Insulin

Insulin

    

• G.B.
  Bolli, David R Owens (Department of Internal
  Medicine, University of Perugia, Italy; Diabetic
  Research Unit, University of Wales College of
  Medicine, UK)
  
  Commentary
  – Insulin Glargine
  
  Lancet,
  vol.356, August 5, 2000, p.443-444
  
    
  
  Insulin
  glargine is a new long-acting insulin analogue,
  approved for use  in patients with type
  I and Type II diabetes mellitus.
  It is approved by US-FDA and also in Europe.
  
    
  
  It
  is produced by recombinant DNA technology.
  It is a clear solution but when injected
  subcutaneously, it forms a microprecipitate at the
  physiological pH of subcutaneous space.
  Absorption is delayed and lasts a long time
  thus providing a fairly constant basal insulin
  supply – similar to basal insulin secretion in
  non-diabetic people in post-absorptive state.
  
    
  
  Insulin
  requiring diabetic patients need a new long-acting
  insulin, because NPH, lente and ultralente cannot
  mimic the effect of basal insulin. All existing long-acting insulin preparations have a peak action
  profile, and large within and between subject
  variability in subcutaenous absorption.
  Glucose homeostasis in the interprandial and
  nocturnal periods is finely regulated by slow
  continuous insulin secretion.
  
    
  
  Thus,
  an insulin with a peakless action profile should
  improve blood glucose control in Type I diabetic
  patients, especially in those with absolute failure
  of the pancreatic beta-cells.