Are they any better ?
Yes, yes and yes, if I needed insulin I would only be on the newest latest of them. Are they for everyone?
I certainly believe individualisation is the key here. We now have so many tools in the armament of diabetes and to this end they require to be prescribed for the greatest benefit for the individual.
So, when it comes to what we call basal insulin – background insulin. The insulin that controls your sugar before a meal and overnight and in the back ground so to speak (out side of meals). We now have a lot to choose from : protophane, other long acting basals, analogue basals like : glargine, detemir, newer ultra-long acting like degludec.
In terms of the choice it needs to match the needs of the patient.
If a patient wishes to only inject twice a day we have an option for that.
If a patient prefers an insulin pump we have an option for that.
If a patient is wanting ultimate control above all else there are choices for that.
What is critical is aiming for an A1c of 7 with very little variability. I am always happy to sacrifice A1c for less variability and my most important criteria is no hypos! or as few as possible. They are “Kak” for both brain and patient.