COMPARISON OF HYPOGLYCEMIA BETWEEN COMBINATION OF INSULIN DETEMIR AND ASPART WITH COMBINATION OF NPH (NEUTRAL PROTAMINE HAGEDORN) AND REGULAR INSULIN IN PATIENTS OF TYPE 1 DIABETES MELLITUS

Introduction: Insulin analogues were developed to improve treatment of insulin-treated diabetes with respect to glycemic control and avoidance of hypoglycemic episodes. Short-acting insulin analogues (aspart, lispro and glulisine) were designed to mimic the fast physiological postprandial insulin release and long-acting insulin analogues (detemir and glargine) were designed to mimic the basal continuous insulin release with minimal peak action, thereby leading to a presumed decreased risk of hypoglycemia. Objectives: To compare the frequency of hypoglycemia between combination of insulin detemir and aspart with combination of NPH and regular insulin in patients of type 1 diabetes mellitus. Study Design: Randomized controlled trial.Settings: Department of Pediatric Medicine, DHQ Hospital Faisalabad. Study Duration: 26th October 2016 to 25th April 2016. Materials & Methods: A total of 90 patients of age between 1 and 15 years of both genders with type 1 diabetes were included. Patients with renal impairment, hepatic dysfunction, obese and cushing syndrome were excluded. In group A, patients received insulin detemir once daily with insulin aspart 3 times daily and in group B, patients received twice-daily NPH insulin accompanied by twice-daily Regular Insulin approximately 30 minutes before meals. There was follow up of each patient after 2 weeks and was checked with signs and symptoms of hypoglycemia. Results: Mean age was 10.23 ± 11.58 years. Out of 90 patients, 47 (52.22%) were males and 43 (47.78%) were females with male to female ratio of 1:1. Hypoglycemia in Group A (combination of insulin detemir and aspart) was seen in 02 (4.44%) patients while in Group B (combination of NPH and regular insulin) was seen in 10 (22.22%) patients (p-value = 0.013).Conclusion: This study concluded that combination of insulin detemir and aspart is better than combination of NPH and regular insulin in patients of type 1 diabetes in terms of hypoglycemia. Keywords: Type 1 diabetes mellitus, insulin detemir, NPH, hypoglycemia