Issue 211 Item 11 Glycemic Control Unaffected by Mixing Lantus with Short Acting

Mixing insulins showed no difference in control. Insulin glargine is a “long acting and peakless insulin” analogue. The major drawback to its use is that it has to be given as a separate injection, and cannot be mixed with other insulins. This results in: 1). Additional insulin injections; 2). Complicates treatment plan; 3). Decreases compliance.

We hypothesized that mixing insulin glargine with short acting insulin would not adversely affect glycemic control. Thirteen adolescents with type 1 diabetes (7M/6F, 13.5 ± 1.6 y, 22.4 ± 1 kg/m², A1C of 7.7 ± 0.7% and duration of diabetes of 22.4 ± 1 mo) were studied on 3 occasions.

All subjects were on glargine (as a separate injection at bedtime) and short acting insulin (Aspart or Lispro) with meals. Using the Minimed CGMS®, subjects were studied at baseline on their current insulin regimen (study B), and then 7 days following splitting the dose of Glargine into two halves and administering one half before breakfast and one half before dinner, either by mixing glargine and short acting insulin in one syringe (study M), or by administering them as separate injections (study S). Studies M and S were randomized. 24h glucose excursions were analyzed using repeated measure ANOVA.

The results showed that the 24h average glucose concentrations (Mean ± SE) were similar in the three studies (167 ± 4 mg/dl in studies B and S, and 150 ± 6 mg/dl in study M) (P<0.6). There were no reported side effects.

From the results it was concluded that mixing insulin glargine with short acting insulin (Aspart or Lispro) in children with type 1 diabetes does not negatively impact the glycemic control. Mixing glargine with short acting insulin may provide predictable insulin action, improve compliance and increase the use of glargine insulin in the pediatric population. Abstract ADA 64th Scientific Sessions
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