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The Reply:

      Ligthelm and Calle review important data about the INITIATE study using biphasic insulin aspart 30. I am in complete agreement that premixed insulin analogues offer advantages compared with basal insulin alone. My point was that for an individual premeal measurement of hyperglycemia, when one would prefer to administer only a rapid-acting analogue to correct the blood glucose, using a pen with a mixture of aspart and protamine insulin would be far from ideal. It seems reasonable that to best reduce glycemic exposure one would use only the rapid-acting analogue.
      • Hirsch I.B.
      Insulin analogues.
      With pen therapy, this would necessitate an extra injection that some patients are reluctant to do.

      Reference

        • Hirsch I.B.
        Insulin analogues.
        N Engl J Med. 2005; 352: 174-183

      Linked Article

      • Intensifying Insulin Therapy in Patients with Type 2 Diabetes
        The American Journal of MedicineVol. 120Issue 8
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          In an article in the May 2005 supplement issue of The American Journal of Medicine, Hirsch gave an interesting and extensive account into the current status and future prospects of the management of type 2 diabetes.1 Unfortunately, we believe the author has made an inaccurate assertion with regard to one aspect of insulin treatment in patients with type 2 diabetes.
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