My eight year old son, who has had type 1 diabetes for fours years, has always had an A1c of 8.5%. By day, his blood sugar is good, but during the night, he will often go over 10 mmol/L [180 mg/dl]. He was on Actrapid before meals with Lantus at night, but his endocrinologist suggested that we try the new Detemir insulin at night with NovoRapid before meals. He told us our son is going to be a part of study o about Detemir and gave us a lot of gifts (free lancets, blood test strips, a brand new glucose meter, kid’s watch, etc).

I’m a little suspicious about this and about genetically derived insulins in general, because I read they can involve some bad consequences (unexpected hypoglycemia). What is your opinion about Detemir and all genetically derived insulin? Can Detemir involve some side effects after many years of use?

Detemir insulin has not yet been approved in the U.S. perhaps because Lantus (insulin glargine) (another substituted insulin) dominates the market. Detemir has been widely used without ill effects in Europe and Japan in a number of clinical trials. Its role is to provide an even basal insulin release throughout the 24 hours which can be combined with a very short acting insulin at mealtimes. This ideally is given just after the meal so that the dose can be adjusted for the premeal blood sugar and the number of ‘carbs’ consumed.

I think you could have your son participate in the trial without anxiety, but basically I don’t think that it has any potential to offer better control than the insulins he is already using.

DOB
Additional comments from Dr. Stuart Brink:
You are already using genetically created insulins so it is not likely that you need have great worries about Detemir compared to Lantus insulin. Both are similar, relatively long lasting insulins to provide basal/background insulin effect and coupled with very fast acting analog insulins like
Humalog

or

NovoLog/Novorapid
for meal time
boluses. Sounds like you will join a study and you will get some free supplies for your participation. Detemir and Lantus insulin have minor differences in their effects but I would assume that this study will document this quite nicely. Any individual may do better with one or another type of insulin but this decision should be made based upon

hemoglobin A1c
levels, day to day glucose control, episodes and severity of

hypoglycemia,
etc. Since both these insulin are similar in their time action and effects, they w ill probably both show comparable results.

If you have any worries about either Lantus or Detemir insulin because they have not been used and available for long periods of time, you should, of course, discuss this with your diabetes care team. The fast acting analogs, lispro and aspart insulin, from Lilly and NovoNordisk, have been available for quite some time and seem to be very safe to use. NPH and Lente insulin also has been available for a long period of time and are both very safe. Once one knows that differences in time action, then any dose change of insulin can be counterbalanced and decisions made about whether the new insulins show benefit or now compared to previous insulins being used.

SB
Additional comments from Dr. John Schulga:
Your question regarding modified insulins is a good one. With regard to long-term problems with any of the newer insulins, the honest answer is, we do not know. However, the safety profile of these insulins is excellent. Lantus and Detemir are similar insulins, so your general question about
long-term effects applies to both of them.

The Detemir study is a multicentre study in Europe involving many different centres across Europe. It will provide good information about how Detemir performs and whether it will have a profile which is better than NPH. I personally do not see it as a problem.

JS