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New insulins will help you to live better

Some of them are already in the market and others are will be lunch to the market in a few months, they are a new generation of insulin analogs the so called long-acting insulin analogs that are not only changing the way we treat diabetes but also its philosophy.

They are a long acting insulin analogs with an action that may last as long as 24 hours and in contrast with the classic long and intermediate insulins that we have been using for years they have a more predictable action and this high reproductibity will help to avoid the striking differences in blood glucose values from day to day that we are so use to see but so often baffles the patient because often they cannot easily understand their blood glucose results and it was mainly due to the variability of NPH insulin that may be as high as 40% from day to day. Besides that the newer long acting insulin analogs has a very small peak of action that means that they will produce less hypoglycemic episodes (an extremely important limiting factor for achieving a good control) and that will produce in some patients with hypoglycemic unawareness the possibility to recover some of their lost hypoglycemic symptoms.

Another important advantage of this type of insulins is that the patient will be free of the mandatory snacks that he was forced to eat in order to avoid an hypoglycemic episode during the peak of action of the former intermediate or long acting insulins.

According to the patients who has already tested these insulins the biggest advantage they have got it is the freedom of a rigid mealtime schedule that they were following before, now the only important thing to remember is to inject every 24 hours the new insulins and in most cases is taken at night before going to bed, and that means that finnaly the patient with diabetes may oversleep on weekends without having to awake up in the morning because the insulin injection and having a breakfast at a fixed hour and now they also have this freedom for lunch, dinner or even the possibility to skip a meal and only the people with diabetes really know the importance of all those "little things" in improving the quality of life.

Of course nothing can be perfect and all the advantages that we were talking about comes with a price to pay and it is true specially in patients with type 1 diabetes they will need a rapid acting insulin analog (aspart or lispro insulins) for every time they eat that means at least three to four times a day since the new long acting insulin analogs are unable to control the postprandial rise in the glucose levels they are intended for just controlling the blood sugar levels between meals .In order to achieve the best results of this type of insulin therapy the doses of the rapid acting insulin analogs must be adjusted daily depending upon the current blood glucose levels, the amount of carbohydrates that will content our next meal and the physical activity that we will plan in the following hours.

By administering insulin with a basal and a bolus philosophy we are just trying to mimic the way that the healthy pancreas works and it is the same philosophy that was behind the continuous subcutaneous insulin infusion (CSII) a successful therapy already available since the early 80's but its implementation was low due to the higher cost of this therapy and only a few patients took advantage of it.

Some of the patients that has been testing the new long acting insulin analogs say that this therapy will become the Poor’s insulin pump therapy but to put the things right it is not exactly the same and CSII will remain the best solution for patients with considerable swings in the blood glucose values or repeated and severe episodes of hypoglycaemia due to hypoglycaemia unawareness or pronounced dawn phenomenon those patients will only achieve a good diabetes control with the help of an insulin pump.

In some patients, specially type’s 1 this therapy will add some extra insulin shots but in my own patient’s experience once they understand and realize the rest of advantages that they can obtain with the long-acting insulin analogues usually they decided to switch to this therapy.

In some patients with type 2 Diabetes the situation is very different and the advantages may be even greater because they are many that can manage their diabetes perfectly with an unique dose of insulin though the day or with combination of the long acting insulin analog with antidiabetic oral agents.

The investigation goes on and does not stop nevertheless not so fast as the people with diabetes would like but until the moment that diabetes will be cured we will welcome all the small steps as the new long-acting insulin analogs or the coming new generation of non-invasive glucose as useful tools to help all the people affected with diabetes and their loves ones to have a better "life".
Dr R.M. Antuña de Alaiz
Clinidiabet - Medical Clinical Director
Published in the magazine: Diabetes Hoy
Buenos Aires - Octuber 2003
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