Insulin

Diabetes as mentioned earlier can be bacause of either insensitity to insulin (insulin resistance) or due to not enough insulin being made.

There are two types of insulin dependant diabetics (IDDM). One produces no insulin ( Type I ) and the other does produce some insulin but this may be reduced and the body may have insulin resistance (Type 2 IDDM).

Types of insulin

There are many different types of insulin with different profiles. The easiest way to think of these is as insulins which have different time spans over which they work and some which may have been mixed in varying proportions to give profiles of action of both.

  • Shortacting ( Rapid Acting & Standard )
  • Intermediate acting
  • Long acting

For each of these the are different types of insulin :

  1. An Insulin analog is an altered form of insulin, different from any occurring in nature, but still available to the human body for performing the same action. The insulin is made using the genetic sequence from human DNA which has been altered to alter absorption, duration of the effect etc.
  2. Insulins may also be derived from animals e.g. Pigs, Cows. These are not so used so much anymore. However, if you are well controlled these do not need to be changed unless this is limited by their production.

Time Profiles of insulins (in development)

Rapidly acting analogue e.g. Novorapid Aspart, Humalog Lispro.

  • Inject immediately before food
  • Onset may be within 15 minutes, duration 3-5 hours
  • Peak action 30-45 minutes

 

Short acting soluble insulin e.g. Actrapid, Humulin S

  • Injected 15-30 minutes before food
  • Onset 30-60 minutes, Duration 6-8 hours
  • Peak action 2-4 hours

Intermediate Human Isophane Insulin’s: Insulatard, Humulin I

Peak action 4-6 hours.Duration 14-16 hours

Long acting insulin e.g. insulatard

  • Onset 6-8 hours, Duration 24-36 hours
  • Can be administered as a once daily basal insulin.
  • No discenernable peak

Long acting analogue insulin e.g.lantus (glargine), Levemir® (insulin detemir [rDNA origin] injection)

Onset ~2hrs

Duration 18-24hrs


Lantus is a clear formula made with glargine, a genetically modified form of human insulin, dissolved in a special solution. Levemir is also a clear formula, but it contains dissolved detemir, a different form of genetically modified insulin.

Unlike glargine, detemir does not form a precipitate upon injection. Instead, detemir’s action is extended because its altered form makes it stick to itself in the subcutaneous depot (the injection site), so it’s slowly absorbed. Once the detemir molecules dissociate from each other, they readily enter the blood circulation, but there the added fatty acid binds to albumin.

More than 98 percent of detemir in the bloodstream is bound to albumin. With the albumin stuck to it, the insulin cannot function. Because it slowly dissociates from the albumin, it is available to the body over an extended period.

http://www.novonordisk.com/diabetes/levemir_splash.asp

http://www.novonordisk.co.uk/documents/home_page/document/index.asp

http://www.sanofi.co.uk/l/gb/en/layout.jsp?scat=4E9D46E4-0AE1-4CC9-8CBF-B8FAB8FB9EF4

Pre-mixed Human Soluble/Isophane: Mixtard 30, Humulin M3 etc

Mixtard 30, M3 refers to % of soluble insulin ie. 30% Soluble 70% Isophane

Onset: See above
Peak: See above
Duration: See above

Pre-mixed Analogues/Isophane: Novo Mix 30, Humalog M50 + M25

Pen Mix 30, M50/M25 refers to % of analogue insulin ie. 30% Analogue : 70% Isophane

Onset: See above
Peak: See above
Duration: See above

Activity of insulin

1 U deals with roughly 10 g of carbohydrate.

However we are all individuals and requirements vary between 0.4 and 0.8 U insulin/kg body weight.

Our requirements of insulin may vary according to :

  • when we ate, what we ate, what combination of foods we ate (fat slows down sugar absorption. This is not saying frequently eat fat as this is harmfuls !!)
  • our activity levels etc.

We need a some  insulin in the background with some peaks to manage our meals.

Insulin inititiation

The type of insulin depends on several factors :

 

  • Lifestyle
  • Occupation
  • Eating patterns
  • Agreed frequency of injections
  • Ability to grasp techniques
  • Dexterity
  • Vision
  • Religion e.g. Pig based insulins

Owen Mumford makers of the autopen, bd-needles etc.

Autopen Classic, 1-21 units in increments of 1 unit
Compatible with Lilly and Wockhardt UK insulin.
AN3810, PIP code: 273-3178
Available on Prescription

Autopen Classic, 2-42 units in increments of 2 unit
Compatible with Lilly and Wockhardt UK insulin.
AN3800, PIP code: 260-3561

Autopen 24, 1-21 units in increments of 1 unit
Compatible with Sanofi insulin.
AN4210, PIP code: 293-5096

Autopen 24, 2-42 units in increments of 2 unit
Compatible with Sanofi insulin.
AN4200, PIP code: 293-5070
Available on Prescription

http://www.owenmumford.com/en/range/6/autopen.html

Novo-nordisk

http://www.novonordisk.com/diabetes_care/insulin_pens_and_needles/default.asp

http://www.novonordisk.com/diabetes_care/insulin_pens_and_needles/innolet/default.asp

 

Sanofi

Sanofi Range of Pens

Lantus OptiClik withdrawn from production

Sanofi-aventis is reducing its range of insulin pens in December 2011 to the following two: SoloSTAR (pre-filled) and ClikSTAR (re-usable).

Eli Lilly

Eli Lilly products e.g. lispro,  humalog, nph, kwik pen

 

Often when patients are started they are started on 10U of insulin and this is titrated up according to the bodys response.

With people who are not on insulin there sugars are generally titrated using the Hba1c which is a blood test that is sent to the hospital. Blood lives for 120 days and this gives an “average” which can be used to alter the dose of medicines if lifestyle chnage such as diet etc. is not possible or cannot be improved.

With insulin the levels are needed to be monitored more tightly due to the number of adjustments necessary and due to the flexibility of dosing with food, and also because of the rapid activity of insulin, and its potential effects on driving etc. and also because of the effects of illness which increases the amount of sugar in the blood.

How to do a blood test

http://www.owenmumford.com/en/?u=1

http://www.novonordisk.co.uk/documents/article_page/document/2007_diabetes_educational_downloads.asp

http://www.diabetesmatters.co.uk/

http://www.apidra.com/

http://www.apidra.com/cooking/recipe-ideas.aspx

http://www.diabeteshelpteam.com/default.aspx?sau=true&WT.mc_id=LNWB2167

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