Pharmacokinetics of subcutaneously administrated insulin and its clinical implications

In 1959 the problems connected to insulin therapy was described by Somogyi. He said »The blood glucose and glucosuria of diabetic patients often show wide fluctuations even when both carbohydrate content of diet and insulin dose are unchanged« (1). When analysing this problem Somogyi defined the »R« ratio as grams of glucose available in the diet/units of insulin injected and the »G/I« ratio as grams of glucose utilized per unit of insulin injected. The observation which caused confusion was »that blood sugar and glucosuria of diabetic patients often show wide fluctuations even when both the carbohydrate content of the diet and the insulin dose are unchanged«; that is to say, the G/I ratio is subject to fluctuations even when R is constant. This paradox of Somogyi and its long-term consequences will be analysed in the following.Somogyi thought of insulin in terms of the dose injected per day and