COMPARISON OF LYS(B28)PRO(B29)-HUMAN INSULIN ANALOG AND REGULAR HUMANINSULIN IN THE CORRECTION OF INCIDENTAL HYPERGLYCEMIA

OBJECTIVE - To obtain clinically applicable data on the effects of reg ular human insulin and the Lys(B28),Pro(B29)-human insulin analogue (l ispro) on the correction of incidental hyperglycemia. RESEARCH DESIGN AND METHODS - The insulins were compared in a non-clamped randomized c rossover study of 27 male IDDM patients. Hyperglycemia was induced by the withdrawal of the normal evening dose of insulin; the next morning patients fasted and received a single dose of study insulin according to a dosing nomogram. Blood glucose concentration and G(R) (a measure of glucose corrected for differences in administered insulin dose: G( R) = glucose concentration x BMI x insulin dose(-1)) were followed for 4 h. RESULTS - The time courses of blood glucose concentration and G( R) were significantly different after regular insulin in comparison wi th lispro (multiple analysis of variance, P < 0.001). At t = 120 min, glucose concentrations had decreased 1.4 mmol/l more with lispro than with regular insulin (95% confidence interval [CI] 0.6-2.3, P = 0.002) . Similarly, G(R) had decreased 4.4 mol . kg . IU-1. m(-5) more with l ispro than with regular insulin (95% CI 2.6-6.2, P < 0.001). The overa ll difference in glucose values was 0.87 mmol/l (lispro < regular insu lin, P = 0.036), and the overall difference in G(R) values was 1.96 mo l . kg . IU-1. m(-5) (lispro < regular insulin, P = NS). Unexpectedly the intrinsic variability of G(R) was higher for lispro than for regul ar insulin. CONCLUSIONS - The more rapid action of lispro is an advant age in the correction of hyperglycemia, even though actual differences in glucose concentrations are smaller than suggested by previous clam ped studies.