title: Meal composition is a determinant of lispro-induced hypoglycemia in IDDM.
abstract: OBJECTIVE
  Lispro is a newly FDA-approved analog of human insulin that will be widely used in patients with IDDM. This insulin, however, may have an increased potential for hypoglycemia because of its very rapid subcutaneous absorption, especially in a setting of decreased carbohydrate intake. Using a short-term prospective randomized parallel group-study design, we studied the incidence of hypoglycemia when lispro was given before breakfast compared with regular human insulin. Since carbohydrate intake is a determinant of postprandial glycemia, we administered three isocaloric meals characterized by low, average, and high carbohydrate content.
  
  
  METHODS
  Two groups of six IDDM subjects were randomized to receive 0.15 U/kg of lispro or regular human insulin subcutaneously before the ingestion of three 500-kcal breakfast meals of differing carbohydrate content on separate days. Lispro was administered at mealtime, and regular insulin was administered 30 min before mealtime.
  
  
  RESULTS
  Postprandial plasma glucose concentrations were decreased in the lispro group compared with the regular-insulin group for all three meal types (P < 0.05), and hypoglycemia developed more frequently and rapidly in the lispro group, compared with the regular-insulin group by survival analysis. Additionally, peak insulin concentrations were higher (P < 0.001) and peaked more rapidly (P < 0.05) in the lispro group, compared with the regular-insulin group.
  
  
  CONCLUSIONS
  We conclude that lispro has a tendency for early postprandial hypoglycemia compared with regular insulin in the setting of reduced carbohydrate intake. This fact should be told to patients who decide to switch from regular insulin to lispro. Health care professionals should instruct their IDDM patients to monitor glucose levels frequently after switching to lispro since adjustments in their carbohydrate intake and/or their lispro dosage may be necessary to avoid hypoglycemia.
authors.affiliation: University of New Mexico Health Sciences Center, Department of Medicine/Endocrinology, Albuquerque 87131, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Burge
authors.forename: K R
authors.initials: KR
authors.lastname: Castillo
authors.forename: D S
authors.initials: DS
authors.lastname: Schade
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004032:Diet / Q000592:standards*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D061268:Insulin Lispro; D008297:Male; D019518:Postprandial Period / Q000187:drug effects / Q000502:physiology*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro