GUIDELINES FOR USING INSULIN LISPRO

OBJECTIVE To review the best evidence-based literature on the insulin analogue, lispro insulin, and to provide guidelines for its use. QUALI TY OF EVIDENCE Using the MeSH terms, lispro and insulin analogues, we searched PubMed, Current Contents, MEDLINE, and EMBASE from January 19 86 to July 1998 and selected 42 articles out of 97 for high quality an d relevance to family medicine. Twenty-eight were randomized controlle d trials, but only two studies were blinded because lispro and regular insulin have different optimal times of administration. MAIN MESSAGE The new insulin analogue, lispro, produces a much more rapid, higher, and shorter-lasting peak level of insulin than regular human insulin, thus mimicking physiologic secretion of insulin more closely. This all ows insulin administration just before or just after meals and means p atients can manage with fewer snacks. Lispro controls postprandial blo od glucose levels better and does not cause hypoglycemia. Although mos t older studies showed no change in glycosylated hemoglobin (HbA(tc)) levels, a few recent studies involving refinements, such as continuous subcutaneous insulin infusion or basal insulin to reduce preprandial glucose levels, have found small but significant improvements. Insulin lispro has also been used successfully in cases of insulin resistance and insulin allergy. CONCLUSIONS Lispro is a useful addition for moti vated diabetic patients who like to achieve better control of HbA(1c) without increased hypoglycemia and to match mealtime insulin injection s with diet, exercise, and various lifestyles.