[Insulin Lispro (Lys B28, Pro B29) treatment in adolescents and young people with type 1 diabetes]

The human insulin analogue, Lispro (Lys B28, Pro B29), is more similar to normal pancreatic insulin response to ingestion. Therefore, it could provide an alternative to the classical treatment of type-1 diabetes in childhood. The aim of this study was to analyze the response to insulin treatment with this analogue during 1 year.

In a study group of twenty puberal diabetic patients (nine male and 11 female) with a mean age of 15.6 years (+/- SD) and with diabetes of a mean of 8.3 years (+/- 4.3 SD), classical intensive treatment, a combination of regular insulin (HR) and NPH insulin (Humulin NPH) was substituted for a new treatment with Lispro and NPH insulin in 3-4 doses. All patients had received diabetic education and performed at least four blood glucose tests daily and self monitoring. We analyzed the 6 months prior to the change in treatment (Group A) and the 12 months after the change (Group B). The amount of insulin (u/kg/day), the fast/intermediate insulin ratio in each dose, dietary modifications, the level of metabolic control given by the HbA1C average measured every 2 months, severe hypoglycemia and the patient s level of satisfaction with the new treatment were compared between the two groups.

The number of daily doses, as well as the daily insulin intake, was the same in both groups (3.7 [+/- 0.6] doses/day; 0.9 [+/- 0.2] u/kg/day). With Lispro treatment the ratio fast/intermediate insulin was reduced. This reduction was statistically significant for the pre-breakfast dose (Classical = 65. 4 +/- 30% vs Lispro = 47.1 +/- 19.6%), and for the pre-lunch dose (Classical = 58.1 +/- 29.3% vs Lispro = 39 +/- 12.8%). Most patients did not need neither mid-morning or mid-afternoon doses. There were no modifications in body mass index. Although metabolic control improved slightly (Classical X A(b) A(1)c = 7 +/- 1.2 vs Lispro X A(b) A(1c) = 6.6 +/- 1.1), the difference was not statistically significant. Three patients had a severe hypoglycemic episode in the first 6 months with the new treatment pattern. All of them were satisfied with the new insulin.

Intensive therapy with Lispro insulin combined with appropriate doses of basal insulin (NPH) can provide a good alternative in the treatment of diabetic teenagers.