In recent years,
insulin analogues are the benefits of the use in functional intensive
insulin therapy for the treatment of diabetes. Shortacting
insulin (lispro, aspart and glulisine) and
long-acting insulin (
glargine and detemir) have been developed for the management of diabetes.
Short-acting insulin analogues are an alternative to regular human
insulin before meals. These new
short-acting insulin analogues show more rapid onset of activity and a shorter duration of action. As a result of these pharmacokinetic differences, an improved postprandial
glycemic control is achieved, without increasing the risk of
hypoglycemia. In addition, these
insulin analogues can be administered immediately before a meal. The
long-acting insulin analogues provide basal
insulin levels for 24 h when administered once (
glargine) or two (detemir) daily. Compared with previous intermediate- or long-acting conventional
insulin, these
insulins shows a flat profile of plasma
insulin levels . The use of these
long-acting insulin analogues appears to be associated with a reduced incidence of
hypoglycemia, especially at night. The availability of these new
insulin analogues has the potential to significantly improve long-term control over
blood glucose in diabetic patients. In recent years more and more frequently the method of multiple daily
injections (MDI) of
insulin is being replaced by the method of continuous subcutaneous
insulin infusion (CSII). It is the most physiological way to administer
insulin. In recent years treatment with
insulin pumps has been used more frequently in the pediatric patients and in the treatment of diabetes in pregnancy. Use of continuous
glucose monitoring systems enables detection of glycemia fluctuations unrevealed by selfmonitoring of
blood glucose, such as night hypoglycemias and early
postprandial hyperglycemias. Real-time systems allow to reduce HbA1c levels and limit number of excursions. Non-invasive
glucose measurement devices are introduced. Fully automated continuous
glucose monitoring systems integrated with
insulin pumps operating in closed-loop model, requiring no patient assistance, are still being researched. Commercially available systems operate in open-loop model, where the patient has to decide on administration and dose of
insulin.