title: Treatment of type 1 diabetes with insulin lispro during Ramadan.
abstract: OBJECTIVE
  To compare insulin lispro with regular human insulin with respect to blood glucose control and frequency of hypoglycaemia in patients with type 1 diabetes who wished to fast during the month of Ramadan.
  
  
  METHODS
  Insulin lispro or regular human insulin was given together with NPH insulin, twice daily before the morning and evening meals, for two weeks each in an open-label, randomised, cross-over design, and 64 patients completed the protocol. Blood glucose was self-monitored at fasting morning and evening, and 1-h and 2-h after the post-sunset meal on three consecutive days at the end of each treatment period.
  
  
  RESULTS
  The 2-h blood glucose excursion after the post-sunset meal was significantly (p=0.026) lower with insulin lispro (2.50 +/- 0.46 mmol/l) than with regular human insulin (3.47 +/- 0.49 mmol/l). Daily insulin doses did not differ between treatments but compliance with recommended time of injection was better with insulin lispro. Hypoglycaemia incidence (insulin lispro, 15 (23.4%) patients; regular human insulin 31 (48.4%) patients; p=0.004) and frequency (insulin lispro, 0.70 +/- 0.19; regular human insulin 2.25 +/- 0.36 episodes/patient/30 days; p<0.001) were lower with insulin lispro. Five (22.7%) of the episodes during insulin lispro occurred during the nocturnal period compared with 27 (36.5%) of the episodes while on regular human insulin.
  
  
  CONCLUSIONS
  Glycaemic control, measured by postprandial glycemic excursions, was improved and hypoglycaemia was significantly reduced with insulin lispro compared with regular human insulin. Patients with type 1 diabetes who insist on fasting during Ramadan may be better managed with insulin lispro.
authors.affiliation: Service d'Endocrinologie, Chu Ibn Sina Rabat, Morocco.
authors.forename: A
authors.initials: A
authors.lastname: Kadiri
authors.forename: A
authors.initials: A
authors.lastname: Al-Nakhi
authors.forename: S
authors.initials: S
authors.lastname: El-Ghazali
authors.forename: A
authors.initials: A
authors.lastname: Jabbar
authors.forename: M
authors.initials: M
authors.lastname: Al Arouj
authors.forename: J
authors.initials: J
authors.lastname: Akram
authors.forename: J
authors.initials: J
authors.lastname: Wyatt
authors.forename: A
authors.initials: A
authors.lastname: Assem
authors.forename: S
authors.initials: S
authors.lastname: Ristic
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005215:Fasting; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D061268:Insulin Lispro; D007514:Islam; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro