TYPES OF INSULIN :-

With the advent of human insulins, bovine or porcine insulins have hardly any role to play in the management of type 1 diabetes in children. Avoiding use of bovine and porcine insulins can successfully obviate the attendant problems of insulin resistance, insulin antibodies, and lipoatrophy.

The introduction of rapid acting insulin analogues, Lispro and Aspart insulin has further facilitated intensive glycemic control by their use in the MDI regimes (16-18) (Fig 2). Further, substituting regular insulin with these analogues can solve many a problem encountered in achieving adequate glycemic control. The foremost among these is a marked reduction in nocturnal hypoglycemic episodes. They also have a special role to play in cases of Somogyi phenomena, Dawn phenomena and brittle diabetes.

Ultralente insulin (bovine) was the closest we had to good basal insulin. However, it was still woefully inadequate. The introduction of Glargine insulin has shown great promise as it provides the near ideal, once a day, peakless, basal insulin.

Pulmonary aerosol (inhalant) insulin is the next major blessing for young diabetics (19). With its introduction, giving a single bedtime dose of Glargine insulin and metered doses of inhaled insulin prior to each meal/snack may further facilitate intensive control.

Fig 2: Mean serum insulin concentration in non - diabetic subjects after subcutaneous injection (0.2 U/kg) of human insulin Aspart (¨) and regular human insulin (o ) at various sites. A. Abdomen B. Deltoid C. Thigh. (20)