmentsequences: (1) a twice-daily regimen with Mix25 just 5 minutesbefore the morning and evening meals for 12 days, followed by atwicedaily therapy with human insulin 30/70 given 30 minutesbefore the morning and evening meals for an additional 12 days;or (2) the alternate sequence. Each patient underwent a mixedmeal test: Humulin 30/70 was administered 30 minutes before themeal, while Mix25 was given 5 minutes before. The 2-hourpost-prandial glucose concentration after breakfast wassignificantly lower during treatment with Mix25 than withHumulin 30/70 (157±43.2 vs. 180±43.2 mg/dl,p<0.05). The glycemicexcursion after dinner on Mix25 treatment was significantlylower than with Humulin 30/70 (12.2±48.01 vs. 35.5±36.92 mg/dl,p<0.05).AUCglucose after Mix25 was lower thanafter Humulin 30/70. Glycemia after test meal was significantlylower with Mix25 than with Humulin 30/70. Insulin and freeinsulin concentrations after the test meal were significantlyhigher with Mix25 in comparison to Humulin 30/70. AUC seruminsulin and free insulin curves after Mix25 were significantlyhigher than after Humulin 30/70 (p=0.028 and p=0.005, respectively). Twice-dailyinjections of Humalog Mix25, compared to human insulin 30/70 intype 2 diabetic patients with Italian dietary habits, provideimproved and lasting post-prandial glycemic control, with thegreat convenience of the injection just before the meal.

OBJECTIVE To evaluate the accuracy of elderly patients in their mixing of regular and intermediate insulins, to assess the safety and efficacy of premixed insulins compared with extemporarily mixed insulins, and to determine patients' preferences. RESEARCH DESIGN AND METHODS We conducted a crossover multicenter study of 5 mo duration. Premixed insulins and patient-mixed, human biosynthetic (rDNA) insulins were used among 64 insulin-treated patients with NIDDM. After a 4-wk run-in period, eligible patients were randomly assigned to treatment 1 (extemporarily mixed insulins) or treatment 2 (premixed insulins) for 8 wk. After that period, the two treatments were crossed for an additional 8-wk period. A blood glucose profile was recorded monthly and HbA1c was measured at the beginning and at the end of each treatment period. An in vitro skills test was performed to assess the accuracy and reproducibility of the patient preparation of insulin doses, and a questionnaire was used to determine their personal preferences for premixed versus extemporarily mixed insulin. RESULTS In our study, the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin. The differences in blood glucose profiles and HbA1c were negligible between type and periods of treatment. The overall number of hypoglycemic episodes increased during the trial in both groups, but the difference between treatments was not significant. The in vitro skills test, however, indicated that the accuracy in the preparation of insulin doses was significantly higher when patients aspirated from one vial compared with preparation from two vials (P < 0.001). The CVs were 3.7% when drawing up a single dose and 5.0% when preparing a mixture, but the ranges were rather elevated (0.1–20.7 and 0.6–35.8%, respectively). Forty-two patients described the preparation of their daily insulin dose as very easy and 21 described it as easy when using premixed insulins versus 11 and 43, respectively, when using extemporarily mixed insulins (P < 0.001). CONCLUSIONS While the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin, the in vitro skills test indicated that insulin preparation by elderly patients is highly inaccurate. In some patients, a modification of the contents of the insulin is likely to occur in a few days. The use of premixed insulins should lessen the errors that occur in mixing insulins and from the contamination of the second insulin vial. Draw-up errors could partially account for the lack of improvement of glucose control during the period when patients received premixed insulins. A longer observation period probably is needed to assess appreciable changes in the quality of diabetes control.

Urines of 6 normal subjects, collected during three consecutive 12-hour periods, were examined for proteinuria and albuminuria. During the first period, subjects were kept in the upright position, and during the next two periods in the recumbent position. Both position (upright and recumbent) and the urine collection period (day or night) significantly modify protein and albumin excretion. Proteinuria is more sensitive to different posture and albuminuria to different times of urine collection.

Hypertonic haemodiafiltration is a simultaneous hypertonic (delta 550, Na 275mEq/L) low volume (7.2 litres) haemofiltration and hypotonic (delta 282) short time (180') haemodialysis. Reduction of the predialysis body pool of MM (-48 per cent) and small molecules (-33 per cent) was obtained. No relationship between vascular stability and MM removal was observed. However, a net UF of 20.5ml/min and a greater removal of solutes up to 1500 daltons mw were obtained with a three hours thrice weekly dialysis programme.

Filtration through membranes with different nominal cut-off was used for isolation of middle molecule fractions from uremic serum. Comparison was made with test substances which in gel filtration did not show a regular relationship between molecular weight and partition coefficient. The XM50 membrane (cut-off 50,000 D) showed the highest permeability to middle molecules (greater than 84%) whereas CF50 (same cut-off) retained middle molecules to some extent if filtration was carried out only once. The UM05 membrane (cut-off 500 D) was highly permeable for small molecules less than 300 D, intermediary permeable for molecules between 300 and 1000 D and retained molecules between 1,100 and 1,350 D more efficiently. It is concluded that filtration through membranes is a suitable method for identification of middle molecules.