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Optimal timing of injection of once-daily insulin glargine in people with Type 1 diabetes using insulin lispro at meal-times

Lookup NU author(s): Dr Simon Ashwell, Janice Gebbie, Emeritus Professor Philip Home

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Abstract

Aims: To compare blood glucose control when insulin glargine is given at lunch-time, dinner-time, and bed-time in people with Type 1 diabetes using insulin lispro at meal-times. Methods: In this 16-week, three-way, cross-over study, 23 people with Type 1 diabetes were randomized to insulin glargine injection at lunch-time (L) [mean 12.37 ± 00.34 (±SD) h], dinner-time (D) (18.12 ± 00.40 h), or bed-time (B) (22.29 ± 00.40 h), each plus meal-time insulin lispro. Each 4-week treatment period concluded with a 24-h inpatient metabolic profile. Results: Insulin doses, HbA 1c, and fructosamine concentration did not differ between treatment periods. Pre-breakfast self-monitored blood glucose (SMBG) concentration was higher with injection of glargine at lunch-time than at other times [L: 9.2 ± 0.3 (±SE) vs. D: 8.2 ± 0.3 or B: 8.0 ± 0.3 mmol/l, P = 0.016], as probably was pre-lunch SMBG (L: 8.6 ± 0.7 vs. D: 6.4 ± 0.7 or B: 6.4 ± 0.8 mmol/l, P = 0.051). Pre-dinner SMBG level was higher with dinner-time glargine than other injection times (D: 9.4 ± 0.9 vs. L: 4.9 ± 0.9 or B: 7.4 ± 1.1 mmol/l, P = 0.007). For 22.00 to 02.00 h, mean inpatient plasma glucose concentration was higher with injection of glargine at bed-time than other times (B: 9.1 ± 0.6 vs. L: 7.8 ± 0.6 or D: 6.7 ± 0.6 mmol/l, P = 0.023). Plasma free insulin concentration was lower at the end of the afternoon with dinner-time glargine than other injection times (D: 11.5 ± 1.4 vs. L: 20.2 ± 1.3 or B: 16.5 ± 1.3 mU/l, P < 0.001). Frequency of hypoglycaemia was not different, but timing of hypoglycaemia differed between treatment periods. Conclusions: Blood glucose levels rise around the time of injection of insulin glargine whether given at lunch-time, dinner-time or bed-time. Bed-time injection leads to hyperglycaemia in the early part of the night which is improved by giving insulin glargine at lunch-time or dinner-time. © 2005 Diabetes UK.

Publication metadata

Author(s): Ashwell SG, Gebbie J, Home PD

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 2006

Volume: 23

Issue: 1

Pages: 46-52

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/j.1464-5491.2005.01726.x

DOI: 10.1111/j.1464-5491.2005.01726.x

PubMed id: 16409565

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