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Dr. H.B. Chandalia 09 Nov 2008
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There will be no place of conventional insulins with availability of analogs

 

 

 

 

 

 

Above view are submited by : Prof. Hemraj B. Chandalia.

  • Endocrinologist and Diabetologist- Jaslok and Breach Candy Hospital.
  • Honorary Prof. of Medicine and Diabetes (Retired), Grant Medical College, Mumbai.

Author does not Agree and he believes that conventional insulin will also have a place.

 

The rapid acting insulin analogs (Aspart, Lyspro, and Apidra) have improved considerably our ability to control prandial blood glucose. Similarly, the basal analogs like Detemir and Glargine have helped producing better basal control. These insulins are distinct improvements over the conventional human insulins- regular, NPH and Lente.

 

Pregnancy is one situation where only the Aspart and Lyspro have been cleared. Hence, use of human NPH or Lente varieties is required in many of these patients.

 

Looking more critically, the Detemir and Glargine have proven to be non-inferior to iso phane insulin, but they have not been proven to be superior. Hence, two dosage of NPH or Lente can still be used quite effectively.

 

The cost of analogues is usually 3 times that of human conventional insulins. Even today in the African, Asian and South American continents, these conventional insulins are not accessible for reason of cost or inadequate transport and maintenance of cold chain. Hence, their discontinuation will further jeopardize insulin supply to these needy countries.

 

Last of all, I wish to discuss an issue which has never been highlighted. What really makes an insulin therapy difficult is the coefficient of variation (C.V.) of its effect day-to-day (Table:1)

Insulin

Coefficient of Variation

NPH, Lente

30-40%

Regular

20-25%

Aspart, Lyspro

20-25%

Glargine

30-40%

Detemir

20-30%

 

This is a serious drawback of insulin therapy. As a matter of fact, although these facts were well known, they only got published when analogue developers wanted to score a point over conventional insulin. However, some analogues have same C.V. as conventional insulins and infact human regular insulin was one of the most favorable C.V. If you think critically, what we need is better insulins then even analogues. In the meanwhile, human regular insulin continues to reign supreme in this regard. When given intravenously in emergencies, human regular is as good as Aspart and Lyspro. Hence all insulin infusion protocol use human regular insulin.

 

I would like to conclude that conventional human insulins should continued to be used until we have analogues which are superior to what we have now and cost same as conventional insulin and are proven to be safe like in pregnancy.

 

 

This Contoversies Topic is open for discussion and you are most welcome give your opinion.

 

 

 

 


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