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

  1. Stuart A. Weinzimer, M.D.1
  1. 1 Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
  2. 2 Yale Center for Clinical Investigation, New Haven, Connecticut

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 & Method: To examine this question, euglycemic glucose clamps were performed twice, in random order, in 11 youth with type 1 diabetes (age 15.1±3y, A1c 7.6±0.6%) with 0.2unit/kg lispro and 0.4unit/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 GIR values after the mixed injections between 60 to 190 minutes and significantly higher values between 270 to 300 minutes, lowered the GIRmax (separate 7.1± 1 vs. mix 3 .9±1, p=0.03) and markedly delayed the time to reach GIRmax (separate 116±8 min vs. mix 209±15 min, p=0.004). The GIR area under the curve (AUC) was significantly lower after the mixed injections. Mixing had similar effects on plasma insulin pharmacokinetics.

Conclusion: 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.

Footnotes

    • Received November 17, 2010.
    • Accepted January 25, 2010.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc09-2118v1
    2. 33/5/1009 most recent