Algorithm adaptation under functional insulin treatment during transfer from regular to insulin lispro

Our aim was to investigate the necessity and degree of dosage adaptation to pre-defined criteria during ambulatory transfer from regular insulin to in sulin lispro under functional insulin treatment (FIT), discriminating betwe en prandial, basal and correctional use of insulin and emphasizing flexibil ity. This open label prospective observation study with within subject comp arison vs baseline observed 63 insulin-dependent diabetic patients who rout inely make acute corrections of hyperglycaemic blood glucose levels, who ha d been transferred to insulin lispro and were evaluated after 2 and 11 week s of observation period with insulin lispro, Basal insulin including either human insulin ultralente in the morning as well as NPH (62% of cases) or l ente type insulin late before bed rest (22%), twice daily ultralente (13%) or twice daily lente (3%) was suitable for insulin lispro. The necessary al gorithm adaptation was of minor degree: increase of delayed-acting insulin before bed rest by 0.3 U (p=0.04), decrease of morning basal short-acting c omponent by 0.3 U (p=0.008), no change in prandial insulin requirements, de crease of algorithm for expected blood glucose lowering per 1 unit of short -acting insulin by 0.1 mmol/l (p=0.004) and decrease of postprandial target for hyperglycaemia correction by 0.2 mmol/l (p=0.008). Transfer to insulin lispro induced in FIT educated patients a lowering of mean blood glucose b y 0.4 mmol/l (p=0.004), of mean postprandial blood glucose by 1.4 mmol/l (p <0.001) and of HbA(1c) (p=0.04). No episodes of severe hypoglycaemia were r ecorded after transfer to insulin lispro, FIT allows safe ambulatory transf er to insulin lispro, a slight decrease in short-acting insulin in the morn ing is recommendable, Diab. Nutr. Metab. 11: 266-272. 1998. (C) 1998. Editr ice Kurtis.