From the Guidelines
For optimal glucose control, insulin lispro is recommended. Both insulin aspart and insulin lispro provide similar glucose control, but insulin lispro may have a slight edge in some situations. Both are rapid-acting insulin analogs used to manage blood sugar in people with diabetes, but studies have shown lispro may lead to slightly lower postprandial (after-meal) glucose levels in some patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
Key Considerations
- Typical dosing for either insulin is individualized based on the patient's needs, usually starting at 0.1-0.2 units/kg/day divided before meals.
- Adjust doses based on blood glucose monitoring.
- The marginal benefit of lispro stems from its slightly faster onset of action (about 15 minutes vs. 20 minutes for aspart) and shorter duration (3-4 hours vs. 3-5 hours for aspart) 1.
- This allows for more precise mealtime dosing and potentially better matching of insulin action to food absorption.
Patient Factors
- Patients should work closely with their doctor to determine the best option for their specific situation.
- The choice between insulin aspart and insulin lispro often comes down to individual patient factors, healthcare provider preference, and insurance coverage.
- Both insulins are highly effective, and the differences between them are small.
Clinical Guidelines
- The American Diabetes Association recommends considering regimen flexibility when devising a plan for the initiation and adjustment of insulin therapy for patients with type 2 diabetes 2, 3, 4, 5, 6, 7, 8, 9, 10.
- Providers can consider switching patients who receive twice-daily premixed insulin and still exceed their HbA1c target to thrice-daily premixed insulin analogues (70/30 aspart mix or a 75/25 or 50/50 lispro mix).
From the Research
Comparison of Aspart and Lispro Insulin
- The pharmacokinetic and pharmacodynamic profiles of insulin lispro and aspart were compared in a study of 20 healthy men, which found that aspart had a more rapid absorption than lispro 11.
- The study also found that aspart had lower glucose concentrations after 50 minutes, and a higher maximum insulin concentration after 40 minutes, compared to lispro 11.
- However, another study found that insulin aspart and insulin lispro had equivalent pharmacodynamic effects on blood glucose excursions in type 1 diabetic patients 12.
- A review of PK/PD studies and clinical trials suggested that the three marketed rapid-acting analogues, including insulin lispro and aspart, are equally efficacious and safe 13.
- A study comparing biphasic insulin aspart with biphasic insulin lispro and biphasic human insulin in patients with type 2 diabetes found that biphasic insulin aspart had superior postprandial glycemic control 14.
- Another study found that insulin aspart and insulin lispro have nearly identical pharmacokinetic and pharmacodynamic profiles, and provide better postprandial glucose control and less hypoglycaemia than regular insulin 15.
Key Findings
- Aspart may have a more rapid absorption than lispro 11.
- Aspart and lispro have equivalent pharmacodynamic effects on blood glucose excursions in type 1 diabetic patients 12.
- Biphasic insulin aspart has superior postprandial glycemic control compared to biphasic insulin lispro and biphasic human insulin in patients with type 2 diabetes 14.
- Aspart and lispro have similar pharmacokinetic and pharmacodynamic profiles, and provide better postprandial glucose control and less hypoglycaemia than regular insulin 15.