Reflections of a clinician on switch from human to analogue insulin treatment

2012 ◽  
Vol 153 (40) ◽  
pp. 1589-1593 ◽  
Author(s):  
László Deák
Keyword(s):  
Insulin Resistance ◽  
Insulin Therapy ◽  
Human Insulin ◽  
Insulin Treatment ◽  
Insulin Analogue ◽  
Insulin Response ◽  
Insulin Analogues ◽  
International Literature ◽  
Clinical Observations ◽  
Basal Bolus

The development of insulin therapy has not been stopped since the manufacturing of human insulin, because better mimic of physiological insulin response made it necessary to modify the human insulin molecule in order to create rapidly absorbing insulin analogues and 24-hour acting basal insulin analogues. Clinical observations indicate that the complete switch from human basal-bolus therapy to insulin analogues means not only “unit-for-unit” switch but it represents a transfer to an insulin therapy with different basal/bolus ratio as a result of different pharmacokinetic and pharmacodynamic properties of insulin and the level of insulin resistance of the patient. With reference to a case-history, the author presents his experience on a switch from human insulin to insulin analogue. Furthermore, the author summarizes data obtained from a few cases reported in international literature which draw the attention to the fact that the basal/bolus ratio should be adjusted individually, which may be the key for the success in the therapy in these cases. Orv. Hetil., 2012, 153, 1589–1593.

Modern insulin therapy with insulin analogues detemir and aspart in children and adolescents: The problems and solutions

2013 ◽  
Vol 59 (6) ◽  
pp. 80-86
Author(s):  
T L Kuraeva
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Human Insulin ◽  
Vascular Complications ◽  
Insulin Analogues ◽  
Diabetic Patients ◽  
Problems And Solutions ◽  
Basal Bolus

DCCT (Diabetes Control and Complications Trial) study showed that intensified insulin therapy associates with significant reduction both of development and progression of vascular complications compared to conventional insulin therapy in type 1 diabetic patients. Modern algorithms of diabetes treatment in children and adolescents reflect the need to achieve and maintenance of glycemic control as closely as possible to normal level. Insulin analogues have improved pharmacokinetic and pharmacodynamic properties, and also have less variability than human insulin. So they have more physiologic and predictable profile actions and, therefore, provide the possibility to achieve optimal glycemic control with low risk of hypoglycemia. Current review demonstrates the benefits of basal-bolus therapy with insulin analogues detemir (Levemir) and aspart (NovoRapid) and advantages of insulin NovoRapid in the continuous subcutaneous insulin infusion (CSII) compared with human insulin in children and adolescents with type 1 diabetes mellitus.

scholarly journals Long-term comparison of human insulin analogue B10Asp and soluble human insulin in IDDM patients on a basal/bolus insulin regimen

Diabetologia ◽  
1995 ◽  
Vol 38 (5) ◽  
pp. 592-598 ◽  
Author(s):  
F. S. Nielsen ◽  
L. N. J�rgensen ◽  
M. Ipsen ◽  
A. I. Voldsgaard ◽  
H. -H. Parving
Keyword(s):  
Human Insulin ◽  
Insulin Analogue ◽  
Insulin Regimen ◽  
Bolus Insulin ◽  
Basal Bolus

scholarly journals Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better?

2021 ◽  
Vol 12 ◽  
Author(s):  
Federico Mecacci ◽  
Federica Lisi ◽  
Silvia Vannuccini ◽  
Serena Ottanelli ◽  
Marianna Pina Rambaldi ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Gestational Diabetes ◽  
Insulin Therapy ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Insulin Analogue ◽  
Combined Therapy ◽  
Insulin Analogues ◽  
Maternal Characteristics ◽  
Long Acting

ObjectiveMaternal characteristics and OGTT values of pregnancies complicated by gestational diabetes mellitus (GDM) were evaluated according to treatment strategies. The goal was to identify different maternal phenotypes in order to predict the appropriate treatment strategy.MethodsWe conducted a retrospective study among 1,974 pregnant women followed up for GDM in a tertiary referral hospital for high-risk pregnancies (Careggi University Hospital, Florence, Italy) from 2013 to 2018. We compared nutritional therapy (NT) alone (n = 962) versus NT and insulin analogues (n = 1,012) group. Then, we focused on different insulin analogues groups: long acting (D), rapid acting (R), both D and R. We compared maternal characteristics of the three groups, detecting which factors may predict the use of rapid or long-acting insulin analogue alone versus combined therapy.ResultsAmong women included in the analysis, 51.3% of them needed insulin therapy for glycemic control: 61.8% D, 28.3% combined D and R, and 9.9% R alone. Age >35 years, pre-pregnancy BMI >30, family history of diabetes, previous GDM, altered fasting plasma glucose (FPG), hypothyroidism, and assisted reproductive technologies (ART) were identified as maternal variables significantly associated with the need of insulin therapy. Altered 1-h and 2-h glucose plasma glucose level at OGTT, age >35 years, and previous GDM were found as independent predicting factors for the use of combined therapy with rapid and long acting analogues for glycemic control. On the contrary, pre-pregnancy BMI <25 and normal fasting plasma glucose values at OGTT were found to be significantly associated to the use of rapid insulin analogue only.ConclusionA number of maternal and metabolic variables may be identified at the diagnosis of GDM, in order to identify different GDM phenotypes requiring a personalized treatment for glycemic control.

Intensive conservative insulin treatment in patients with type 2 diabetes mellitus

2012 ◽  
Vol 153 (38) ◽  
pp. 1487-1493
Author(s):  
György Jermendy
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Conventional Treatment ◽  
Insulin Treatment ◽  
Fasting Blood Glucose ◽  
Insulin Analogues ◽  
Postprandial Blood Glucose ◽  
Medical Team ◽  
Basal Bolus

In the last couple of years, the intensive conservative insulin treatment (basal-bolus regime) became more and more popular even in patients with type 2 diabetes. Using this insulin treatment, continuous patient education, co-operation between the medical team (diabetologist, dietician and diabetes-nurses) and the patient as well as the availability of modern insulins, pens and glucometers are of great importance. Clearly, the basal-bolus treatment with human insulin has advantages over the conservative (conventional) treatment with twice daily premix insulins. Moreover, the basal-bolus treatment with insulin-analogues proved to be superior in some aspects as compared to human insulins. The intensive insulin treatment (basal-bolus regime with insulin-analogues) approaches the optimal insulin substitution and, with its use the adequate correction of each element of the glucose triad (fasting blood glucose, postprandial blood glucose, HbA1c) should be considered feasible even in patients with type 2 diabetes. Orv. Hetil., 2012, 153, 1487–1493.

scholarly journals Insulin Therapy and Cancer in Type 2 Diabetes

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Edoardo Mannucci
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Human Insulin ◽  
Epidemiological Studies ◽  
Insulin Analogues ◽  
Negative Effects ◽  
Beneficial Effects ◽  
Increased Risk

Despite the availability of many other agents, insulin is widely used as a treatment for type 2 diabetes. In vitro, insulin stimulates the growth of cancer cells, through the interaction with insulin-like growth factor-1 (IGF-1) receptors and its own receptors. In observational surveys on type 2 diabetes, insulin therapy is associated with an increased incidence of several forms of cancer, although it is difficult to discriminate the effect of confounders from that of insulin itself. Randomized trials do not confirm the increased risk associated with insulin therapy, although they do not allow to rule out some negative effects on specific forms of cancer, at least at higher doses. Among insulin analogues, glargine has a higher affinity for the IGF-1 receptor and a greater mitogenic potency in vitro than human insulin, but it is extensively metabolized in vitro to products with low IGF-1 receptor affinity. Overall, epidemiological studies suggest a possible increase of risk with glargine, with respect to human insulin, only at high doses and for some forms of cancer (i.e., breast). Data from clinical trials do not confirm, but are still insufficient to totally exclude, such increased risk. However, beneficial effects of insulin outweigh potential cancer risks.

scholarly journals Insulin degludec/insulin aspart is the first co-formulation of basal and prandial insulin analogues

2014 ◽  
Vol 17 (4) ◽  
pp. 108-119
Author(s):  
Ivan Ivanovich Dedov ◽  
Marina Vladimirovna Shestakova
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Aspart ◽  
Basal Insulin ◽  
Diabetes Management ◽  
Insulin Analogues ◽  
Insulin Degludec ◽  
Diabetic Patients ◽  
Prandial Insulin ◽  
Basal Bolus

Achievement of glycemic control is the major therapeutic aim to prevent or delay the onset and progression of diabetes related complications. Insulin therapy represents a cornerstone in the treatment of diabetes and has been used widely for achieving glycemic goals. The aim for insulin therapy is to mimic the physiological profile of insulin secretion seen in nondiabetic patients. Development of the insulin analogs has offered new opportunities in the diabetes management to achieve greater safety and tolerability of diabetes treatment. Insulin degludec/insulin aspart(IDegAsp) (Ryzodeg?, Novo Nordisk, Denmark) is the first soluble co-formulation of 70% ultra-long acting insulin degludec and 30% rapid-acting prandial insulin aspart, providing both basal insulin coverage and a prandial insulin bolus in a single injection. This review discusses data regarding the efficacy, safety, tolerability and clinical benefits of IDegAsp. According to the clinical development program IDegAspprovides an achievement of similar glycemic control with superiority in lowering FPG with using less number of injections and lower daily insulin dose, and also associated with numerically lower rates of confirmed and nocturnal confirmed hypoglycaemia in comparison with premixed or basal insulin analogues, as well as a basal component for basal?bolus therapy with supplementary mealtime insulin aspart.Trial results suggest that IDegAspQD or BID maybe an appropriate and reasonable option for initiating insulin therapy in type 1 and type 2 diabetic patients inadequately controlled on maximal doses of oral antidiabetic drugs,and also a simple alternative to basal?bolus treatment in patients who require intensification of insulin therapy, especially when adherence to more complex regimens is challenging.

scholarly journals Influence of the dynamics of body weight on the risk factors of cardiovascular disease in patients with type 2 diabetes during the first year of insulin treatment

2013 ◽  
Vol 10 (1) ◽  
pp. 22-25
Author(s):  
T S Dzhavakhishvili ◽  
T I Romantsova ◽  
O V Roik
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Insulin Treatment ◽  
Insulin Analogues ◽  
First Year ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

The aim of the present study was to investigate whether insulin treatment-induced weight gain had an adverse impact on cardiovascular risk factors in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy when insulin analogues or human insulins are used. A total of 157 patients with newly insulinized type 2 diabetes were included in the study. The patients were divided in two groups. First group consisted of subjects (mean age 57 [45; 73], duration of diabetes of 10 years [4; 16]) who had received long-acting basal (glargine, detemir), premixed (biphasic insulin aspart 30, Humalog Mix 25) or short-acting (aspart, lispro) insulin analogues. Patients from second group (mean age 59 [46; 75], duration of diabetes of 10 years [5; 15]) were treated with intermediate-acting basal (Protophane, Humulin NPH insulin), premixed (biphasic human insulin 30, Humulin M3) and regular (Actrapid, Humulin R) human insulins. Our study has shown that insulin-induced weight gain may not adversely affect cardiovascular risk factors, particularly, lipid profile, in insulin-treated type 2 diabetic patients during the first year after initiating insulin therapy. Use of insulin analogues for treatment of type 2 diabetes patients results in better glycaemic control, significant declines in blood lipid concentrations, less increase in waist circumference compared with human insulins during the first year after initiating insulin therapy.

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