INTRANASAL INSULIN - THE EFFECTS OF 3 DOSE REGIMENS ON POSTPRANDIAL GLYCEMIC PROFILES IN TYPE-II DIABETIC SUBJECTS

In both fasting normal and diabetic subjects, nasally administered ins ulin achieves significant falls in plasma glucose concentrations. Repe ated administration before and during a meal has been necessary to low er postprandial glycaemic excursion in subjects with NIDDM. We have st udied the use of Novolin(R) Nasal which employs a non-irritant, lecith in-based enhancer as a vehicle for human insulin, on postprandial gluc ose profiles in NIDDM subjects to determine efficacy, optimal dose fre quency, and tolerability. Seventeen NIDDM subjects (15 men, 2 women) p articipated in a randomized, partially blinded, placebo-controlled, cr ossover trial of three active treatment regimens (nasal insulin, 120 U at 0 min, 60 U at 0 and +20 min or 120 U at +20 min) in relation to a standardized mixed meal given at 0 min. All active treatments signifi cantly reduced postprandial glucose concentrations compared to placebo . Intranasal insulin given at 0 min at a dose of 60 U or 120 U resulte d in a 50 % reduction in postprandial incremental glucose compared to placebo over the first 2 h, whereas treatment with 60 U both at 0 and 20 min lead to a 70 % reduction over the 240 min postprandial period. Post-prandial intravenous insulin was the least effective. There were no episodes of symptomatic hypoglycaemia. Local tolerability was excel lent with only four reports of transient nasal irritation out of a tot al of 68 doses. The delivery device was accurate with intra-device CV of delivered dose of 4.8 %. We conclude that nasal insulin is effectiv e in reducing postprandial glycaemia in subjects with NIDDM and is wel l tolerated. Repeated dosing achieved the greatest reduction in postpr andial glycaemic responses to a mixed meal.