These
insulins are more rapidly acting than conventional human insulin, and
enable the person with diabetes to have less fluctuation in blood
glucose after meals, to have fewer episodes of hypoglycaemia and
reduced weight gain with improved overall glycaemic control when
compared with soluble insulin. A further analogue insulin, Insulin Glargine
(Lantus), has been recently released. This insulin has a “flatter”
action profile, with a markedly prolonged length of action. This
profile offers the possibility of improved basal action, with less
nocturnal hypoglycaemia and lower fasting blood glucose concentrations.
The combination of this analogue with one of the shorter acting
analogues looks very promising in the search for an insulin regime that
supports normal post-meal excursions of glucose concentrations without
fasting hypoglycaemia. Recently, a further new insulin, Detimir, has
been release which seems very predictable in it's action, with a
typical duration of about 14-16 hours
However,
even with these improvements, insulin treatment will continue to be
difficult until we have automatic and self-governing insulin
administration devices, or grafts of genetically manipulated insulin
secreting cells.