ADVANCES IN THE TREATMENT OF DIABETES-MELLITUS IN THE ELDERLY - DEVELOPMENT OF INSULIN ANALOGS

Current insulin therapy only crudely mimics physiological secretion of insulin, Part of this difficulty is related to the hexameric structur e of pharmacological preparations of insulin, This structure delays th e absorption of insulin from the injection site, results in changes in the time to peak insulin action, and causes changes in its duration o f action as a function of changing dosage. These changes occur with bo th regular and intermediate acting insulin. Insulin analogues. which a re monomeric. will have a faster onset of action (more closely approxi mating endogenous insulin) and greater reproducibility of effect. Insu lin analogues with low isoelectric points may provide more stable basa l delivery as support to endogenous insulin production (i.e. monothera py) or in conjunction with prandial insulins or oral agent therapy. Th e main advantages of these preparations in elderly diabetic patients m ay be a reduced risk of hypoglycaemia, improved predictability of resp onse, and greater flexibility in more frail elderly patients. such as those with variable oral intake or compromised renal function.