insulins.docx

Short duration: rapid acting. Short-duration insulins are administered in association with meals to control the postprandial rise in blood glucose. To provide glycemic control between meals and at night, short-acting insulins must be used in conjunction with an intermediate- or long-acting agent in...

Short duration: rapid acting. Short-duration insulins are administered in association with meals to control the postprandial rise in blood glucose. To provide glycemic control between meals and at night, short-acting insulins must be used in conjunction with an intermediate- or long-acting agent in people with type 1 diabetes. Insulin lispro. Insulin lispro (Humalog) is a rapid-acting analog of regular insulin. Effects begin within 15 to 30 minutes of subcutaneous (subQ) injection and persist for 3 to 6 hours. Insulin lispro acts faster than regular insulin but has a shorter duration of action. Because of its rapid onset, insulin lispro can be administered immediately before eating or even after eating. In contrast, regular insulin is generally administered 30 to 60 minutes before meals. The structure of insulin lispro is nearly identical to that of natural insulin. The only difference is that the positions of two amino acids have been switched. Because of this switch, molecules of insulin lispro aggregate less than do molecules of regular insulin, which explains why insulin lispro acts more rapidly. Insulin aspart. Insulin aspart (NovoLog) is an analog of human insulin with a rapid onset (10 to 20 minutes) and short duration (3 to 5 hours). Insulin aspart is very similar to insulin lispro. Insulin glulisine. Like insulin lispro and insulin aspart, insulin glulisine (Apidra) is a synthetic analog of natural human insulin with a rapid onset (10 to 15 minutes) and short duration (3 to 5 hours). Owing to its rapid onset, the drug should be administered close to the time of eating. Inhaled human insulin. As mentioned briefly before, when regular human insulin is inhaled, the time action profile is altered such that the regular insulin works more quickly and has a shorter duration when compared with regular insulin when injected subQ. Inhaled human insulin (Afrezza) is a mealtime insulin product that can be used in people with type 1 and type 2 diabetes. The insulin product is available commercially in cartridges that contain 4, 8, or 12 units each. Short duration: short acting Regular insulin injection. Regular insulin (Humulin R, Novolin R) is unmodified human insulin. The product has four approved routes: subQ injection, subQ infusion, and intramuscular (IM) injection (used rarely). For routine treatment of diabetes, regular insulin can be (1) injected before meals to control postprandial hyperglycemia and (2) infused subcutaneously via insulin pump to provide basal glycemic control. After subQ injection, molecules of regular insulin form small aggregates at the injection site. As a result, absorption is slightly delayed. Effects begin in 30 to 60 minutes, peak in 1 to 5 hours, and last up to 10 hours. Onset is slower than with the rapid-acting insulins and faster than with the longer acting insulins. Because of this delay, most people using insulin pumps use a rapid-acting insulin analog instead of regular insulin. Intermediate duration Neutral protamine Hagedorn insulin suspension. Neutral protamine Hagedorn (NPH) insulin (Humulin N, Novolin N), also known as isophane insulin, is prepared by conjugating regular insulin with protamine (a large protein). The presence of protamine decreases the solubility of NPH insulin and thus delays absorption. As a result, onset of action is delayed and duration of action is extended. Because onset is delayed, NPH insulin cannot be administered at mealtime to control postprandial hyperglycemia. Rather, the drug is injected twice or three times daily to provide glycemic control between meals and during the night. Of the longer-acting insulins in current use, NPH insulin is the only one suitable for mixing with short-acting insulins. Because protamine is a foreign protein, allergic reactions are possible. Long duration Insulin glargine (U-100). U-100 insulin glargine (Lantus, Basaglar) is a modified human insulin with a prolonged duration of action (up to 24 hours). The drug is indicated for once-daily subQ dosing to treat adults and children with type 1 diabetes and adults with type 2 diabetes. That being said, some patients require twice-daily administration to achieve the full 24 hours of basal coverage. Dosing may be done any time of day (morning, afternoon, or evening) but should be done at the same time every day, if possible. U-100 insulin glargine differs from natural human insulin by four amino acids. Hence, when injected subcutaneously, it forms microprecipitates that slowly dissolve and thereby release insulin glargine in small amounts over an extended time. In contrast to other long-acting insulins (e.g., insulin detemir), which cause blood levels to rise to a peak and then fall to a trough, insulin glargine achieves blood levels that are relatively steady. Insulin detemir. Insulin detemir (Levemir) is a human insulin analog with a slow onset and dose-dependent duration of action. At low doses (0.2 units/kg), effects persist about 12 hours. At higher doses (0.4 units/kg), effects persist for up to 20 to 24 hours. Because of its slow onset and prolonged duration, insulin detemir is used to provide basal glycemic control. It is not given before meals to control postprandial hyperglycemia. Compared with NPH insulin, insulin detemir has a slower onset and longer duration. Ultralong duration Insulin glargine (U-300). U-300 insulin glargine (Toujeo) is similar to U-100 insulin glargine except that it is three times concentrated, which prolongs its duration of action to be in excess of 24 hours. The drug is indicated for once-daily subQ dosing to treat both type 1 and type 2 diabetes. Because U-300 insulin glargine has a longer duration of action than U-100 insulin glargine, use of this product is an option for those individuals who do not realize a full 24 hours of effect with the U-100 product. Insulin degludec. Insulin degludec (Tresiba) is the only human insulin analog with effects that persist for up to 42 hours. Because of its prolonged duration, insulin degludec is used to provide basal glycemic control. Similarly to insulin glargine, insulin degludec does not have a peak.