Insulin analogues vs human insulin in type 1 diabetes

Pratik Choudhary, MBBS, MD, is a professor and honorary consultant in diabetes in the Diabetes Research Centre at the University of Leicester, UK.

What are the clinical differences regarding the use of insulin analogues versus human insulin in patients with type 1 diabetes?

Of course, with our patients with type 1 diabetes, we need to try and optimize the basal insulin and the bolus insulin to replicate physiology.

With the modern long-acting analogues for the basal insulin, we're finding that we can achieve the same glucose control with less hypoglycemia. So, [with] the first-generation analogues, like Lantus, we can get ~30% reduction in hypoglycemia compared with neutral protamine Hagedorn (NPH). And with the second-generation basals, [there] is a further 10% reduction in hypoglycemia, particularly the nighttime hypoglycemia, which patients are scared of.

And then when we come to the bolus insulin, we've now got the rapid-acting analogues, which have shown a significant reduction in hypoglycemia. But again, now with the ultrafast-acting insulins, the big advantage we're getting is in quality of life. For the old insulins, even the novel rapid Humalog^®, you have to inject [them] 15 minutes pre-meal, which you know... In a busy lifestyle it's hard to do. And with the very fast, ultrarapid-acting insulins, people can really inject and go.

Those are the major benefits of reduction of hypoglycemia and improved quality of life with these modern analogues.