Issue 215 Item 12 Postprandial Administration of Insulin Lispro Effective Altern

No significant difference in glycemic excursion with respect to the time of lispro dose.

Postprandial administration of insulin lispro (IL), a fast-acting human insulin analogue, in pregnant women with diabetes produces a similar glycemic excursion profile to preprandial injections. According to a recent British study, this finding suggests that postprandial administration may serve as an effective alternative for diabetic women who experience nausea or vomiting during pregnancy.

At least 50% of European women are estimated to experience nausea and vomiting during the first 12 to 16 weeks of pregnancy, and the problem can persist throughout later stages of pregnancy for a subset of women. This creates an important concern for diabetic women who take insulin before meals, as they may be at risk for hypoglycemia if vomiting occurs soon after the meal.

"It may be particularly advantageous to take IL after a meal so that if nausea or vomiting occurs, hypoglycemia can be avoided if the insulin is omitted," writes Stephen Lindow, of Hull Royal Infirmary, Hull, United Kingdom. To test the efficacy of postprandial IL injections researchers compared the glucose excursion profiles associated with preprandial and postprandial IL administration in pregnant women with diabetes.

Nine pregnant diabetic women regularly treated with IL were asked to bring their usual lunch to an antenatal day unit on 4 separate visits. The participants were assigned to receive IL 5 minutes before eating on 2 random visits and immediately after finishing the meal on the other 2 occasions. Maternal glycemia was monitored before starting the meal and at 15-minute intervals for 3 hours following the meal. Glucose excursions were calculated by subtracting the preprandial glucose level from the values at each time point.

A total of 27 meals were completed during the study. No significant difference was detected between the mean fasting blood glucose associated with preprandial and postprandial IL administration (5.8 vs. 5.7 mmol/L, t=.03). Furthermore, no significant differences in glucose excursion levels were detected between preprandial and postprandial administration at any of the time points analysed. None of the women experienced hypoglycemic attacks during the study, and no evidence of fetal compromise was detected.

Although the study did not include women with nausea and vomiting, the researchers suggest that the findings can be extrapolated to the clinical management of women who do experience the problem. "Our data presented demonstrates that there is no significant difference in glycemic excursion with respect to the time of IL dose and therefore we recommend the postprandial administration of IL as an option in the management of pregnant women with diabetes," they conclude.
J Obstet Gynaecol 2004;24:4:382-386