The genetically engineered basal and bolus insulin analogues have profiles that more closely match pancreatic insulin secretion than the traditional basal and bolus insulins.
- The first insulin analogue – the bolus insulin lispro – became available about 10 years ago.
- The basal insulin analogues detemir and glargine have relatively flat and reproducible profiles over 24 hours. Once-daily dosing with these insulins gives more constant and more predictable blood glucose levels than those associated with use of the isophane insulins.
- The bolus insulin analogues aspart, glulisine and lispro each have a quicker onset of action, a sharper peak and a shorter duration of action than neutral insulin. They may give better postprandial glycaemic control than neutral insulin, and less hypoglycaemia.
- Premix preparations of aspart and lispro are available. However, and at least when starting insulin, better glycaemic control, less weight gain and less hypoglycaemia is generally achieved using bedtime basal insulin and maintaining oral hypoglycaemics than using a premixed insulin.
- Insulin injectors are now used by most patients but patients should have syringes available and know how to draw up insulin from the insulin cartridge or prefilled injector in case their injector is broken.