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PRESCRIBING INSULIN ZINC SUSPENSION MIXTURES
190 soluble insulin, and probably so when the proportion of S.l. to P.Z.I. is high. In this latter group the proportion of
amorphous to i.z.s. crystalline may need to be changed. Our experience with outpatients not included
i.z.s.
in this series has confirmed these views. In patients with strict biochemical control the distribution of dietary carbohydrate is likely to need alteration at the time of transfer; less carbohydrate will be required at breakfast and more at lunch and tea (see fig. 3). When biochemical control is poor, alteration of the diet is less urgent but is likely to be necessary later.
Summary Of 30 cases of diabetes mellitus transferred from another form of insulin to an equal dose of insulin zinc suspension lente, a third were less well controlled, while in half the control was unchanged. Transfer to insulin zinc suspension lente from other insulin is not free of risk. We wish to thank Dr. P. W. S. Blake and Dr. P. R. Knight for their help with the nocturnal blood-sugar estimations; Dr. R. Gaddie and Mr. Garfield Thomas for the biochemical results and helpful criticism ; and others who have helped in various ways. Generous supplies of insulin were provided by Evans Medical Supplies and Burroughs Wellcome & Co.
mixture is described in thisway it is difficult to calculate the exact dose of each type of insulin which is being ordered. i.z.s. lente is a mixture of known percentage : 30% of i.z.s. (A) and 70% of i.z.s. (c) ; therefore it seems logical that one should think of other mixtures in the same terms. With the aid of a graph (see figure) the amount of each type of insulin in a given dose of i.z.s. lente can be seen ; the exact dose of each type of insulin in mixtures of different percentages is also clear. It is then simple to calculate how much i.z.s. (A) or i.z.s. (c) should be added to a dose of i.z.s. lente to make mixtures The prescriber will then know of other percentages. the number of units of each type of insulin which he is ordering. I am most grateful graph.
—
—
PRESCRIBING INSULIN ZINC SUSPENSION MIXTURES M.D.
P. A. THORN Lond., M.R.C.P., D.C.H. SENIOR REGISTRAR
From the Diabetic
Clinic, General Hospital, Birmingham
IN the treatment of diabetic patients with insulin zinc suspension it is likely that various proportions ofI.Z.S. Amorphous’ (I.z.s. [A]) andI.Z.S. Crystalline’ (i.z.s. [c]) will be required. In previous reports (Nabarro and Stowers (1953a and b)) and in the manufacturers’ literature it is suggested that mixtures of the two should be prescribed as a given proportion of ’I.Z.S. Lente ’ to one of its two ingredients (1:1, 2 : 1, &c.). When the
Mr. T. F. Dee for
reproducing
the
REFERENCES
Nabarro, J. D. N., Stowers, J. M. (1953a) Proc. R. Soc. Med. 46, 864. (1953b) Brit. med. J. ii, 1027. —
—
A FATAL CASE OF
SODIUM NITRITE POISONING G. M. G. BARTON
REFERENCES
Hallas-Møller, K., Jersild, M., Peterson, K., Schlichtkrull, J. (1952) First Congress of the International Diabetes Federation. Leyden. Lawrence, R. D., Oakley, W. (1953) Brit. med. J. i, 242. Murray, I., Wilson, R. B. (1953) Ibid, ii, 1023. Nabarro, J. D. N., Stowers, J. M. (1953a) Proc. R. Soc. Med. 46, 864. (1953b) Brit. med. J. 1953, ii, 1027. Oakley, W. (1953) Ibid, p. 1021.
to
B.Sc., M.B. Lond. ASSISTANT PATHOLOGIST SALISBURY
THE
HOSPITALS,
WILTS.
cases of fatal sodium nitrite that I have been able to trace are those of a family of two adults and a child (McQuiston 1936). Sodium nitrite was found in the salt-cellar and basin of cooking-salt, and was isolated from the stomach contents of the three patients and from remnants of the meal. It was not established how sodium nitrite came to be in the salt, but one of the victims had access to this substance at work. Oppe (1951) describes a case in which a fatal outcome was prevented in a baby aged 2 months by giving intravenous methylene-blue. The baby had sodium nitrite 2 added to its feed of sodium citrate. instead gr. In the following case death occurred about three hours after taking sodium nitrite.
only previous
poisoning
A boy, aged 2 years, vomited while playing with his elder brother. After vomiting a second time he was given a glass of water and made to lie on the bed. The elder brother then produced an almost empty open bottle of sodium nitrite which the child had been licking. The child vomited once or twice On admission he was deeply more and was taken to hospital. cyanosed, collapsed, and crying with spasms of pain. His stomach was washed out, and administered, but his condition oxygen remained unchanged for three-quarters of an hour, after which he had a spasm and died.
Necropsy Findings.—The body was that of a well-developed cyanosed child. The mouth and oesophagus were normal, but the gastric mucosa was slightly inflamed. In spite of the vomiting and gastric lavage, the stomach contained a considerable amount of undigested food. The blood was darker than usual. The other organs were normal. 6-15 mg. of sodium nitrite was obtained from the stomach washings and 0-15 mg. from the stomach contents (Ilosvay’s reaction) Vomited material was not available for Nitric oxide haemoglobin was analysis. shown to be present in the blood by spectroscopy and by the colour reaction after boiling (Lucas 1935). The sodium nitrite had been bought Graph showing number of units of insulin in varying percentages of the total dose of I.Z.S.
chemist’s
at
shop by the child’s elder brother, aged 9, who wanted it for a chemical experiment about which he had a
amorphous to i.z.s. crystalline may need to be changed. Our experience with outpatients not included
i.z.s.
in this series has confirmed these views. In patients with strict biochemical control the distribution of dietary carbohydrate is likely to need alteration at the time of transfer; less carbohydrate will be required at breakfast and more at lunch and tea (see fig. 3). When biochemical control is poor, alteration of the diet is less urgent but is likely to be necessary later.
Summary Of 30 cases of diabetes mellitus transferred from another form of insulin to an equal dose of insulin zinc suspension lente, a third were less well controlled, while in half the control was unchanged. Transfer to insulin zinc suspension lente from other insulin is not free of risk. We wish to thank Dr. P. W. S. Blake and Dr. P. R. Knight for their help with the nocturnal blood-sugar estimations; Dr. R. Gaddie and Mr. Garfield Thomas for the biochemical results and helpful criticism ; and others who have helped in various ways. Generous supplies of insulin were provided by Evans Medical Supplies and Burroughs Wellcome & Co.
mixture is described in thisway it is difficult to calculate the exact dose of each type of insulin which is being ordered. i.z.s. lente is a mixture of known percentage : 30% of i.z.s. (A) and 70% of i.z.s. (c) ; therefore it seems logical that one should think of other mixtures in the same terms. With the aid of a graph (see figure) the amount of each type of insulin in a given dose of i.z.s. lente can be seen ; the exact dose of each type of insulin in mixtures of different percentages is also clear. It is then simple to calculate how much i.z.s. (A) or i.z.s. (c) should be added to a dose of i.z.s. lente to make mixtures The prescriber will then know of other percentages. the number of units of each type of insulin which he is ordering. I am most grateful graph.
—
—
PRESCRIBING INSULIN ZINC SUSPENSION MIXTURES M.D.
P. A. THORN Lond., M.R.C.P., D.C.H. SENIOR REGISTRAR
From the Diabetic
Clinic, General Hospital, Birmingham
IN the treatment of diabetic patients with insulin zinc suspension it is likely that various proportions ofI.Z.S. Amorphous’ (I.z.s. [A]) andI.Z.S. Crystalline’ (i.z.s. [c]) will be required. In previous reports (Nabarro and Stowers (1953a and b)) and in the manufacturers’ literature it is suggested that mixtures of the two should be prescribed as a given proportion of ’I.Z.S. Lente ’ to one of its two ingredients (1:1, 2 : 1, &c.). When the
Mr. T. F. Dee for
reproducing
the
REFERENCES
Nabarro, J. D. N., Stowers, J. M. (1953a) Proc. R. Soc. Med. 46, 864. (1953b) Brit. med. J. ii, 1027. —
—
A FATAL CASE OF
SODIUM NITRITE POISONING G. M. G. BARTON
REFERENCES
Hallas-Møller, K., Jersild, M., Peterson, K., Schlichtkrull, J. (1952) First Congress of the International Diabetes Federation. Leyden. Lawrence, R. D., Oakley, W. (1953) Brit. med. J. i, 242. Murray, I., Wilson, R. B. (1953) Ibid, ii, 1023. Nabarro, J. D. N., Stowers, J. M. (1953a) Proc. R. Soc. Med. 46, 864. (1953b) Brit. med. J. 1953, ii, 1027. Oakley, W. (1953) Ibid, p. 1021.
to
B.Sc., M.B. Lond. ASSISTANT PATHOLOGIST SALISBURY
THE
HOSPITALS,
WILTS.
cases of fatal sodium nitrite that I have been able to trace are those of a family of two adults and a child (McQuiston 1936). Sodium nitrite was found in the salt-cellar and basin of cooking-salt, and was isolated from the stomach contents of the three patients and from remnants of the meal. It was not established how sodium nitrite came to be in the salt, but one of the victims had access to this substance at work. Oppe (1951) describes a case in which a fatal outcome was prevented in a baby aged 2 months by giving intravenous methylene-blue. The baby had sodium nitrite 2 added to its feed of sodium citrate. instead gr. In the following case death occurred about three hours after taking sodium nitrite.
only previous
poisoning
A boy, aged 2 years, vomited while playing with his elder brother. After vomiting a second time he was given a glass of water and made to lie on the bed. The elder brother then produced an almost empty open bottle of sodium nitrite which the child had been licking. The child vomited once or twice On admission he was deeply more and was taken to hospital. cyanosed, collapsed, and crying with spasms of pain. His stomach was washed out, and administered, but his condition oxygen remained unchanged for three-quarters of an hour, after which he had a spasm and died.
Necropsy Findings.—The body was that of a well-developed cyanosed child. The mouth and oesophagus were normal, but the gastric mucosa was slightly inflamed. In spite of the vomiting and gastric lavage, the stomach contained a considerable amount of undigested food. The blood was darker than usual. The other organs were normal. 6-15 mg. of sodium nitrite was obtained from the stomach washings and 0-15 mg. from the stomach contents (Ilosvay’s reaction) Vomited material was not available for Nitric oxide haemoglobin was analysis. shown to be present in the blood by spectroscopy and by the colour reaction after boiling (Lucas 1935). The sodium nitrite had been bought Graph showing number of units of insulin in varying percentages of the total dose of I.Z.S.
chemist’s
at
shop by the child’s elder brother, aged 9, who wanted it for a chemical experiment about which he had a