POSTPRANDIAL INSULIN LISPRO - A NEW-THERAPEUTIC OPTION FOR TYPE-1 DIABETIC-PATIENTS

OBJECTIVE - For intensified insulin therapy of type 1 diabetes, bolus injection of regular human insulin 30-15 min before a meal is currentl y recommended. This randomized study is aimed to determine whether ins ulin lispro (LIS), a new insulin analog with a rapid onset of action, can provide comparable blood glucose (BG) control by injection after t he meal. RESEARCH DESIGN AND METHODS - Eighteen type 1 diabetic subjec ts injected regular insulin (REG) at 40, 20, or 0 min before or LIS at 20 or 0 min before or 15 min after the start of a standardized test m eal. BG excursions and area under the curve of BG excursions (AUG) at the six visits were compared by analysis of variance. Hypoglycemic eve nts (BG less than or equal to 2.78 mmol/l) were evaluated in relation to the achieved postprandial BG control. RESULTS - Mean AUC values wer e 2.00, 2.55, and 3.33 mmol.h.l(-1) for REG given 40, 20, and 0 min be fore the test meal, respectively, and -2.19, -2.15, and 1.98 mmol.h.l( -1) for LIS given 20 and 0 min before and 15 min after the start of th e test meal, respectively. LIS injected 20 min (-20) or immediately (0 ) before the meal was significantly more effective in controlling post prandial BG excursion (P < 0.001) than any REG treatment. Postprandial injection of LIS (15) did not compromise postprandial BG control and resulted in less hypoglycemia. REG -40 and LIS -20 were associated wit h early hypoglycemia, but other hypoglycemic events were equally distr ibuted among groups. CONCLUSIONS - The optimal time for bolus insulin injection was 20 min before the meal for REG and immediately before th e meal for LIS. LIS injected immediately after a standard meal provide d postprandial BG control at least as good as REG injected from 40 to 0 min before the meal. Postprandial injection of LIS is an attractive new therapeutic option.