Does the species of insulin affect the risk of hypoglycaemia

The question of whether human insulin might contribute to hypoglycaemia unawareness was raised during the 1980s. The development of recombinant insulin of human structure resulted in its widespread introduction to many patients who previously been using animal insulin without problems. A minority complained vociferously of different problems including a major reduction in hypoglycaemic warning signs, which improved when they were transferred back to animal insulin. However, repeated studies have failed either to confirm a consistent reduction in physiological responses and symptoms in those on human insulin or identify any convincing mechanisms. Furthermore, the concerns were confined to only a few countries such as the UK and Switzerland. The introduction of human insulin in others such as the USA and Germany produced few problems. To some, the most likely explanation is that the time of transfer coincided with attempts to tighten glycaemic control, and it was this that led to a loss of hypoglycaemic warning. Others have suggested that an increased rate of asymptomatic nocturnal hypoglycaemia due to differences in insulin kinetics could have caused a reduction in autonomic symptoms. Many years later, the question remains unresolved and it now seems unlikely that a study with sufficient power will ever be mounted. It is ironic that recombinant technology has now resulted in the development of both short- and long-acting insulin analogues whose chief benefit is to reduce the incidence of hypoglycaemia.

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