Postprandial Insulin
Lispro May Impair Long-Term Glycemic Control
Preprandial Lispro more effective then postprandial
Lispro
Administering insulin lispro postprandially appears
to be a useful strategy for patients with an unpredictable
eating schedule, although for continuous long-term
use, the risk of poorer glycemic control may need
to be considered.
Postprandial insulin administration
allows adjustment of the insulin dose according
to the calories actually ingested. Therefore,
this may be a useful strategy for some patients
with unpredictable schedules, such as children,
frequent travelers, or those with decreased gastric
emptying rate.
Guntram Schernthaner, MD, with the
Department of Internal Medicine, at the Rudolfstitung
Hospital, in Vienna, Austria, and colleagues conducted
a 6-month, crossover study comparing the metabolic
effects of routine use of preprandial versus postprandial
injection of bolus insulin lispro.
Thirty-one patients with type 1
diabetes injected insulin lispro either preprandially
or postprandially for a 3-month period. They then
switched and to the alternate regimen for a further
3 months. The researchers measured glycosylated
hemoglobin (HbA1c), fructosamine, and 8-point
self-determined blood glucose profiles.
With preprandial insulin lispro,
mean HbA1c decreased slightly from baseline whereas
it increased slightly with postprandial administration,
and this resulted in a significant difference
in final HbA1c level (P = .008).
Mean fructosamine also decreased
slightly with preprandial insulin lispro but was
almost unchanged with postprandial insulin. Overall
daily blood glucose was similar between the two
treatments (P = .312). However, mean preprandial
glucose was lower (P = .026), whereas mean postprandial
glucose was higher (P = .031) with postprandial
insulin lispro administration.
In addition, mean blood glucose
excursions were higher with postprandial compared
with preprandial insulin lispro, indicating greater
daily fluctuations. No difference in incidence
of hypoglycemia was observed with the two treatment
regimens, however.
The researchers conclude that postprandial
administration of insulin lispro "appears
to be an acceptable treatment regimen since it
adequately controls blood glucose."
However, they point out that "the
daily fluctuations appear to be increased and
this could result in increasing HbA1c levels with
continuous postprandial administration for long
periods. Therefore, HbA1c should continue to be
monitored and the benefits of postprandial administration
may have to be balanced against less beneficial
glycemic control," they suggest.
Diabet Med 2004 Mar;21:3:279-84
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