title: Optimal administration of lispro insulin in hyperglycemic type 1 diabetes.
abstract: OBJECTIVE
  Lispro is a new rapidly absorbed insulin analog. At present, there are no recommendations for the optimal injection time of lispro insulin in hyperglycemic patients. In contrast to normoglycemic patients with diabetes, we hypothesized that injection of lispro insulin 15-30 min before meal ingestion would improve postprandial glucose excursion in hyperglycemic diabetic subjects.
  
  
  METHODS
  In 48 randomized overnight studies, 12 healthy adult type 1 diabetic patients received lispro insulin 0.15 U/kg admixed with human ultralente 0.2 U/kg (as background insulin) subcutaneously at minutes (-30, -15, 0, and +15) relative to the ingestion of an American Diabetes Association breakfast of 8.6 kcal/kg. Pre-breakfast hyperglycemia of 10.2 +/- 0.2 mmol/l was established before the study by continuous overnight infusion of intravenous insulin, which was stopped 30 min before lispro insulin injection. Glucose and insulin levels were measured every 30 min for 5 h after breakfast.
  
  
  RESULTS
  Results demonstrated that postprandial glucose excursion was reduced when lispro insulin was administered 15 or 30 min before the meal compared with lispro insulin injected at the meal (P < 0.002). The postprandial glucose excursion (millimoles per liter per hour) was -6.4 +/- 3 for the -30-min group, -5.1 +/- 2.9 for the -15-min group, 3.4 +/- 4.1 for the 0-min group, and 5.7 +/- 4.4 for the +15-min group. Although injecting lispro insulin at 30 min before the meal resulted in a significant reduction in postprandial glycemia, it was accompanied by loss of glucose control at 4 h postmeal in two subjects.
  
  
  CONCLUSIONS
  Optimization of lispro insulin in hyperglycemic patients requires timing of the insulin injection at least 15 min before the meal.
authors.affiliation: Department of Medicine/Endocrinology and Metabolism, University of New Mexico School of Medicine, Albuquerque 87131, USA. arassam@salud.unm.edu
authors.forename: A G
authors.initials: AG
authors.lastname: Rassam
authors.forename: T M
authors.initials: TM
authors.lastname: Zeise
authors.forename: M R
authors.initials: MR
authors.lastname: Burge
authors.forename: D S
authors.initials: DS
authors.lastname: Schade
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003927:Diet, Diabetic; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D061268:Insulin Lispro; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000627:therapeutic use; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro; D049528:Insulin, Long-Acting