WHO study group report 1985
A. Clinical Class : Diabetes Mellitus (DM)
Insulin Dependent Diabetes Mellitus (IDDM) or Type -1,
Non-Insulin Dependent Diabetes Mellitus (NIDDM) or Type – 2
(a) Non-obese
(b) Obese
Malnutrition Related Diabetes Mellitus (MRDM):
Secondary Diabetes :
(a) Pancreatic diseases (b) diseases of hormonal aetiology (c) drug induced or chemical induced conditions (d) abnormalities of insulin or its receptors (e) certain genetic syndromes (f) miscellaneous
Impaired Glucose Tolerance (IGT)
(a) Non-obese
(b) Obese
(c) Associated with certain conditions and syndromes
Gestational diabetes Mellitus (GDM)
B. Statistical Risk Classes :
Subjects with normal glucose tolerance but substantially increased risk of developing diabetes.
Previous abnormality of glucose tolerance,
Potential abnormality of glucose tolerance.
An International Expert Committee, working under the sponsorship of the American Diabetes Association was established in May 1995 to review the classification and diagnosis of diabetes based on aetiology and the new classification was published in July 1997. According to it
The terms IDDM & NIDDM are eliminated.
The terms Type -1 & Type -. 2 diabetes are retained with arabic numerals being used.
The class Malnutrition Related Diabetes Mffllitus (MRDM) has been eliminated.
The stage Impaired Glucose Tolerance (IGT) & Gestational Diabetes Mellitus (GDM) are retained.
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There are a number of different brands and types of insulin called Insulin Zinc Suspensions. The presence of zinc in the insulin suspension slows down the action of the insulin.

Ultratard HM (Insulin zinc suspension)

Ultratard has a very slow action.

This is very slow acting insulin and it is a suspension of insulin zinc crystals. It has its main effect from about eight hours to twenty-eight hours and then a slow fading away of effect until thirty hours or even longer. Some doctors, however, recommend giving a single dose of Ultratard at night so that there is a small amount of insulin in the body throughout the twenty-four hours, and then give extra unmodified insulin such as Actrapid before each meal.

Humulin UL (Insulin zinc suspension) Humulin UL has a very slow action.

This is very slow acting insulin and it is a suspension of insulin zinc crystals. It has its main effect from about eight hours to twenty-eight hours and then a slow fading away of effect until thirty hours or even longer. Some doctors, however, recommend giving a single dose of Hamelin UL at night so that there is a small amount of insulin in the body throughout the twenty-four hours, and then give extra unmodified insulin such as Hamelin R before each meal.

Monotard HM (Insulin zinc suspension) Monotard HM has a moderately slow effect.

Monotard is rather slow acting insulin. It has a start of effect about four hours after injection with the maximum effect from six to about eighteen hours and a fading of activity after this time to about twenty-four hours.

A hypoglycemic reaction due to Monotard insulin given before breakfast may occur either in the late afternoon or particularly during the night. Because of this late effect it is common to mix Monotard with Actrapid insulin to give a better effect during the day. This combination modifies the effect of insulin through the Actrapid and may retain some of its own activity as well. It is also common for Monotard with Actrapid to be given in a divided dose, morning and evening rather than as a single dose in the morning.

Humulin L (Insulin zinc suspension) Humulin L has a moderately slow effect.

Humulin L is rather slow acting insulin. It has a start of effect about four hours after injection with the maximum effect from six to about eighteen hours and a fading of activity after this time to about twenty-four hours.

A hypoglycemic reaction due to Humulin L insulin given before breakfast may occur either in the late afternoon or particularly during the night. Because of this late effect, it is common to mix Humulin L with Humulin R insulin to give a better effect during the day. This combination modifies the effect of insulin through the Humulin R and may retain some of its own activity as well. It is also common for Humulin L with Humulin R to be given in a divided dose, morning and evening, rather than as a single dose in the morning.

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