Strategies toward improved control during insulin lispro therapy in IDDM - Importance of basal insulin

OBJECTIVE - To examine whether overall glycemic control can be improved with insulin lispro by adjustment of the basal insulin regimen without an increased risk of hypoglycemia. RESEARCH DESIGN AND METHODS - A 5-month open study was performed in 66 IDDM patients after they had been transferred from human regular insulin to insulin lispro as a premeal therapy The premeal and basal insulin regimens were adjusted according to self-monitoring of blood glucose during the visits at 2-week to 1-month intervals. Diurnal glucose profile, hypoglycemic events, HbA(1c), and patient satisfaction were evaluated. RESULTS - The mean daily glucose level decreased from 9.2 +/- 0.2 to 8.4 +/- 0.2 mmol/l (P = 0.001) and HbA(1c) decreased from 8.8 +/- 0.1 to 8.0 +/- 0.1% (P < 0.001) (mean +/- SD). The number of daily NPH injections increased from 1.4 +/- 0.1 at baseline to 3.1 +/- 0.1 at the end of the study. Total daily insulin dose increased by 3 U (7%) because of an 8-U (43%) rise in basal insulin, whereas premeal insulin dose decreased by 5 U (20%). The number of hypoglycemic episodes did not change during the study. Of the patients, 86% considered insulin lispro equal or better than human regular insulin. CONCLUSIONS - Although the study was open, the data suggest that the appropriate combination of insulin lispro and basal insulin can improve postmeal hyperglycemia, HbA(1c), and treatment satisfaction without increasing the risk of hypoglycemia.