Basal insulin replacement and use of rapid-acting insulin analogues in patients with type 1 diabetes.

Objective: To analyze various treatment strategies for replacement of basal insulin in patients with type 1 diabetes who are receiving rapid-acting insulin with meals. Methods: Recently published studies are reviewed, and the available information on basal insulin adjustment is summarized. Results: In a comparison of presupper insulin lispro versus regular human insulin in adolescent patients, postprandial blood glucose excursion was much lower with insulin lispro. Patients who were given regular insulin at supper and no bedtime snack had a significantly higher occurrence of nocturnal hypoglycemia than did those given insulin lispro at supper and no snack at bedtime. In another study that attempted to identify the optimal basal insulin in the context of multidose therapy with insulin lispro, NPH insulin yielded lower blood glucose levels and a trend toward better glycosylated hemoglobin levels than did Ultralente insulin. For improvement of glycemic control during insulin lispro therapy, adjustments in th...