Use of Insulin Lispro Protamine Suspension in Pregnancy

Maternal metabolism changes substantially during pregnancy, which poses numerous challenges to physicians managing pregnancy in women with diabetes. Insulin is the agent of choice for glycemic control in pregnant women with diabetes, and the insulin analogs are particularly interesting for use in pr...

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Main Authors:	Lapolla, Annunziata, Grazia Dalfrà, Maria, Romoli, Ester, Bonomo, Matteo, Moghetti, Paolo
Format:	Online
Language:	English
Published:	Springer Healthcare 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635182/

id	pubmed-4635182
recordtype	oai_dc
spelling	pubmed-46351822015-11-10 Use of Insulin Lispro Protamine Suspension in Pregnancy Lapolla, Annunziata Grazia Dalfrà, Maria Romoli, Ester Bonomo, Matteo Moghetti, Paolo Review Maternal metabolism changes substantially during pregnancy, which poses numerous challenges to physicians managing pregnancy in women with diabetes. Insulin is the agent of choice for glycemic control in pregnant women with diabetes, and the insulin analogs are particularly interesting for use in pregnancy. These agents may reduce the risk of hypoglycemia and promote a more physiological glycemic profile than regular human insulin in pregnant women with type 1 (T1D), type 2 (T2D), or gestational (GDM) diabetes. However, there have been concerns regarding potential risk for crossing the placental barrier, mitogenic stimulation, teratogenicity, and embryotoxicity. Insulin lispro protamine suspension (ILPS), an intermediate- to long-acting insulin, has a stable and predictable pharmacological profile, and appears to have a favorable time–action profile and produce desirable basal and postprandial glycemic control. As the binding of insulin lispro is unaffected by the protamine molecule, ILPS is likely to have the same mitogenic and immunogenic potential as insulin lispro. Insulin lispro produces similar outcomes to regular insulin in pregnant women with T1D, T2D, or GDM, does not cross the placental barrier, and is considered a useful treatment option for pregnant women with diabetes. Clinical data support the usefulness of ILPS for basal insulin coverage in non-pregnant patients with T1D or T2D, and suggest that the optimal regimen, in terms of balance between efficacy and hypoglycemic risk, is a once-daily injection, especially in patients with T2D. Available data concerning use of ILPS in pregnant women are currently derived from retrospective analyses that involved, in total, >1200 pregnant women. These analyses suggest that ILPS is at least as safe and effective as neutral protamine Hagedorn insulin. Thus, available experimental and clinical data suggest that ILPS once daily is a safe and effective option for the management of diabetes in pregnant women. Springer Healthcare 2015-10-26 2015 /pmc/articles/PMC4635182/ /pubmed/26499176 http://dx.doi.org/10.1007/s12325-015-0244-y Text en © The Author(s) 2015
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Lapolla, Annunziata Grazia Dalfrà, Maria Romoli, Ester Bonomo, Matteo Moghetti, Paolo
spellingShingle	Lapolla, Annunziata Grazia Dalfrà, Maria Romoli, Ester Bonomo, Matteo Moghetti, Paolo Use of Insulin Lispro Protamine Suspension in Pregnancy
author_facet	Lapolla, Annunziata Grazia Dalfrà, Maria Romoli, Ester Bonomo, Matteo Moghetti, Paolo
author_sort	Lapolla, Annunziata
title	Use of Insulin Lispro Protamine Suspension in Pregnancy
title_short	Use of Insulin Lispro Protamine Suspension in Pregnancy
title_full	Use of Insulin Lispro Protamine Suspension in Pregnancy
title_fullStr	Use of Insulin Lispro Protamine Suspension in Pregnancy
title_full_unstemmed	Use of Insulin Lispro Protamine Suspension in Pregnancy
title_sort	use of insulin lispro protamine suspension in pregnancy
description	Maternal metabolism changes substantially during pregnancy, which poses numerous challenges to physicians managing pregnancy in women with diabetes. Insulin is the agent of choice for glycemic control in pregnant women with diabetes, and the insulin analogs are particularly interesting for use in pregnancy. These agents may reduce the risk of hypoglycemia and promote a more physiological glycemic profile than regular human insulin in pregnant women with type 1 (T1D), type 2 (T2D), or gestational (GDM) diabetes. However, there have been concerns regarding potential risk for crossing the placental barrier, mitogenic stimulation, teratogenicity, and embryotoxicity. Insulin lispro protamine suspension (ILPS), an intermediate- to long-acting insulin, has a stable and predictable pharmacological profile, and appears to have a favorable time–action profile and produce desirable basal and postprandial glycemic control. As the binding of insulin lispro is unaffected by the protamine molecule, ILPS is likely to have the same mitogenic and immunogenic potential as insulin lispro. Insulin lispro produces similar outcomes to regular insulin in pregnant women with T1D, T2D, or GDM, does not cross the placental barrier, and is considered a useful treatment option for pregnant women with diabetes. Clinical data support the usefulness of ILPS for basal insulin coverage in non-pregnant patients with T1D or T2D, and suggest that the optimal regimen, in terms of balance between efficacy and hypoglycemic risk, is a once-daily injection, especially in patients with T2D. Available data concerning use of ILPS in pregnant women are currently derived from retrospective analyses that involved, in total, >1200 pregnant women. These analyses suggest that ILPS is at least as safe and effective as neutral protamine Hagedorn insulin. Thus, available experimental and clinical data suggest that ILPS once daily is a safe and effective option for the management of diabetes in pregnant women.
publisher	Springer Healthcare
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635182/
_version_	1613498190252736512

Use of Insulin Lispro Protamine Suspension in Pregnancy

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