Continuous subcutaneous insulin infusion with human regular insulin

Abstract

Continuous subcutaneous insulin infusion has proven to be extremely effective in treating type 1 diabetes. It provides glycemic control superior to that of conventional therapy and comparable or slightly superior to MDI. It also decreases the frequency and/or severity of hypoglycemic reactions and increases lifestyle flexibility. Some specific patient situations may be especially attractive for the use of CSII, including pregnancy and diabetes presenting in childhood or adolescents. A rapid acting analogues insulin has a more rapid onset and shorter duration of action compared with soluble insulin. Improved glycaemic control and reduction in hypoglycaemia has been reported with analogues in CSII. Caution must, however be advised as metabolic decompensation after interruption of CSII may be brisk. In recent years, three short-acting (insulin lispro, insulin aspart and insulin glulisine) analogues have been developed for the management of diabetes. Compared with regular human insulin, these new shortacting insulin analogues show faster subcutaneous absorption, a more rapid onset of activity and a shorter duration of action. As a result of these pharmacokinetic differences, an improved postprandial glycemic control is achieved, reduction the risk of hypoglycemia. However, no study was designed to investigate possible long term effects. For safety purpose, we need a longterm followup of large numbers of patients who use short acting insulin analogues. Furthermore, we need well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child. These new insulins are more expensive than conventional insulins and this may be a limiting factor for some patients. Many analysis suggest only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin, this trial has shown that soluble human insulin and insulin analogues had similar effects upon metabolic control.