Medicina (Kaunas) 2006; 42 (9): 770-779

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An update on multiple insulin injection therapy in type 1 and 2 diabetes

Eglė Varanauskienė, Indrė Varanauskaitė1, Jonas Čeponis

Department of Endocrinology, 1Faculty of Medicine, Kaunas University of Medicine, Lithuania

Key words: diabetes mellitus, multiple insulin injection therapy, insulin analogs.

Summary. Achieving and maintaining glycemic control (glycated hemoglobin – HbA1c≤7.0% according to American Diabetes Association and ≤6.5% according to International Diabetes Federation) is the primary goal in treating diabetes, which lowers the risk for diabetes-related complications.

Insulin therapy is essential for type 1 diabetes treatment. Insulin therapy in type 2 diabetes is initiated when glycemic control is inadequate despite the combination of antihyperglycemic drugs. The type of insulin therapy is selected according to the patient’s lifestyle and needs. Multiple insulin injection therapy and premixed insulin therapy are usually administered.

In multiple insulin injection therapy, basal insulin is administered one or two times a day, and regular human insulin or rapid-acting insulin analog is administered with each meal. The duration of action of regular insulin is 6–8 hours; therefore, the risk for postprandial hypoglycemia is increased. The action of novel insulin analogs (rapid- and long-acting) closely mimics physiological insulin secretion. Three rapid-acting insulin analogs are currently available: insulin lispro, insulin aspart, and insulin glulisine. Insulin glulisine is the most recently approved rapid-acting insulin analog. It is safe, flexible, and effective in achieving target postprandial glycemic control. Moreover, the pharmacokinetics of insulin glulisine does not depend on the amount of subcutaneous fat.

Basal insulins include intermediate-acting human insulins (neutral protamine Hagedorn) and long-acting insulin analogs (insulin glargine, insulin detemir). The latter are the optimal choice covering basal insulin requirement. Compared to neutral protamine Hagedorn insulin, long-acting insulin analogs have no pronounced concentration peak and reduce nocturnal hypoglycemia risk and weight gain.

Correspondence to E. Varanauskienė, Department of Endocrinology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail:

Received 27 April 2006, accepted 16 August 2006