K. Howorka et al., Algorithm adaptation under functional insulin treatment during transfer from regular to insulin lispro, DIABET NUTR, 11(5), 1998, pp. 266-272
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.