A comparison of premixed with patient-mixed insulins

Blood glucose control in 12 C-peptide negative patients has been compared in a crossover trial of four insulin treatment regimens: porcine soluble and isophane, premixed porcine soluble/isophane, porcine soluble and lente, all taken twice daily, and once daily bovine ultralente with three porcine soluble injections before meals. Each regimen lasted 8 weeks and included home blood glucose monitoring, telephoned advice on dose adjustment during the first 2 weeks, and home collection of seven-point capillary blood profiles for laboratory analysis. No significant differences between the regimens could be demonstrated when HbA1c, 24 h mean blood glucose, and M-values were evaluated. The average range of blood glucose values for four capillary samples taken at the same time point on different days was 8.0 mmol/l, compared with a maximum difference between regimens of 3.6 mmol/l at any time point, suggesting that blood glucose control is more heavily influenced by erratic insulin absorption than by the insulin regimen chosen. Premixed insulins offer convenience of use without significant deterioration of blood glucose control.