DOCTOR'S VIEW ARCHIVE
Diabetes Update #5 Day 2, Saturday June 11 from the American Diabetes Association National Meeting
Diabetes Conference - Differences in Long Acting Insulins
Dr. Ruchi Mathur offers perspectives of interest on topics from the American Diabetes Association's 65th Annual Scientific Sessions (held in San Diego, California June 10-14, 2005)
This is Dr. Ruchi Mathur with another update from the annual meeting of the American Diabetes Association. This update focuses on whether there really is a difference between the long acting insulin analogs currently available.
Most patients on insulin are familiar with the concept of long acting and short acting insulin. These agents are used in what's called a basal/bolus pattern - allowing for a long acting agent to always be on board and letting the short acting agent work in spurts such as after meals. The most recognized long acting out there is called NPH. (It's actually been around since 1946!) The problem with NPH is its variability. Because of the way it's formulated, it has noticeable peaks and troughs during the day, and because of the length of its action, it usually has to be dosed twice daily.
More recently, 2 other long acting insulins have been produced- Insulin glargine and insulin detemir.
Both of these insulins have been studied in detail. They are less variable then NPH insulin in their patterns of reproducibility of response in patients. In addition, studies suggest that when given to patients with type 1 diabetes , they lower fasting glucose by up to 30mg/dl over NPH, they cause less symptomatic hypoglycemia, less severe hypoglycemia requiring assistance, and less nocturnal hypoglycemia then NPH.
Another interesting fact mentioned was that when side effect profiles were reviewed, weight gain in those on insulin glargine and NPH were similar, however there was less weight gain in patients with both type 1 and type 2 diabetes who were given insulin detemir. What's the bottom line? Any long acting agent can be used successfully in combination with short acting insulins or in combination with oral therapy to treat blood sugars to goal. However, with the newer glargine and detemir, there may be less hypoglycemia - and with detemir, there may be less weight gain which is so often seen with insulin therapy. Read and hear the next installment from the conference.
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