Treatment of type 1 diabetes with insulin lispro during Ramadan

Objective: To compare insulin lispro with regular human insulin with respec t to blood glucose control and frequency of hypoglycaemia in patients with type I diabetes who wished to fast during the month of Ramadan. Research design and methods: Insulin lispro or regular human insulin was gi ven together with NPH insulin, twice daily before the morning and evening m eals, for two weeks each in an open-label, randomised, crossover design, an d 64 patients completed the protocol. Blood glucose was self-monitored at f asting morning and evening, and 1-h and 2-h after the post-sunset meal on t hree consecutive days at the end of each treatment period. Results: The 2-h blood glucose excursion after the post-sunset meal was sig nificantly (p = 0.026) lower with insulin lispro (2.50 +/- 0.46 mmol/l) tha n with regular human insulin (3.47 +/- 0.49 mmol/l). Daily insulin doses di d not differ between treatments but compliance with recommended time of inj ection was better with insulin lispro. Hypoglycaemia incidence (insulin lis pro, 15 (23.4%) patients; regular human insulin 31 (48.4%) patients; p = 0. 004) and frequency (insulin lispro, 0.70 +/- 0.19; regular human insulin 2. 25 +/- 0.36 episodes/patient/30 days; p < 0.001) were lower with insulin li spro. Five (22.7%) of the episodes during insulin lispro occurred during th e nocturnal period compared with 27 (36.5%) of the episodes while on regula r human insulin. Conclusions: Glycaemic control, measured by postprandial glycemic excursion s, was improved and hypoglycaemia was significantly reduced with insulin li spro compared with regular human insulin. Patients with type 1 diabetes who insist on fasting during Ramadan may be better managed with insulin lispro .