This study analyzed the risk of severe hypoglycemic events according to the type of insulin used among type 2 diabetic patients.

Various types of insulin are available for the treatment of diabetes. Rapid acting insulin, such as lispro (Humalog), aspart (Novolog, Novorapid) and glulisine (Apidra), is quickly absorbed, fast acting, and is used to supply the level of insulin needed during mealtimes. Long acting basal insulin, such as glargine (Lantus), detemir (Levemir) and NPH insulin (Humulin, Novolin), is released slowly over a period of 8 to 24 hours, and supplies basal levels of insulin needed during the day. Novolin 70/30 and Humulin 70/30 are examples of pre-mixed insulin, containing both rapid and basal insulin, often also employed in the management of diabetes.

Hypoglycemia (low blood glucose levels) is the most common complication of any insulin treatment. Sever hypoglycemia may be life threatening, and requires emergency medical attention.

This study evaluated the risk of sever hypoglycemia requiring emergent medical attention among 8626 type 2 diabetic patients newly started on insulin therapy. Patients were classified into insulin groups based on their most frequently used insulin type (rapid acting, premixed, NPH, detemir or glargine), and were followed for an average of 4 years. Over 65% of patients were found to be receiving basal insulin therapy. Insulin glargine was the most frequently prescribed type of basal insulin.

Overall, severe hypoglycemic events requiring emergency care occurred in 1.9% of patients. Use of rapid-acting insulin was associated with the greatest risk of hypoglycemic events. Compared to insulin glargine users, the risk of severe hypoglycemia was almost 3-times higher among rapid-acting insulin users. Use of pre-mixed insulin more than doubled the risk of severe hypoglycemia compared to insulin glargine use. Among basal insulin users, NPH insulin was associated with twice the risk of severe hypoglycemic events compared to insulin glargine. No statistically significant difference was seen in the risk of severe hypoglycemia between insulin detemir and insulin glargine use.

This study concluded that the use of newer basal insulin, such as detemir or glargine, is associated with lower rates of severe hypoglycemic events requiring emergency care.

This retrospective study only compared the rate of severe hypoglycemic events but not the overall efficiency of treatment.

Consult with your physician on how to avoid the risk of hypoglycemic events during insulin therapy.