Detemir Insulin

OBJECTIVEdMixing rapid acting insulin analogs with detemir insulin to minimize daily injections has been adopted as a common regimen, especially for some children with type 1 diabetes, despite the manufacturing company’s caution against mixing these analogs in the same syringe. The effect of this practice on the pharmacodynamics (PD) of rapid-acting insulin has not been widely studied. This crossover, randomized study was undertaken to determine whether mixing aspart with detemir insulin has an adverse effect on the early glucodynamic action of rapid-acting insulin analog in humans. RESEARCH DESIGN AND METHODSdEight adolescents with type 1 diabetes (age 17.3 6 0.6 years and A1C 7.3 6 0.3%) had two euglycemic glucose clamps during which 0.2 units/kg aspart and 0.4 units/kg detemir insulin were injected either as a separate or single mixed injection in random order. RESULTSdMixing the two insulins diminished the peak and overall early aspart insulin action with significantly lower maximum glucose infusion rate (GIRmax separate 6.16 0.7 mg/kg/min vs. mix 4.56 0.5 mg/kg/min; P = 0.03) values and the area under curve for GIR during the first 3 h of the insulin action study (separate 757 6 105 mg/kg vs. mix 491 6 66 mg/kg; P = 0.04)