title: Strategies toward improved control during insulin lispro therapy in IDDM. Importance of basal insulin.
abstract: OBJECTIVE
  To examine whether overall glycemic control can be improved with insulin lispro by adjustment of the basal insulin regimen without an increased risk of hypoglycemia.
  
  
  METHODS
  A 5-month open study was performed in 66 IDDM patients after they had been transferred from human regular insulin to insulin lispro as a premeal therapy. The premeal and basal insulin regimens were adjusted according to self-monitoring of blood glucose during the visits at 2-week to 1-month intervals. Diurnal glucose profile, hypoglycemic events, HbA1c, and patient satisfaction were evaluated.
  
  
  RESULTS
  The mean daily glucose level decreased from 9.2 +/- 0.2 to 8.4 +/- 0.2 mmol/l (P = 0.001) and HbA1c decreased from 8.8 +/- 0.1 to 8.0 +/- 0.1% (P < 0.001) (mean +/- SD). The number of daily NPH injections increased from 1.4 +/- 0.1 at baseline to 3.1 +/- 0.1 at the end of the study. Total daily insulin dose increased by 3 U (7%) because of an 8-U (43%) rise in basal insulin, whereas premeal insulin dose decreased by 5 U (20%). The number of hypoglycemic episodes did not change during the study. Of the patients, 86% considered insulin lispro equal or better than human regular insulin.
  
  
  CONCLUSIONS
  Although the study was open, the date suggest that the appropriate combination of insulin lispro and basal insulin can improve postmeal hyperglycemia, HbA1c, and treatment satisfaction without increasing the risk of hypoglycemia.
authors.affiliation: Department of Medicine, Helsinki University Hospital, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Ebeling
authors.forename: P A
authors.initials: PA
authors.lastname: Jansson
authors.forename: U
authors.initials: U
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Lalli
authors.forename: G B
authors.initials: GB
authors.lastname: Bolli
authors.forename: V A
authors.initials: VA
authors.lastname: Koivisto
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005215:Fasting / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D061268:Insulin Lispro; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro