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Pregestational Diabetes
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
F. Weston Loehr, A. Dhanya Mackeen, Michael J. Paglia
Though satisfactory glucose control may be obtained solely with an intermediate-acting insulin rather than a short-acting insulin [57], we suggest optimizing metabolic control with one evening injection of long-acting insulin (e.g., insulin glargine), and meal-time (three daily) injections of short-acting insulin (e.g., lispro or aspart) (Figures 5.1 and 5.2). Glargine cannot be mixed in the same syringe with other insulins. Intermediate-acting insulin (e.g., neutral protamine Hagedorn [NPH]) twice daily can also be used, instead of insulin glargine. Studies have shown that short-acting insulin is as effective as regular insulin and may result in improved postprandial glucose control and less preterm deliveries [58, 59]. Insulin lispro should be given immediately before eating. As compared to two daily insulin injections, additional doses are associated with improved glycemic control [60]. A meta-analysis of cohort studies comparing insulin glargine to NPH did not reveal any significant differences in outcomes including infant birth weight, congenital anomalies, and respiratory distress [61]. A large randomized trial including 310 pregnancies compared insulin detemir with NPH and found no differences between maternal HgbA1c, the frequency of major hypoglycemic episodes [62], early fetal loss, congenital anomalies, or adverse events [63]. Insulin analogs have not been associated with an increased risk of congenital anomalies [64].
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Insulin lispro is a rapid-acting insulin analogue of recombinant origin. Substitution of a lysine residue for proline at position B28 on the native human insulin molecule results in a rapid onset of action (between 5 and 20 minutes), a peak of action at around 60 minutes and a shorter total duration of action (between 2 and 3 hours) than is seen with soluble human insulin.
Diabetes
Published in Hugh McGavock, Dennis Johnston, Treating Common Diseases, 2017
Hugh McGavock, Dennis Johnston
The ideal diet for individual diabetics should be prescribed by a dietitian. It should be high in soluble fibre, low in saturated fats, contain plenty of poultry, fish and veal, and carbohydrate from wholegrain products (for slow release of glucose), and supply no more than the estimated daily calorie requirement. More than 50% of all diabetics comply very poorly with their diet. Those who do comply include those who become skilled in ‘calorie counting’ - they self-administer 1 unit of insulin lispro for every 10-15 grams of carbohydrate eaten. They also adjust their insulin dosage according to that day’s exercise and increase it during infections.
Improving the treatment of patients with diabetes using insulin analogues: current findings and future directions
Published in Expert Opinion on Drug Safety, 2021
Eveline Lefever, Joke Vliebergh, Chantal Mathieu
As mentioned, the main target organ for insulin effect is the liver, whereas the peripheral subcutaneous administration of insulin, in whatever format, leads to over-insulinization of the peripheral organs like muscle and fat, when trying to achieve a similar suppression of hepatic glucose output than when the same amount of insulin would be released by the beta-cell in the portal system. Hence, to avoid the weight gain associated with this phenomenon, manufacturers have pursued the development of ‘liver-preferred’ insulins. PEGylated insulin lispro was an insulin where a lumpy PEG molecule was linked to insulin lispro, impeding progression of the lispro through the tight capillary walls present in the peripheral tissues, but allowing progression through the fenestrated capillary structures in liver [130].
Identifying insulin treatment responders with a composite measure: beyond Hba1c < 7% in patients with type 2 diabetes
Published in Current Medical Research and Opinion, 2018
Ignacio Conget, M. Sue Kirkman, Dachuang Cao, Mayme Wong, Jesus Reviriego, David M. Kendall
Two databases were used in the present study. Analyses were conducted with data from an integrated database (IDB) with over 16,000 patients from 53 Phase 3 and 4 clinical trials in the insulin lispro development program conducted between 1992 and 2013 inclusive. Although patients may have been treated with other comparator insulins in these studies, only those that received at least one dose of insulin lispro, which comprised the majority of patients, were chosen for this analysis to ensure consistency. The IDB analysis population included 4,908 patients with T2D treated with any insulin regimen with a baseline and one or more post-baseline HbA1c value(s) at 24 weeks. To compare the results from clinical trials to real-world evidence (RWE), the analyses were repeated using the US-based MedMining electronic medical records database, which has de-identified data on 30,040 individuals in the Geisinger integrated health system from 2004–2015. The RWE analysis cohort included 1,134 patients with T2D aged ≥18 years who initiated any insulin regimen (with first use as the index date) and had HbA1c values available at the baseline index date and at the 6-month post-index end-point, both within 90-day windows.
SAR342434 - an insulin biosimilar for the treatment of type II diabetes
Published in Expert Opinion on Biological Therapy, 2018
Jingbo Hu, Min Wang, Yufen Zhao
Insulin lispro is of great importance in the management of type 1 and 2 diabetes mellitus. As a substantial financial burden to health-care systems, the availability of new biosimilar products may enable more people to have access to insulin treatment benefiting from their lower costs than original agents. SAR342434, an insulin lispro biosimilar, is under phase III trials, and so far it shows similar efficacy and long-term safety (including immunogenicity) to the reference insulin lispro according to the available data. Approved in all indications held by insulin lispro, SAR342434 has the potential to reduce treatment costs and thereby increase patient access to insulin therapy.