[Advantages and drawbacks of human insulin]

Abstract

Insulin (I) preparations used formerly contained a large number of protein contaminants which are thought to be immunogenic and, hence, caused lipodystrophy, I-allergy and sometimes antibody-mediated I-resistance in many patients. Monocomponent (MC)-I and human I (HI) are virtually free of these peptides and are, therefore, very rarely accompanied by the above mentioned immunologic side effects. In this respect, however, HI offers only little advantage over MC-I although HI is the least immunogenic I. On the other hand, the formation of antibody to I in the diabetic mother is an important determinant of fetal outcome. And since children from diabetic mothers treated with HI are less frequently macrosomic, the use of HI is strongly recommended in women with diabetes before and during their childbearing years. Neutral HI action is somewhat shorter, although clinically not to a relevant extent and, furthermore, metabolic control is not improved by using HI compared wtih MC-I. These findings have been regarded as disadvantages of HI, together with the fact that about 20% of HI-treated patients experience a change of hypoglycemia symptoms during the course of their illness. While autonomic symptoms become weaker or disappear, patients have to react to neuroglycogenic symptoms which normally remain constant. However, the incidence of hypoglycemic events does not change during treatment with HI. Several reasons for this change of symptoms are discussed, such as long duration of diabetes, intensified therapy with near-normoglycemia, development of autonomic neuropathy, alcoholic beverages, and often insufficient instruction of patients.(ABSTRACT TRUNCATED AT 250 WORDS)