Ahmed A B, Home P D
Human Metabolism and Diabetes Research Centre, University of Newcastle upon Tyne, UK.
Diabetes Care. 1998 Oct;21(10):1707-13. doi: 10.2337/diacare.21.10.1707.
Insulin lispro improves early postprandial blood glucose control but can result in late interprandial hyperglycemia. As an approach to resolving this problem, we performed a randomized, crossover study with four treatment arms, comparing the daytime metabolic profile after either premeal lispro alone or premeal lispro with optimal daytime NPH insulin and with standard human regular insulin.
Twelve C-peptide negative type 1 diabetic patients were studied on four separate study days, at least 7 days apart. On each study day, patients received one of the four study insulin treatments, in random order, with identical meals and snacks. The four treatments were 1) premeal human regular insulin before lunch and supper at unchanged dose; 2) premeal lispro (unchanged dose) at lunchtime and dinner; 3) pre-lunch reduced-dose lispro (70%) before lunch and supper with supplemental lunchtime NPH and with a 6-h interval until dinner; and 4) pre-lunch reduced-dose lispro (70%) before lunch and supper with supplemental lunchtime NPH and with a 8-h interval until dinner. All patients were using their usual premeal plus basal insulin regimen during the period of the study, with human regular insulin before meals and NPH insulin at bedtime.
Postprandial blood glucose concentrations (1230-1500) were lower after reduced or usual lispro dose compared with human regular insulin (5.5+/-0.2 and 5.6+/-0.2 vs. 8.2+/-0.5 mmol/l, P < 0.001), with no difference between the lispro doses. However, prepran-Dial (1800) blood glucose levels deteriorated to higher levels after usual-dose lispro alone compared with either human regular insulin (P < 0.05) or reduced-dose lispro plus NPH (P < 0.05) (8.9+/-0.3 vs. 7.1+/-0.8 and 6.4+/-0.4 mmol/l), with no difference between human regular insulin and reduced-dose lispro plus NPH. During the 2 h between the usual and delayed mealtime, blood glucose concentrations remained controlled on lispro plus NPH (2000: 6.5+/-0.4 mmol/l).
Reduced-dose lunchtime lispro plus NPH maintained the improvement in postprandial blood glucose control with no deterioration in interprandial blood glucose control, even up to a late meal.
赖脯胰岛素可改善餐后早期血糖控制，但可能导致餐间后期高血糖。为解决这一问题，我们进行了一项有四个治疗组的随机交叉研究，比较单独餐前使用赖脯胰岛素、餐前使用赖脯胰岛素联合最佳日间中性鱼精蛋白锌胰岛素（NPH）以及联合标准人常规胰岛素后的日间代谢情况。
12例C肽阴性的1型糖尿病患者在四个独立的研究日接受研究，研究日间隔至少7天。在每个研究日，患者随机接受四种胰岛素治疗中的一种，饮食和零食相同。四种治疗方法分别为：1）午餐和晚餐前按不变剂量使用人常规胰岛素；2）午餐和晚餐前使用赖脯胰岛素（剂量不变）；3）午餐前使用减量赖脯胰岛素（70%），午餐和晚餐前使用，午餐时补充NPH，晚餐间隔6小时；4）午餐前使用减量赖脯胰岛素（70%），午餐和晚餐前使用，午餐时补充NPH，晚餐间隔8小时。在研究期间，所有患者均使用其通常的餐前加基础胰岛素治疗方案，即餐前使用人常规胰岛素，睡前使用NPH胰岛素。
与使用人常规胰岛素相比，使用减量或常规剂量赖脯胰岛素后餐后血糖浓度（12:30 - 15:00）较低（5.5±0.2和5.6±0.2 vs. 8.2±0.5 mmol/L，P < 0.001），两种赖脯胰岛素剂量之间无差异。然而，与使用人常规胰岛素（P < 0.05）或减量赖脯胰岛素加NPH（P < 0.05）相比，单独使用常规剂量赖脯胰岛素后餐前（18:00）血糖水平恶化至更高水平（8.9±0.3 vs. 7.1±0.8和6.4±0.4 mmol/L），人常规胰岛素与减量赖脯胰岛素加NPH之间无差异。在正常进餐时间和延迟进餐时间之间的2小时内，赖脯胰岛素加NPH组血糖浓度保持在可控范围内（20:00时为6.5±0.4 mmol/L）。
午餐时使用减量赖脯胰岛素加NPH可维持餐后血糖控制的改善，且餐间血糖控制不会恶化，即使到晚餐较晚时也是如此。
