Insulin lispro (Lys(B28), Pro(B29)) in the treatment of diabetes during the fasting month of Ramadan

Aims To compare insulin lispro with soluble human insulin in patients with Type 2 diabetes mellitus fasting during Ramadan, with respect to the rate o f hypoglycaemic episodes and postprandial blood glucose values after the ma in meal after sunset. Methods The insulins were compared in an open-label, randomized, crossover study of 70 outpatients. Hypoglycaemic episodes were recorded by the patien ts in a self-monitoring diary. Fasting, 1-h and 2-h postprandial blood gluc ose values were recorded by the patient on three consecutive days at the en d of each treatment period. Results The fasting blood glucose values before sunrise (P > 0.4) and after sunset (P > 0.6) were similar and did not differ significantly between bot h treatment groups. The rise in blood glucose after the main meal after sun set was 3.0 +/- 0.4 mmol/l after 1 h in the insulin lispro treatment group compared to 4.3 +/- 0.4 mmol/l in the soluble insulin treatment group (P < 0.01), and 2.6 +/- 0.4 mmol/l after 2 h with insulin lispro compared to 4.0 +/- 0.5 mmol/l with soluble insulin (P < 0.008). Mean hypoglycaemic episod es per patient over 14 days were 1.3 +/- 0.1 vs. 2.6 +/- 0.2, P < 0.002, re spectively, for insulin lispro and soluble insulin. Most hypoglycaemic epis odes occurred during the time period from 6 h after the before sunrise meal until breaking the fast after sunset. Conclusions The significantly lower rate of hypoglycaemic episodes combined with better control of postprandial blood glucose suggest insulin lispro m ay be more suitable prandial insulin for patients treated with Type 2 diabe tes who fast during Ramadan.