Insulin in Type 1 and Type 2 Diabetes—Should the Dose of Insulin Before a Meal be Based on Glycemia or Meal Content?

Krzymień, Janusz; Ładyżyński, Piotr

doi:10.3390/nu11030607

Cited by 18 publications

(21 citation statements)

References 70 publications

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“…22 Patients with diabetes are required to adjust their prandial insulin doses based on size and content of a meal and premeal blood glucose levels to achieve optimum PPG control. 24 Across the 3 clinically relevant doses studied, insulin lispro exposure after URLi increased proportionally with increasing dose. In addition, the accelerated insulin lispro absorption, reduction in late exposure, and an overall shorter PK duration with URLi compared with Lispro was consistent across the doses (7, 15, and 30 U).…”

Section: Discussionmentioning

confidence: 98%

Pharmacokinetic and Glucodynamic Responses of Ultra Rapid Lispro vs Lispro Across a Clinically Relevant Range of Subcutaneous Doses in Healthy Subjects

Leohr

Dellva

Labell

et al. 2020

Clinical Therapeutics

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Purpose: Ultra rapid lispro (URLi) is a novel insulin lispro formulation developed to more closely match physiological insulin secretion and improve postprandial glucose control. This study compared the pharmacokinetic and glucodynamic parameters of URLi and Lispro (Humalog ®) at 3 dose levels in healthy subjects. Methods: This randomized, 6-period, subject-and investigator-blind, crossover study included 42 healthy subjects. At each period, subjects received a single subcutaneous dose of 7, 15, or 30 U of URLi or Lispro followed by a 10-h automated euglycemic clamp. Insulin lispro and blood glucose concentrations were measured. Findings: Across all 3 doses, insulin lispro appeared in the serum 2e5 min faster, and exposure was 6-to 8fold greater in the first 15 min, with URLi versus Lispro. Exposure beyond 3 h postdose was 45%e 52% lower, and duration of exposure was 67e86 min shorter with URLi versus Lispro for all dose levels. Onset of insulin action was 7e9 min faster and insulin action was~3-fold greater in the first 30 min with URLi versus Lispro across the dose levels. Insulin action beyond 4 h was reduced by 32%e45%, and duration of action was reduced by 47e67 min, with URLi versus Lispro for all 3 dose levels. Overall exposure and total glucose infused were similar between URLi and Lispro at each dose level. Dose proportionality was observed for maximum and overall exposure after URLi. Less than dose-proportional increases in maximum and total glucose infused were observed and were similar for both URLi and Lispro. Implications: URLi exhibited ultra-rapid pharmacokinetic and glucodynamic parameters across all 3 dose levels studied and exhibited doseproportional increases in exposure in healthy subjects. ClinicalTrials.gov identifier: NCT03286751.

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Section: Discussionmentioning

confidence: 98%

Pharmacokinetic and Glucodynamic Responses of Ultra Rapid Lispro vs Lispro Across a Clinically Relevant Range of Subcutaneous Doses in Healthy Subjects

Leohr

Dellva

Labell

et al. 2020

Clinical Therapeutics

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“…Despite the improvements achieved with the new insulin formulations, multiple daily injection therapy does not allow variations in the speed or duration of prandial insulin delivery [74]. Greater flexibility is guaranteed by the insulin pump therapy, which enables to modify prandial insulin delivery according to the composition of the meal so as to mitigate PP glucose excursions [75]. Several studies have evaluated PP glucose response following meals with different composition and different types of insulin boluses (single/quick bolus, two/split bolus, square wave bolus, dual wave bolus) [76,77,78,79].…”

Section: Other Factors Influencing Postprandial Glucose Controlmentioning

confidence: 99%

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

2019

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The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.

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“…The management of type 2 diabetes may also include the administration of insulin. But questions remain whether the dose of insulin before a meal should be based on glycemia or meal content [24]. Krzymien et al [24] reviewed existing guidelines and scientific evidence on insulin dosage in people with type 1 and type 2 diabetes and explored the effect of the meal composition such as carbohydrate, protein and fat on postprandial glucose.…”

mentioning

confidence: 99%

“…But questions remain whether the dose of insulin before a meal should be based on glycemia or meal content [24]. Krzymien et al [24] reviewed existing guidelines and scientific evidence on insulin dosage in people with type 1 and type 2 diabetes and explored the effect of the meal composition such as carbohydrate, protein and fat on postprandial glucose. The authors found that in most current guidelines aimed at establishing prandial insulin doses in type 1 diabetes, only carbohydrates are counted, whereas in type 2 diabetes the meal content is often not taken into consideration.…”

mentioning

confidence: 99%

“…The authors found that in most current guidelines aimed at establishing prandial insulin doses in type 1 diabetes, only carbohydrates are counted, whereas in type 2 diabetes the meal content is often not taken into consideration. Therefore, it was concluded that prandial insulin doses in managing people with diabetes should take into account the pre-meal glycemia, as well as the size and composition of the meals [24].…”

mentioning

confidence: 99%

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Dietary Intake and Type 2 Diabetes

Ojo

2019

Nutrients

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This editorial aims to examine the risk factors associated with type 2 diabetes and to discuss the evidence relating to dietary strategies for managing people with this condition. It is clear from the evidence presented that a range of dietary interventions can provide useful approaches for managing people with type 2 diabetes, including the regulation of blood glucose and lipid parameters, and for reducing the risks of acute and chronic diabetic complications.

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Insulin in Type 1 and Type 2 Diabetes—Should the Dose of Insulin Before a Meal be Based on Glycemia or Meal Content?

Cited by 18 publications

References 70 publications

Pharmacokinetic and Glucodynamic Responses of Ultra Rapid Lispro vs Lispro Across a Clinically Relevant Range of Subcutaneous Doses in Healthy Subjects

Pharmacokinetic and Glucodynamic Responses of Ultra Rapid Lispro vs Lispro Across a Clinically Relevant Range of Subcutaneous Doses in Healthy Subjects

Postprandial Glucose Control in Type 1 Diabetes: Importance of the Gastric Emptying Rate

Dietary Intake and Type 2 Diabetes

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