Our readers report that hypoglycemia and the fear of going low is the hardest part of diabetes (Poll from April 2016). Therefore it makes sense that anything that can be done to reduce the risk of hypoglycemia, without sacrificing blood glucose control, would be welcomed.
Recent studies have shown that an insulin regimen of either (a) multiple daily injections, using Lantus® (Insulin Glargine) as a basal and either NovoLog® (Insulin Aspart) or Humalog® (Insulin Lispro) to cover food, or (b) insulin pump therapy, results in a reduced risk of hypoglycemia, especially at night, while maintaining good control. This is great news for everyone who uses insulin. This quote sums up the data:
“Combination therapy with insulin glargine plus lispro reduced the incidence of nocturnal hypoglycemia and was at least as effective as R/NPH insulin therapy in maintaining glycemic control in adolescents on multiple injection regimens.”1
Evidence of this data being put into practice was demonstrated clearly in a poll we ran in January 2016, asking readers which insulin(s) they used. Among users of rapid-acting insulin, the use of Regular has dropped to 6%, with NovoLog being used by 49%, Humalog by 34%, and Apidra by 11%. This is a dramatic decline from 2000, when 26% of people reported using Regular. Among users of long-acting insulin, the change is equally dramatic, with NPH use dropping to just over 13% compared with 73% in 2000. The use of Lantus has grown from zero in 2000 to 65% of people using long-acting insulin, with Levemir, new in 2005, at 22%. (See the Excel spreadsheet from the poll for specific details.)
For parents of toddlers, while not ideal, the fast-acting insulin analogs can be injected after a meal is eaten. For anyone who given a toddler an injection of Regular insulin and then watched them refuse to eat, the ability to inject after the meal is a major benefit.
- Effect of insulin analogues on risk of severe hypoglycaemia in patients with type 1 diabetes prone to recurrent severe hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-endpoint crossover trial.
- Effects of Insulin Detemir and NPH Insulin on Body Weight and Appetite-Regulating Brain Regions in Human Type 1 Diabetes: A Randomized Controlled Trial. Free full text available in HTML and PDF formats.
- A comparison of insulin detemir and neutral protamine Hagedorn (isophane) insulin in the treatment of diabetes: a systematic review.
- Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen.
- Long-acting insulin analogue detemir compared with NPH insulin in type 1 diabetes: a systematic review and meta-analysis.
- Comparison of human insulin and insulin analogues on hypoglycaemia and metabolic variability in type 1 diabetes using standardized measurements (HYPO score and Lability Index).
- Optimizing the Replacement of Basal Insulin in Type 1 Diabetes Mellitus: No Longer an Elusive Goal in the Post-NPH Era.
- Lower HbA1c after 1 year, in children with type 1 diabetes treated with insulin glargine vs. NPH insulin from diagnosis: a retrospective study.
- Clinical Experience with Insulin Glargine in Type 1 Diabetes.
- Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden.
- Cost-effectiveness of insulin detemir compared to NPH insulin for type 1 and type 2 diabetes mellitus in the Canadian payer setting: modeling analysis.
- Insulin Analogs versus Human Insulin in the Treatment of Patients with Diabetic Ketoacidosis: a randomized controlled trial.
- Institution of Basal-Bolus Therapy at Diagnosis for Children With Type 1 Diabetes Mellitus. Free full text available in HTML and PDF formats.
- Improved glycaemic control by switching from insulin NPH to insulin glargine: a retrospective observational study. Free full text available in PDF format.
- A Comparison of Glycemic Variability Associated With Insulin Glargine and Intermediate-Acting Insulin When Used as the Basal Component of Multiple Daily Injections for Adolescents With Type 1 Diabetes.
- Long-term improvement of fasting glycaemia after switching basal insulin from NPH to detemir in children with type 1 diabetes: a 1-year multicentre study.
- Insulin Glargine Versus Intermediate-Acting Insulin as the Basal Component of Multiple Daily Injection Regimens for Adolescents with Type 1 Diabetes Mellitus.
- Cost of severe hypoglycaemia in patients with type 1 diabetes in Spain and the cost-effectiveness of insulin lispro compared with regular human insulin in preventing severe hypoglycaemia.
- Long-term efficacy and safety of insulin detemir compared to Neutral Protamine Hagedorn insulin in patients with Type 1 diabetes using a treat-to-target basal-bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial.
- Improved glycemic control and lower frequency of severe hypoglycemia with insulin detemir; long-term experience in 105 children and adolescents with type 1 diabetes.
- Treatment satisfaction and quality of life with insulin glargine plus insulin lispro compared with NPH insulin plus unmodified human insulin in people with Type 1 diabetes.
- A Randomized, Controlled Trial Comparing Twice-a-Day Insulin Glargine Mixed With Rapid-Acting Insulin Analogs Versus Standard Neutral Protamine Hagedorn (NPH) Therapy in Newly Diagnosed Type 1 Diabetes. Free full text available in HTML and PDF formats.
- Survey of glargine use in 115 pregnant women with Type 1 diabetes.
- Clinical experience in treatment with the long-term insulin analogue glargine in a diabetes centre.
- Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. U.S. Study Group of Insulin Glargine in Type 1 Diabetes [Diabetes Care, 23:639-643, 2000]. Full text available as PDF.
- Insulin Detemir Is Associated With More Predictable Glycemic Control and Reduced Risk of Hypoglycemia Than NPH Insulin in Patients With Type 1 Diabetes on a Basal-Bolus Regimen With Premeal Insulin Aspart [Diabetes Care 26:590-596, 2003]. Full text available as HTML or PDF.
- Hypoglycemia Prevalence in Prepubertal Children With Type 1 Diabetes on Standard Insulin Regimen: Use of Continuous Glucose Monitoring System [Diabetes Care 26:662-667, 2003]. Full text available as HTML or PDF.
- Randomized Cross-Over Trial of Insulin Glargine Plus Lispro or NPH Insulin Plus Regular Human Insulin in Adolescents With Type 1 Diabetes on Intensive Insulin Regimens [Diabetes Care 26:799-804, 2003]. Full text available as HTML or PDF.
- Intensive Replacement of Basal Insulin in Patients With Type 1 Diabetes Given Rapid-Acting Insulin Analog at Mealtime: A 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime [Diabetes Care 26:1490-1496, 2003]. Full text available as HTML or PDF.
- A Comparison of Postprandial and Preprandial Administration of Insulin Aspart in Children and Adolescents With Type 1 Diabetes [Diabetes Care 26:2359-2364, 2003]. Full text available as HTML or PDF.
- Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus [JAMA. 2003;289:2254-2264]
- Tight Control of Type 1 Diabetes: Recommendations for Patients from the American Academy of Family Physicians recommends Lantus over NPH (see page 5)
- Treatment with the insulin analogue lispro in children and adolescents with type 1 diabetes mellitus: evaluation over a 3-year period [Diabetes Nutr Metab. 2002 Feb;15(1):7-13].
- Comparison of insulin lispro with regular human insulin for the treatment of type 1 diabetes in adolescents [Clin Ther. 2002 Apr;24(4):629-38].
- Efficacy of Humalog injections before an afternoon meal and their acceptance by children and adolescents with type 1 diabetes [Diabet Med. 2002 Dec;19(12):1026-31].
- Intensive insulin treatment versus conventional regimen for adolescents with type 1 diabetes, benefits and risks [Saudi Med J. 2003 May;24(5):485-7].
- Insulin glargine: an updated review of its use in the management of diabetes mellitus [Drugs. 2003;63(16):1743-78].
- Effect of therapy with insulin glargine (lantus) on glycemic control in toddlers, children, and adolescents with diabetes [Diabetes Technol Ther. 2003;5(5):801-6].
- Nocturnal hypoglycemia: clinical manifestations and therapeutic strategies toward prevention [Endocr Pract. 2003 Nov-Dec;9(6):530-43].
- Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin [J Pediatr. 2003 Dec;143(6):737-40].
- Prevalence of chronic diabetes complications in dependence on insulin therapy method in children and adolescents with type 1 diabetes.
- Is insulin detemir able to favor a lower variability in the action of injected insulin in diabetic subjects?
- Intensive insulin therapy today: ‘basal-bolus’ using multiple daily injections or CSII?
- Long-acting insulin analogues (insulin glargine or determir) and continuous subcutaneous insulin infusion in the treatment of type 1 diabetes mellitus in the paediatric population.
- A review of human and analogue insulin trials.
- Evaluation of the cost-effectiveness of insulin glargine versus NPH insulin for the treatment of type 1 diabetes in the UK.
- An economic assessment of analogue basal-bolus insulin versus human basal-bolus insulin in subjects with type 1 diabetes in the UK.
- Glargine versus NPH insulin: Efficacy in comparison with insulin aspart in a basal bolus regimen in type 1 diabetes-The glargine and aspart study (GLASS) A randomised cross-over study.
- Glycaemic control and hypoglycaemia in children, adolescents and young adults with unstable type 1 diabetes mellitus treated with insulin glargine or intermediate-acting insulin.
- Treatment with insulin glargine reduces asymptomatic hypoglycemia detected by continuous subcutaneous glucose monitoring in children and adolescents with type 1 diabetes.
- Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy.
- Glycemic variation and hypoglycemia in patients with well-controlled type 1 diabetes on a multiple daily insulin injection program with use of glargine and ultralente as basal insulin.