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Effects of a a fixed mixture of 25% insulin lispro and 75% NPL on plasma glucose during and after moderate physical exercise in patients with type 2 diabetes

To comparethe plasma glucose(PG) response with a fixed mixture of 25% insulin lispro and 75% NPL (Mix 25), prior to meal and 3h before exercise, to human insulin 30/70 (30/70) in patients with type 2 diabetes. Thirtyseven patients were treated in a randomized, open-label, 8-week, two-period crossover study. Mix25 was injected 5 min before breakfast and dinner throughout the study, as was 30/70 on inpatient test days and on outpatient dose titration days. Following the 4-week outpatient phase, patients were hospitalized, and exercised at a heart rate of 120 beats/min on a cycle ergometer two times for 30 min, separated by 30 min rest. starting 3h after a 339 kcal breakfast. The 2-h postprandial PG was significantly lower with Mix25 (mean+-SEM) 10.5+-0, 4 mmol/l vs 11, 6+-0, 4mmol/l ; p= 0.016). maximum decrease in PG from onsetof exercise to end of exercise was significantly less with Mix25(-3, 6+-0, 29 mmol/l vs -4, 7+-0, 31 ; p=0.001). The maximum decrease in PG over 6h, after exercise onset, was significantly less with Mix25 (-4, 3+-0, 4mmol/l, p<0.001).The frequency of hypoglycemia(blood glucose(BG) < 3mmol/l or symptoms) during the inpatient test was not different between treatments. During the outpatient phase, the frequency of patient-recorded hypoglycemia was significantly lower with Mix25(0, 7+-0, 2 episodes/30d vs 1, 2+-0, 3 episodes/30 d ; p00.042). Mix25 resulted in better postprandial PG control without an increase in exercise-induced hypoglycemia. The smaller decrease in PG during the postprandial phase after exercise may suggest a lower risk of exercise-induced hypoglycemia with Mix25 than with human insulin 30/70, especially for patients in tight glycemic control.

insulin mixtures ; physical activity ; Type 2 diabetes mellitusd

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