Clinical Medicine Insights: Therapeutics

Insulin lispro (Humalog®) is a recombinant human insulin analogue with reversed amino acids at position 28 and 29 on the insulin B-chain (Lys(B28), Pro(B29)). It has a faster onset and shorter duration of glucose-lowering activity than regular human insulin (RHI), which is a great advantage. Insulin lispro can be injected immediately before meals or even after meals. This short injection-meal interval contributes greatly to convenience, flexibility, treatment compliance, and patients' quality of life, which in turn lead to better glycemic control. Numerous clinical trials have demonstrated that insulin lispro, alone or as mixture-25 or -50, controls postprandial blood glucose and stabilizes diurnal variation satisfactorily. The risk of hypoglycemia, including severe or nocturnal episodes, was lower in insulin lispro users than in RHI users. This insulin might be suitable for type 1 diabetic patients, especially when using an insulin pump. Combination therapy of lispro with a sulphonylurea or glargine is safe and efficacious. Several pharmacoeconomic studies have revealed the usefulness of this insulin.