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Reduced Plasma High Density Lipoprotein-Cholesterol Concentrations Need Not Increase when Hyperglycemia Is Conttolled With insulin in Nonisnulin-Dependent Diabetes Mellitus^*

Department of Medicine, Stanford University School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Administration Medical Center Palo Alto, California 94304

Address all correspondence and requests for reprints to: G.M.Rraven, M.D., Veterans Administration Medical Center (GRECC 640/182B), 3801 Miranda Avenue, Palo Alto, California 94304.

The ability of intensive insulin treatment to increase plasma high density lipoprotein (HDL)-cholesterol levels was evaluated in 12 patients with noninsulin-dependent diabetes mellitus. Patients were treated for 6 weeks with one daily morning injection of ultralente insulin, in combination with administration of regular insulin before breakfast, lunch, and dinner. The mean (±SEM) fasting plasma glucose concentration fell from 289 ± 21 to 122 ± 9 mg/dl(P < 0.001), and the mean hourly postprandial glucose concentration fell from 313 ± 24 to 102 ± 7 mg/dl (P < 0.001). In addition, insulin treatment was associated witha reduction in both fasting plasma triglyc–eride (256 ± 45 to 137 ± 18 mg/dl; P < 0.001) and cholesterol (224 ± 25 to 199 ± 19 mg/dl; P < 0.05) concentrations. However, plasma HDL-cholesterol concentrations, which were low to begin with, did not rise in association with excellent glycemic control. These results demonstrate that hyperglycemia and hypertriglyceridemia can be effectively reduced by an aggressive program of insulin treatment in patients with noninsulin-dependent diabetes mellitus, but this intervention need not lead o t an improvement in the abnormal HDL-cholesterol metabolism in these patients.

^* This work was supported by grants from the Research Service of the V.A., the NIH (RR-70-22 and HL-08506), and the Nora Eccles Treadwell Foundation.

Received June 17, 1985.

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