Reducing snacks when switching from conventional soluble to lispro insulin treatment: effects on glycaemic control and hypoglycaemia
✍ Scribed by Rönnemaa, T.; Viikari, J.
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 90 KB
- Volume
- 15
- Category
- Article
- ISSN
- 0742-3071
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✦ Synopsis
The lack of significant improvement in HbA 1c during insulin lispro treatment in previous studies may have been due to inadequate dietary adjustments. We tested whether reduction of snacks and a compensatory increase in main meals results in improved metabolic control when switching to lispro treatment. One hundred and forty-one Type 1 diabetic patients, mean ± SD age 36 ± 9 years, diabetes duration 14 ± 10 years, had two daily NPH injections throughout the study. After a baseline visit, the patients used conventional soluble insulin preprandially thrice daily for 12 weeks. Thereafter they were switched to lispro insulin and advised to transfer Ն50 % of their snack carbohydrates to preceding main meals. Mean HbA 1c at baseline was 8.05 %. After the conventional period and the 12-week lispro period, HbA 1c was 7.81 and 7.70 % (p = 0.088), respectively. In those patients who diminished their snacks as advised (n = 67), HbA 1c decreased from 7.91 to 7.66 % (p = 0.014) during lispro, whereas no change was observed in patients not compliant with the dietary change. The number of hypoglycaemic episodes was lower during lispro period (blood glucose Ͻ2.5 mmol l -1 : 1.43 vs 2.19 episodes, p = 0.004; symptomatic nocturnal hypoglycaemia 1.16 vs 1.67 episodes, pϽ0.001). When switching from conventional soluble to lispro insulin, reduction of snack carbohydrates is safe and results in slightly improved HbA 1c in patients who are fully compliant with the dietary change.