Multiple Diabetes Injections Could Yield to Injections Just 3 Times a Week

March 10, 2011— -- If Vicki Taniwaki eats three meals in a day, she will have "stuck" herself with insulin at least five times by the time she goes to bed at night.

Taniwaki has been diagnosed with type 1 and type 2 diabetes. She must take two basal injections, or background insulin, and three bolus injections, an insulin to control her glucose levels after meals, every single day of her life.

But, as normal as this routine has become for Taniwaki, who was diagnosed with type 2 diabetes in August 2007, she said there is certainly room for error with all those sticks and pricks.

"Anything you do that much becomes routine, but the opportunity to screw it up also goes up as you become more lax and comfortable with it," said 50-year-old Taniwaki.

When Taniwaki heard about a study that found the background shot of insulin could be lowered from one or two times a day to three times a week, she said it could be a positive change to her day.

"Anything that would diminish or curtail that maintenance routine would be good," said Taniwaki. "Some people could argue that then you would have to worry about trying to remember when you did that background injection, but if I could do roughly half of what I'm doing now I would be very happy."

While the new type of insulin is not available on the market right now, Taniwaki could be cutting back on stick and pricks in the future.

A new study, published in the Lancet, found that a longer acting form of insulin, known as degludec, is just as effective as the existing long-lasting insulin, glargine.

One injection of glargine lasts 18 to 26 hours, but study participants who used degludec had the same amount of blood sugar control as glargine while only getting injected three times a week instead of daily.

Sticks and Pricks of the Study

Participants who took degludec had lower rates of hypoglycemia.

"This would give patients the same level of control in insulin with much less chance of hypoglycemia," said Dr. Bernard Zinman, director of the Leadership Sinai Center for Diabetes and lead author of the study. "It was so long-acting that we looked at administering it less frequently, and even under those circumstances we had an excellent response with respect to lowering glucose."

Researchers enrolled 245 people aged 18 to 75 years old with type 2 diabetes onto the preliminary trial. Patients were randomly assigned to receive the three-times-a-week or the daily insulin injection.

"This was a proof-of-concept study," said Zinman. "We need to wait for much larger studies involving more patients under different circumstances to see whether this would be valuable in the clinical setting."

Dr. Gerald Bernstein, director of the Diabetes Management Program at Beth Israel Medical Center in New York, said that other "basal-like," or background, insulins, like NPH and Levemir, already are being used today.

"In my mind, there is no question that, with hundreds of millions of people with Type 2 diabetes, there will be subgroups that would benefit and respond to one of these insulins," said Bernstein.

"If this new preparation would get more people to take insulin earlier, that would be a plus," said Bernstein. "As it proves itself out, it may be of significant value in the future."

According to the American Diabetes Association, nearly 26 million people have diabetes in the United States. Type 2 diabetics often do not have indicating symptoms of the disease but sometimes they will suffer from frequent infections in the skin, gums or bladder, blurred vision, bruises that are slow to heal and tingling in the extremities.

Type 2 diabetics do not produce enough insulin or the cells ignore the insulin.

Potential Breakthrough When Lowering Hypoglycemia

Most diabetic patients who take insulin need about two shots per day to control blood sugar levels. But it is not uncommon for people to inject insulin four times a day.

"Another long-acting basal insulin that might be effective when given every three days could improve adherence and reduction in hypoglycemia, [which] is always an important goal in that hypoglycemia deters adherence with and acceptance of insulin therapy in type 2," said Dr. Francine Kaufman, director of the Comprehensive Childhood Diabetes Center at the Children's Hospital of Los Angeles.

"I think this is another advance in diabetes therapy for type 2 diabetes patients in that it adds to the armamentarium," added Kaufman.

While study authors warned that the insulin is not ready for clinical use, many doctors remain hopeful that the drug will cut down insulin maintenance for diabetic patients in the future.

"This is a promising advance in the management of diabetic patients, easy to take, less cumbersome, perhaps cheaper and, if indeed [it] has less hypoglycemia episodes, even better," said Dr. Albert Levy, assistant professor of medicine at Albert Einstein College of Medicine in New York. "The most common side effect of practically all insulin injections is hypoglycemia, and if this unwanted side effect is minimized it would be a major breakthrough."