October 24, 2012

Do you need Ferrari or F-150 insulin?

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The BMJ medical journal published an article on the assessment of “Newer insulins in Type 2 Diabetes“. The author of the paper, Edwin Gale, did a very good job in prefacing the chronology of insulin from the pure natural insulin of the 70s, to the genetically engineered synthetic analogues of the 80s, through the “super human” insulin analogues of today.

The two industry leading analogues of today are Lantus and Levemir. Both act as basal insulins whereby their duration is long enough to hold your glucose level throughout the day. Their mechanism of action is different. Lantus form micro-crystals upon injection where the crystals are “time-released” throughout the day . Levemir is attached to a free fatty acid and upon injection binds to albumin in the blood and “time-releases. Levemir may have a longer lasting effect than Lantus. The novelty in these insulins is not their ability to move glucose any faster or slower to the cells but their delivery system: micro-crystals or free fatty acids that bind to albumin in the blood.

As an aside, Edwin comments that the convenience of newer insulins has not translated into a clinical advantage in studies for diabetes control. However he notes that the newest insulins offer an advantage in Type 1 diabetes control because they have a smoother delivery in insulin which calms the swings in blood glucose.

The older insulins do not pose any significant risks to speak of. However, Lantus does raise eyebrows insofar as its microgenicity. What is meant by this is that it has more of an overlap with IGF (insulin growht factor) than Levemir. This has been shown to promote the growth of certain cancer cells.  For the record “the epidemiology is not clear at this point.”

The Car Talk of this article basically says some cars are better suited for certain drivers. Edwin compares the benefits of T1D insulin management to T2D insulin management like the difference between driving a sports car and driving a lorry (truck). He explains that the sports car performance of current insulin may not be as beneficial in handling T2D as it is for T1D.

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