Basal insulin replacement and use of rapid-acting insulin analogues in patients with type 1 diabetes

To analyze various treatment strategies for replacement of basal insulin in patients with type 1 diabetes who are receiving rapid-acting insulin with meals.

Recently published studies are reviewed, and the available information on basal insulin adjustment is summarized.

In a comparison of presupper insulin lispro versus regular human insulin in adolescent patients, postprandial blood glucose excursion was much lower with insulin lispro. Patients who were given regular insulin at supper and no bedtime snack had a significantly higher occurrence of nocturnal hypoglycemia than did those given insulin lispro at supper and no snack at bedtime. In another study that attempted to identify the optimal basal insulin in the context of multidose therapy with insulin lispro, NPH insulin yielded lower blood glucose levels and a trend toward better glycosylated hemoglobin levels than did Ultralente insulin. For improvement of glycemic control during insulin lispro therapy, adjustments in the ratio of bolus to basal insulin and the number of basal insulin injections have been shown to be useful. In addition, use of insulin lispro in continuous subcutaneous insulin infusion therapy significantly reduced the rate of occurrence of hypoglycemic episodes in comparison with regular insulin.

Rapid-acting insulin analogues improve postprandial blood glucose control and decrease the frequency of hypoglycemia in patients with type 1 diabetes whether insulin pump therapy or a multidose insulin injection regimen is being used. For full benefit of short-acting insulin analogues, adjustments must be made in basal insulin replacement.