Insulin Analogues

In the 1990s, the value of glycemic control in the management of diabetes became incontrovertible. The interest in producing insulin formulations that are safer than previous formulations and that more closely duplicate the basal and mealtime components of endogenous insulin secretion has yielded insulin analogues with action profiles that afford more flexible treatment regimens and a lower risk of hypoglycemia. This article examines the use of these newer insulins in clinical practice. The interest in producing insulin formulations that are safer has yielded insulin analogues that afford more flexible treatment regimens and a lower risk of hypoglycemia. This article examines the use of newer insulins in clinical practice. The discovery of insulin more than 80 years ago is considered one of the greatest medical breakthroughs of the 20th century. 1 The first commercial insulin preparations contained numerous impurities and varied in potency from lot to lot by as much as 25 percent. Manufacturing techniques improved rapidly, however, which allowed the production of higher-quality formulations from bovine and porcine sources. In the 1930s, the first long-acting preparation, protamine zinc insulin, was developed to reduce the number of injections necessary for adequate insulin replacement. 2 This preparation was often used once daily, without the addition of regular insulin, which set a trend . . .