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In an Italian study to compare once-daily injections of insulin glargine (Lantus) with once-daily injections of insulin detemir (Levemir), 24 patients with type 1 diabetes were treated for two weeks with either one or the other in a randomized double-blind study.
At the study's outset, the patients were injected with 0.35 units of insulin per kilogram, which comes to about 28.6 units for a 180-pound man. (See Dr. Bernstein's article about "long-acting" insulins for his opinion about giving experimental subjects high doses of long-acting insulin, "In My Opinion: There is No 24-Hour Basal Insulin")
Plasma glucose was clamped at 100 mg/dl for the 24 hours after the insulin injections. This means that for the 24 hours after the insulin injection, to prevent hypoglycemia, the patients were infused with just enough glucose to keep their blood sugar from dropping below 100 mg/dl.
With glargine, blood sugar remained at about 103 mg/dl for up to 24 hours. With detemir, things were fine for about sixteen hours, but then blood sugar began to increase progressively.
The glucose infusion rate was similar between the two insulins for twelve hours, after which it dropped more rapidly with detemir. Only about a third of the detemir subjects completed the study with blood sugar levels below 180 mg/dl.
The researchers, led by Francesca Porcellati, MD, concluded that glargine and detemir are similar for the first twelve hours, but that detemir begins to poop out during the second twelve hours.
Source: Diabetes Care, September 2007
14 comments - Dec 4, 2007
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