Early pharmacokinetic and pharmacodynamic effects of mixing lispro with glargine insulin: results of glucose clamp studies in youth with type 1 diabetes

Eda Cengiz, William V Tamborlane, Melody Martin-Fredericksen, James Dziura, Stuart A Weinzimer, Eda Cengiz, William V Tamborlane, Melody Martin-Fredericksen, James Dziura, Stuart A Weinzimer

Abstract

OBJECTIVE Clinicians who treat children with type 1 diabetes often try to minimize the number of daily injections to reduce treatment burden and improve compliance. Despite the manufacturer's cautions against mixing glargine with rapid-acting insulin analogs, clinical studies have failed to demonstrate deleterious effects of mixing on glucose excursions or A1C levels. However, no formal glucose clamp studies have been performed to determine whether mixing with glargine has an adverse effect on the early pharmacodynamic action of rapid-acting insulin in humans. RESEARCH DESIGN AND METHODS To examine this question, euglycemic glucose clamps were performed twice, in random order, in 11 youth with type 1 diabetes (age 15.1 +/- 3 years, A1C 7.6 +/- 0.6%) with 0.2 units/kg lispro and 0.4 units/kg glargine, given either as separate or as a single mixed injection. RESULTS Mixing the two insulins shifted the time action curve to the right, with significantly lower glucose infusion rate (GIR) values after the mixed injections between 60 and 190 min and significantly higher values between 270 and 300 min, lowered the GIR(max) (separate 7.1 +/- 1 vs. mix 3.9 +/- 1, P = 0.03), and markedly delayed the time to reach GIR(max) (separate 116 +/- 8 min vs. mix 209 +/- 15 min, P = 0.004). The GIR area under the curve was significantly lower after the mixed injections. Mixing had similar effects on plasma insulin pharmacokinetics. CONCLUSIONS These data demonstrate that mixing lispro with glargine markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions.

Figures

Figure 1
Figure 1
Pharmacodynamic profiles. Insulin action, as expressed as GIR, required to maintain euglycemia after a standard bolus of 0.2 units/kg insulin lispro and 0.4 units/kg of insulin glargine mixed or separate during the 5 h of study are shown. Data are means ± SEM. *Time points where differences between the two studies were statistically significant (P < 0.05–0.001).
Figure 2
Figure 2
Pharmacokinetic profiles. Insulin concentration, measured by ELISA with a reported cross-reactivity of 44% for insulin glargine, for separate and mixed injections depicted in means ± SEM for separate and mixed insulin glargine-lispro injections. *Time points where differences between the two studies were statistically significant (P < 0.05–0.001).

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Source: PubMed

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