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Prandial Insulins: A Person-Centered Choice

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Abstract

Purpose of Review

Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management.

Recent Findings

Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods.

Summary

The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.

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Acknowledgement

We thank Dr. Roopa Mehta for reviewing the manuscript.

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Authors and Affiliations

  1. Department of Endocrinology, Sarvodaya Hospital, Faridabad, Haryana, India

    Bhawna Attri

  2. Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

    Lakshmi Nagendra

  3. Department of Endocrinology, Center for Endocrinology Diabetes Arthritis and Rheumatism (CEDAR) Super-Speciality Healthcare, Dwarka, Delhi, India

    Deep Dutta

  4. Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, India

    Sahana Shetty

  5. Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India

    Shehla Shaikh

  6. Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India

    Sanjay Kalra

  7. Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, Delhi, 110076, India

    Saptarshi Bhattacharya

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  1. Bhawna Attri
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SK, SB, SS1 conceptualized the manuscript. BA, LN, SB, SS2 wrote the main manuscript. DD AND SS2 made the figures and table. All authors reviewed the manuscript.

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Correspondence to Saptarshi Bhattacharya.

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Attri, B., Nagendra, L., Dutta, D. et al. Prandial Insulins: A Person-Centered Choice. Curr Diab Rep (2024). https://doi.org/10.1007/s11892-024-01540-8

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