REVIEW OF INSULIN THERAPY
Main Article Content
Keywords
Type 1 diabetes, insulin, A1C, dosing, comparison.
Abstract
The objective of this article is to review the different types of insulin and to explain some of the different dosing regimens that are used. Articles were obtained via a MEDLINE search and product package inserts. There is no one insulin therapy that is best for all patients. Type 1 diabetes patients require insulin therapy to maintain life. Studies support intensive in-sulin dosing in these patients to obtain an A1C of less than 7.0%. Insulin therapy for type 2 diabetes patients may be a little less clear. Long-acting insulin in combination with an oral agent may be just as effective as insulin alone, and in pa- tients who fail oral therapy, a simple insulin regimen is preferred over a complex one.
References
1. DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA. 2003;289: 2254-2264.
2. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26:S33- S50.
3. American Diabetes Association. Insulin administration. Diabe- tes Care. 2000;23:S86.
4. DeWitt DE, Dugdale DC. Using new insulin strategies in the out- patient treatment of diabetes: clinical applications. JAMA. 2003; 289:2265-2269.
5. Campbell RK, Setter SM. Optimizing diabetes management: fo- cus on insulin therapies. American Pharmacists Association Highlights Newsletter. 2003;6(1):1-6.
6. Allen J. Insulins. Pharmacist’s Letter. 2003;19(190806):1-11.
7. Eli Lilly and Company. Humalog insulin lispro injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
8. Novo Nordisk. NovoLog insulin aspart (rDNA origin) [injection package insert]. Princeton, NJ: Novo Nordisk; 2002.
9. Heller SR, Amiel SA, Mansell P. Effect of the fast-acting insulin analog lispro on the risk of nocturnal hypoglycemia during in- tensified insulin therapy. Diabetes Care. 1999;22:1607-1611.
10. Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, An- derson JH. Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. Diabetes Care. 1997;20:1827-1832.
11. Brunelle R, Llewelyn J, Anderson JH, Gale EAM, Koivisto V. Meta-analysis of the effect of insulin lispro on severe hypogly- cemia in patients with type 1 diabetes. Diabetes Care. 1998;21: 1726-1731.
12. Pfutzner A, Kustner E, Forst T, et al. Intensive insulin therapy with insulin lispro in patients with type 1 diabetes reduces the frequency of hypoglycemic episodes. Exp Clin Endocrinol Dia- betes. 1996;104:25-30.
13. Bastyr EJ, Johnson ME, Trautmann ME, Anderson JH, Vignati L. Insulin lispro in the treatment of patients with type 2 diabetes mellitus after oral agent failure. Clin Ther. 1999;21(10):1703- 1714.
14. Gale EAM. A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with type 1 diabe- tes on intensified insulin therapy. Diabet Med. 2000;17:209-214.
15. Vignati L, Anderson JH, Iversen PW. Efficacy of insulin lispro in combination with NPH human insulin twice per day in patients with insulin-dependent or non-insulin-dependent diabetes mellitus. Clin Ther. 1997;19(6):1408-1421.
16. Daniels AR, Bruce R, McGregor L. Lispro insulin as premeal therapy in type 1 diabetes: comparison with Humulin R. N Z Med J. 1997;110:435-438.
17. Raskin P, Holcombe JH, Tamborlane WV, et al. A comparison of insulin lispro and buffered regular insulin administered via con- tinuous subcutaneous insulin infusion pump. J Diabetes Complicat. 2001;15:295-300.
18. Melki V, Renard E, Lassmann-Vague V, et al. Improvement of HbA1c and blood glucose stability in IDDM patients treated with lispro insulin analog in external pumps. Diabetes Care. 1998;21: 977-982.
19. Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabe- tes. 1997;46(3):440.
20. Home PD, Lindholm A, Hylleberg B, Round P. Improved gly- cemic control with insulin aspart: a multicenter randomized double-blind crossover trial in type 1 diabetic patients. Diabetes Care. 1998;21:1904-1909.
21. Tamas G, Marre M, Astorga R, Dedov I, Jacobsen J, Lindholm A. Glycaemic control in type 1 diabetic patients using optimised insulin aspart or human insulin in a randomised multinational study. Diabetes Res Clin Pract. 2001;54:105-114.
22. Home PD, Lindholm A, Riist A. Insulin aspart vs human insulin in the management of long-term blood glucose control in type 1 diabetes mellitus: a randomized controlled trial. Diabet Med. 2000;17:762-770.
23. Plank J, Wutte A, Brunner G, et al. A direct comparison of insulin aspart and insulin lispro in patients with type 1 diabetes. Diabe- tes Care. 2002;25:2053-2057.
24. Eli Lilly and Company. Humulin R regular insulin human injec- tion, USP (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2000.
25. Novo Nordisk. Novolin R [package insert]. Clayton, NC: Novo Nordisk; 1999.
26. Novo Nordisk. Novolin N [package insert]. Clayton, NC: Novo Nordisk; 1999.
27. Eli Lilly and Company. Humulin N pen NPH Humulin insulin (rDNA origin) isophane suspension [package insert]. Indianapo- lis, IN: Eli Lilly; 2002.
28. Eli Lilly and Company. Humulin L lente human insulin (rDNA origin) zinc suspension [package insert]. Indianapolis, IN: Eli Lilly; 2000.
29. Aventis Pharmaceuticals Inc. Lantus (insulin glargine (rDNA or- igin) injection [package insert]. Kansas City, MO: Aventis Pharmaceuticals Inc; 2003.
30. Eli Lilly and Company. Humulin U ultralente human insulin (rDNA origin) extended zinc suspension [package insert]. India- napolis, IN: Eli Lilly; 2000.
31. Levien TL, Baker DE, White JR, Campbell RK. Insulin glargine: A new basal insulin. Ann Pharmacother. 2002;36:1019-1027.
32. Tunbridge FKE, Newens A, Home PD, et al. A comparison of hu- man ultralente- and lente-based twice-daily injection regimens. Diabet Med. 1989;6:496-501.
33. Kelly JL, Hirsch IB, Trence DL. Rapid decrease in clinically sig- nificant hypoglycemia with insulin glargine. Diabetes. 2002;51(suppl 2):A123.
34. Ratner RE, Hirsch IB, Neifing JL, Satish KG, Mecca TE, WIlson CA. Less hypoglycemia with insulin glargine in intensive ther- apy for type 1 diabetes. Diabetes Care. 2000;23:639.
35. Pieber TR, Eugene-Jolchine I, Derobert E. Efficacy and safety of HOE 901 versus NPH insulin in patients with type 1 diabetes. Diabetes Care. 2000;23:157-162.
36. Rosenstock J, Schwartz SL, Clark CM, Park GD, Donley DW, Ed- wards MB. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Dia- betes Care. 2001;24:631-636.
37. Raskin P, Klaff L, Bergenstal R, Halle JP, Donley D, Mecca T. A 16- week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care. 2000;23:1666- 1671.
38. Yki-Jarvinen H, Dressler A, Zieman M. Less nocturnal hypoglycemia and better post-dinner glucose control with bed- time insulin glargine compared with bedtime NPH insulin dur- ing insulin combination therapy in type 2 diabetes. Diabetes Care. 2000;23:1130-1136.
39. Eli Lilly and Company. Humulin 70/30 pen 70% human insulin isophane suspension and 30% human insulin injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
40. Novo Nordisk. Novolin 70/30 injection [package insert]. Clay- ton, NC: Novo Nordisk; 1999.
41. Eli Lilly and Company. Humalog Mix 75/25 75% insulin lispro protamine suspension and 25% insulin lispro injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
42. Novo Nordisk. Novolog Mix 70/30 [package insert]. Princeton, NJ: Novo Nordisk; 2002.
43. Malone JK, Yang H, Woodworth JR, et al. Humalog Mix25 offers better mealtime glycemic control in patients with type 1 or type 2 diabetes. Diabetes Metab. 2000;26:481-487.
44. Boehm BO, Home PD, Behrend C, Kamp NM, Lindholm A. Pre- mixed insulin aspart 30 vs premixed human insulin 30/70 twice daily: a randomized trial in type 1 and type 2 diabetic patients. Diabet Med. 2002;19:393-399.
45. Herz M, Arora V, Campaigne BN, Scholtz HE, Potgieter MA, Mollentze W. Humalog Mix25 improves 24-hour plasma glucose profiles compared with the human insulin mixture 30/70 in pa- tients with type 2 diabetes mellitus. S Afr Med J. 2003;93:219- 223.
46. Colombel A, Murat A, Krempf M, Kuchly-Anton B, Charbonnel B. Improvement of blood glucose control in type 1 diabetic pa- tients treated with lispro and multiple NPH injections. Diabet Med. 1999;16:319-324.
47. Fritsche A, Schweitzer MA, Haring H. Improved glycemic con- trol and reduced nocturnal hypoglycemia in patients with type 2 diabetes with morning administration of insulin glargine com- pared with NPH insulin. Diabetes. 2002;51(suppl 2):A54.
48. Yki-Jarvinen H, Ryysy L, Nikkila K, Tulokas T, Vanamo R, Heikkila M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med. 1999;130:389-396.
49. Yki-Jarvinen H, Kauppila M, Kujansuu E, et al. Comparison of insulin regimens in patients with non-insulin-dependent diabe- tes mellitus. N Engl J Med. 1992;327:1426-1433.
50. Hamann A, Matthaei S, Rosak C, Silvestre L. A randomized clin- ical trial comparing breakfast, dinner, or bedtime administration of insulin glargine in patients with type 1 diabetes. Diabetes Care. 2003;26:1738-1744.
51. Taylor R, Davies R, Fox C, Sampson M, Weaver JU, Wood L. Ap- propriate insulin regimens for type 2 diabetes: a multicenter ran- domized crossover study. Diabetes Care. 2000;23:1612-1618.
2. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003;26:S33- S50.
3. American Diabetes Association. Insulin administration. Diabe- tes Care. 2000;23:S86.
4. DeWitt DE, Dugdale DC. Using new insulin strategies in the out- patient treatment of diabetes: clinical applications. JAMA. 2003; 289:2265-2269.
5. Campbell RK, Setter SM. Optimizing diabetes management: fo- cus on insulin therapies. American Pharmacists Association Highlights Newsletter. 2003;6(1):1-6.
6. Allen J. Insulins. Pharmacist’s Letter. 2003;19(190806):1-11.
7. Eli Lilly and Company. Humalog insulin lispro injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
8. Novo Nordisk. NovoLog insulin aspart (rDNA origin) [injection package insert]. Princeton, NJ: Novo Nordisk; 2002.
9. Heller SR, Amiel SA, Mansell P. Effect of the fast-acting insulin analog lispro on the risk of nocturnal hypoglycemia during in- tensified insulin therapy. Diabetes Care. 1999;22:1607-1611.
10. Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, An- derson JH. Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. Diabetes Care. 1997;20:1827-1832.
11. Brunelle R, Llewelyn J, Anderson JH, Gale EAM, Koivisto V. Meta-analysis of the effect of insulin lispro on severe hypogly- cemia in patients with type 1 diabetes. Diabetes Care. 1998;21: 1726-1731.
12. Pfutzner A, Kustner E, Forst T, et al. Intensive insulin therapy with insulin lispro in patients with type 1 diabetes reduces the frequency of hypoglycemic episodes. Exp Clin Endocrinol Dia- betes. 1996;104:25-30.
13. Bastyr EJ, Johnson ME, Trautmann ME, Anderson JH, Vignati L. Insulin lispro in the treatment of patients with type 2 diabetes mellitus after oral agent failure. Clin Ther. 1999;21(10):1703- 1714.
14. Gale EAM. A randomized, controlled trial comparing insulin lispro with human soluble insulin in patients with type 1 diabe- tes on intensified insulin therapy. Diabet Med. 2000;17:209-214.
15. Vignati L, Anderson JH, Iversen PW. Efficacy of insulin lispro in combination with NPH human insulin twice per day in patients with insulin-dependent or non-insulin-dependent diabetes mellitus. Clin Ther. 1997;19(6):1408-1421.
16. Daniels AR, Bruce R, McGregor L. Lispro insulin as premeal therapy in type 1 diabetes: comparison with Humulin R. N Z Med J. 1997;110:435-438.
17. Raskin P, Holcombe JH, Tamborlane WV, et al. A comparison of insulin lispro and buffered regular insulin administered via con- tinuous subcutaneous insulin infusion pump. J Diabetes Complicat. 2001;15:295-300.
18. Melki V, Renard E, Lassmann-Vague V, et al. Improvement of HbA1c and blood glucose stability in IDDM patients treated with lispro insulin analog in external pumps. Diabetes Care. 1998;21: 977-982.
19. Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabe- tes. 1997;46(3):440.
20. Home PD, Lindholm A, Hylleberg B, Round P. Improved gly- cemic control with insulin aspart: a multicenter randomized double-blind crossover trial in type 1 diabetic patients. Diabetes Care. 1998;21:1904-1909.
21. Tamas G, Marre M, Astorga R, Dedov I, Jacobsen J, Lindholm A. Glycaemic control in type 1 diabetic patients using optimised insulin aspart or human insulin in a randomised multinational study. Diabetes Res Clin Pract. 2001;54:105-114.
22. Home PD, Lindholm A, Riist A. Insulin aspart vs human insulin in the management of long-term blood glucose control in type 1 diabetes mellitus: a randomized controlled trial. Diabet Med. 2000;17:762-770.
23. Plank J, Wutte A, Brunner G, et al. A direct comparison of insulin aspart and insulin lispro in patients with type 1 diabetes. Diabe- tes Care. 2002;25:2053-2057.
24. Eli Lilly and Company. Humulin R regular insulin human injec- tion, USP (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2000.
25. Novo Nordisk. Novolin R [package insert]. Clayton, NC: Novo Nordisk; 1999.
26. Novo Nordisk. Novolin N [package insert]. Clayton, NC: Novo Nordisk; 1999.
27. Eli Lilly and Company. Humulin N pen NPH Humulin insulin (rDNA origin) isophane suspension [package insert]. Indianapo- lis, IN: Eli Lilly; 2002.
28. Eli Lilly and Company. Humulin L lente human insulin (rDNA origin) zinc suspension [package insert]. Indianapolis, IN: Eli Lilly; 2000.
29. Aventis Pharmaceuticals Inc. Lantus (insulin glargine (rDNA or- igin) injection [package insert]. Kansas City, MO: Aventis Pharmaceuticals Inc; 2003.
30. Eli Lilly and Company. Humulin U ultralente human insulin (rDNA origin) extended zinc suspension [package insert]. India- napolis, IN: Eli Lilly; 2000.
31. Levien TL, Baker DE, White JR, Campbell RK. Insulin glargine: A new basal insulin. Ann Pharmacother. 2002;36:1019-1027.
32. Tunbridge FKE, Newens A, Home PD, et al. A comparison of hu- man ultralente- and lente-based twice-daily injection regimens. Diabet Med. 1989;6:496-501.
33. Kelly JL, Hirsch IB, Trence DL. Rapid decrease in clinically sig- nificant hypoglycemia with insulin glargine. Diabetes. 2002;51(suppl 2):A123.
34. Ratner RE, Hirsch IB, Neifing JL, Satish KG, Mecca TE, WIlson CA. Less hypoglycemia with insulin glargine in intensive ther- apy for type 1 diabetes. Diabetes Care. 2000;23:639.
35. Pieber TR, Eugene-Jolchine I, Derobert E. Efficacy and safety of HOE 901 versus NPH insulin in patients with type 1 diabetes. Diabetes Care. 2000;23:157-162.
36. Rosenstock J, Schwartz SL, Clark CM, Park GD, Donley DW, Ed- wards MB. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Dia- betes Care. 2001;24:631-636.
37. Raskin P, Klaff L, Bergenstal R, Halle JP, Donley D, Mecca T. A 16- week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care. 2000;23:1666- 1671.
38. Yki-Jarvinen H, Dressler A, Zieman M. Less nocturnal hypoglycemia and better post-dinner glucose control with bed- time insulin glargine compared with bedtime NPH insulin dur- ing insulin combination therapy in type 2 diabetes. Diabetes Care. 2000;23:1130-1136.
39. Eli Lilly and Company. Humulin 70/30 pen 70% human insulin isophane suspension and 30% human insulin injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
40. Novo Nordisk. Novolin 70/30 injection [package insert]. Clay- ton, NC: Novo Nordisk; 1999.
41. Eli Lilly and Company. Humalog Mix 75/25 75% insulin lispro protamine suspension and 25% insulin lispro injection (rDNA origin) [package insert]. Indianapolis, IN: Eli Lilly; 2002.
42. Novo Nordisk. Novolog Mix 70/30 [package insert]. Princeton, NJ: Novo Nordisk; 2002.
43. Malone JK, Yang H, Woodworth JR, et al. Humalog Mix25 offers better mealtime glycemic control in patients with type 1 or type 2 diabetes. Diabetes Metab. 2000;26:481-487.
44. Boehm BO, Home PD, Behrend C, Kamp NM, Lindholm A. Pre- mixed insulin aspart 30 vs premixed human insulin 30/70 twice daily: a randomized trial in type 1 and type 2 diabetic patients. Diabet Med. 2002;19:393-399.
45. Herz M, Arora V, Campaigne BN, Scholtz HE, Potgieter MA, Mollentze W. Humalog Mix25 improves 24-hour plasma glucose profiles compared with the human insulin mixture 30/70 in pa- tients with type 2 diabetes mellitus. S Afr Med J. 2003;93:219- 223.
46. Colombel A, Murat A, Krempf M, Kuchly-Anton B, Charbonnel B. Improvement of blood glucose control in type 1 diabetic pa- tients treated with lispro and multiple NPH injections. Diabet Med. 1999;16:319-324.
47. Fritsche A, Schweitzer MA, Haring H. Improved glycemic con- trol and reduced nocturnal hypoglycemia in patients with type 2 diabetes with morning administration of insulin glargine com- pared with NPH insulin. Diabetes. 2002;51(suppl 2):A54.
48. Yki-Jarvinen H, Ryysy L, Nikkila K, Tulokas T, Vanamo R, Heikkila M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med. 1999;130:389-396.
49. Yki-Jarvinen H, Kauppila M, Kujansuu E, et al. Comparison of insulin regimens in patients with non-insulin-dependent diabe- tes mellitus. N Engl J Med. 1992;327:1426-1433.
50. Hamann A, Matthaei S, Rosak C, Silvestre L. A randomized clin- ical trial comparing breakfast, dinner, or bedtime administration of insulin glargine in patients with type 1 diabetes. Diabetes Care. 2003;26:1738-1744.
51. Taylor R, Davies R, Fox C, Sampson M, Weaver JU, Wood L. Ap- propriate insulin regimens for type 2 diabetes: a multicenter ran- domized crossover study. Diabetes Care. 2000;23:1612-1618.
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Nov 26, 2022
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How to Cite
Ahlam salih sahel alenazi, Asmaa Abdulleh Alenazi, Noura Attallah Alonaze, Sheemah bakeet alonazi, Wafa bakeet alonazi, Nawal bakeet alonazi, Aladham hamdan alanazi, Amal Mohammed alanizi, & Yousef miqed Alharbi. (2022). REVIEW OF INSULIN THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1771-1783. https://doi.org/10.53555/jptcp.v29i04.4885
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Author Biographies
Ahlam salih sahel alenazi
Nursing health assistant Alnazeem South PHC
Asmaa Abdulleh Alenazi
Nursing technician alnazeem North pHc , Riyadh
Noura Attallah Alonaze
Nursing technician Alnazeem South PHC, Riyadh
Sheemah bakeet alonazi
Nursing technician Alnazeem South PHC, Riyadh
Wafa bakeet alonazi
Nursing technician Alnazeem South PHC, Riyadh
Nawal bakeet alonazi
Nursing technician Prince Sultan Health center, Riyadh
Aladham hamdan alanazi
nursing health assistant Alnazeem South PHC , Riyadh
Amal Mohammed alanizi
Nursing technician AlNazeem South PHC, Riyadh
Yousef miqed Alharbi
Epidemiological monitoring technician, Al-Nazim Health Center South, Riyadh
How to Cite
Ahlam salih sahel alenazi, Asmaa Abdulleh Alenazi, Noura Attallah Alonaze, Sheemah bakeet alonazi, Wafa bakeet alonazi, Nawal bakeet alonazi, Aladham hamdan alanazi, Amal Mohammed alanizi, & Yousef miqed Alharbi. (2022). REVIEW OF INSULIN THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1771-1783. https://doi.org/10.53555/jptcp.v29i04.4885