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May 13, 2002

Insulin

Question from Wolcott, Vermont, USA:

I have type 1 or possibly Late-onset Autoimmune Diabetes of Adulthood (LADA). How can I learn about the new insulin currently undergoing Phase III Clinical Trials, insulin detemir. My question is -- will this long-acting insulin be taken in a split dose? What is the duration? I would prefer this over the 24 hour basal insulin that has been released because I now take 8 units of NPH in the morning. Yet I only need 1 Unit in the evening. I do not want to take the large dose of any insulin in the evening due to my diabetes type and current insulin needs.

Answer:

Insulin detemir is a mixture of a long and short-acting insulin that has been modified from the original insulin molecule. This concept is not different than other previously released preparations in that you can purchase other mixed insulins on the market. This insulin is different because the long-acting component has not been previously released in the U.S. but the short-acting component has. Whether you would do better with this insulin over other insulin is not clear to me. If you did use the insulin detemir you would have to take at least two shots per day, probably at breakfast and supper. If you only take 1 unit of NPH in the evening, you may not be able to tolerate the insulin detemir because, in addition to the long-acting insulin, you will have a short-acting insulin that could acutely lower your sugars.

I think that a reasonable compromise would be to work with your physician to titrate the insulin and when that is accomplished, see if the dose you take will easily allow you to switch to the pre-mixed preparation.

JTL

[Editor’s comment: See information from Novo for abstracts including some about detemir [Note: this is an Acrobat file.]

WWQ]