Maximizing Physiologic Response to Control Fasting Blood Glucose

Supported by an unrestricted educational grant from Novo Nordisk Pharmaceuticals, Inc.

Wed June 16, 2004
7:15 – 9:00 PM

Program Director:
John Clore, MD

Faculty:
Bruce Bode, MD
William Isley, MD

Reviewed by Joelle Escoffery, PhD

The goals of this symposium were to review the physiology of basal insulin secretion and to address strategies for achieving desirable fasting glucose levels. Treatment for diabetes should mimic normal physiologic action of insulin as closely as possible.  Pump therapy and intensive treatment with multiple daily injections (MDI) can approximate normal physiologic insulin action reasonably well by providing both basal and bolus insulin. The optimal basal insulin is one that can create a balance between glucose production and glucose utilization at the desired glycemic target (eg, 80 mg/dL to 100 mg/dL). Research suggests that basal insulin analogs such as insulin glargine and insulin detemir can be used to normalize fasting glucose levels among people with diabetes. Unlike NPH and ultralente, glargine is relatively peakless and lasts for approximately 24 hours.  Treatment with insulin glargine has been associated with significant improvements in A1C and a reduced risk of nocturnal hypoglycemia, when compared with NPH use among people with type 1 diabetes. Insulin detemir provides glycemic control comparable to or slightly better than that achieved with NPH, and also is associated with less weight gain and less hypoglycemia. Importantly, detemir also is associated with a decreased within-subject variability, as compared with NPH or glargine.  The decreased variability may prove to be beneficial for the improvement of glycemic control.