Abstract

In insulin therapy of diabetes, short-acting prandial insulin and long-acting basal insulin are combined, the former mimicing insulin response after food intake and the latter mimicing constant release of insulin that regulates lipolysis and the output of hepatic glucose. The major pitfall of classical basal insulin – NPH insulin – is the increased risk of hypoglycemia attributable to its peak action profile and high variability of plasma concentration. Novel long-acting insulin analogues – glargine and detemir – are designed to mimic the level of basal insulin more physiologically. In Estonia, insulin glargine  has been successfully used since 2004, while insulin detemir became available only recently. Insulin detemir is an acylated insulin analogue, which binds to albumin in the subcutis and plasma to create a long-lasting reservoir of insulin. Clinical studies have demonstrated more stable blood glucose level and a significantly reduced risk of daily and nocturnal hypoglycemia with insulin detemir compared with NPH insulin. In addition, trials have consistently shown that insulin detemir has a weight-sparing effect both in patients with type 1 and type 2 diabetes.