Effectiveness of human ultralente versus NPH insulin in providing basal insulin replacement for an insulin lispro multiple daily injection regimen. A double-blind randomized prospective trial. The Canadian Lispro Study Group.

Abstract

UL or NPH insulin, when used as the basal insulin for multiple injection regimens, results in similar glycemic control in patients using insulin lispro before meals. However, in patients who require a second injection of basal insulin, NPH insulin appears to provide lower prebreakfast and prelunch glucose levels compared with UL insulin.

The use of human ultralente is limited by great intraindividual variability in overnight plasma insulin profiles

“…As days with extreme variations create problems with glucose control, this might explain the dif®culties in achieving an acceptable morning blood glucose without night-time hypoglycaemia, which would be in agreement with the previous study by Haakens et al [3] and also by Smith et al [13]. In a recent study by the Canadian Lispro Study Group, lower fasting blood glucose was found when using NPH insulin twice daily in combination with insulin lispro before meals than when using ultralente insulin with insulin lispro [5]. On the other hand, Parillo et al [16] found lower fasting blood glucose with ultralente insulin than with NPH insulin, but in that study the NPH insulin was administered before dinner, which increases the risk that the duration is too short for controlling fasting blood glucose.…”

A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with Type 1 diabetes on intensified insulin therapy

“…Insulin lispro is a safe and effective alternative to soluble insulin, but it is still necessary to learn how best to take advantage of its altered pharmacokinetics. Daytime basal insulin supplementation is a logical strategy[4], and resulted in improved control in selected patients participating in an uncontrolled feasibility study[17]. Patient convenience may have been over‐emphasized as an indication for use of rapidly absorbed insulin analogues, since this study suggests that patients could achieve equivalent overall control simply by injecting soluble insulin shortly before meals.…”

“…A double‐blind comparison of insulin lispro and soluble insulin has been performed in patients on continuous subcutaneous insulin therapy[3], and basal insulins have been compared in a blinded fashion in patients taking lispro[4]. No direct comparison of lispro and soluble insulin has been reported in patients on injection therapy.…”

Basal insulin glargine (HOE 901) versus NPH insulin in patients with type 1 diabetes on multiple daily insulin regimens. U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group.

“…A recent study by Zinman et al (15) showed that these 2 insulins are similar in safety and efficacy and highlighted their inadequacy to provide 24-h coverage. The implications of this study support the idea that in the long-term, twicedaily injections of either of these 2 insulins are eventually needed to control blood glucose levels in patients with longer duration of disease and greater hyperglycemia.…”