Question

Insulin Types;

Short Acting

Intermediate acting Insuline

Insulin Mixture

Insulin Analogs

Analogs Mixtures

Include the following informations:

1. Brand Name

2. Characteristics: minimum of 3 per type

3. Routes able to administer

4. Onset, Peak and Duration

Answer 1

WHAT IS INSULIN:-Insulin is a naturally-occurring hormone secreted by the pancreas. Insulin is required by the cells of the body in order for them to remove and use glucose from the blood. Cells use glucose to produce energy that they need to carry out their functions. Researchers first gave an active extract of the pancreas containing insulin to a young diabetic patient in 1922, and the FDA first approved insulin in 1939. Currently, insulin used for treatment is derived from beef and pork pancreas as well as recombinant (man-made) technology. The first recombinant human insulin was approved by the FDA in 1982.

TYPES OF INSULIN:- There are three main groups of insulins: Fast-acting, Intermediate-acting and Long-acting insulin. Fast-acting insulin: Is absorbed quickly from your fat tissue (subcutaneous) into the bloodstream. Is used to control the blood sugar during meals and snacks and to correct high blood sugars.

1) SHORT ACTING INSULIN:-Short-acting insulins are often used before eating to control the large rise of blood glucose that often occurs after a meal. Ideally, short-acting insulin is taken approximately 30-45 minutes before the meal, as it takes up to 2 hours to see its main effect. However, most people take their insulin just before eating.

2) INTERMEDIATE ACTING INSULIN:-Intermediate acting insulins may also be referred to as ‘isophane’or ‘NPH’ (Neutral Protamine Hagedorn) insulins.

Those who inject intermediate acting insulins should be aware of the risk of hypoglycemia, and particularly the risk of night time hypoglycemia.Intermediate acting insulins are often taken in conjunction with a short acting insulin. Intermediate acting insulins start to act within the first hour of injecting, followed by a period of peak activity lasting up to 7 hours.

3) INSULIN MIXTURE:- The sugar level one day is really a guide to you next days insulin.

• If you have a low or high sugar at the same time of day for a couple of days, adjust your insulin on the third day.
• Naturally you adjust the insulin before the time in question.
• If the sugar was consistently high, you would increase your insulin dose before the measurement as below.
• If the sugar was consistently low, reduce dose as below.
• Sometimes adjustments of 1 unit can be helpful if there is only a slightly low or high sugar (if you use a low dose of insulin)
• If your blood sugar level is below 8.0 mmol/l before bed, make sure that you have a snack.
• Mixtard/Humulin insulin's should be taken 20-30 mins BEFORE food
• Novomix 30, Humalog mix 25 or Humalog mix 50 should be taken WITH food

4) INSULIN ANALOGS:-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 as human insulin in terms of glycemic control. Through genetic engineering of the underlying DNA, the amino acid sequence of insulin can be changed to alter its ADME (absorption, distribution, metabolism, and excretion) characteristics.

5) ANALOGS MIXTURES:-

Lispro insulin (Humalog, Eli Lilly) has been shown to be a safe and effective alternative to regular insulin for the treatment of diabetic ketoacidosis in dogs.10 Engineered through recombinant DNA technology, the penultimate lysine and proline residues on the C-terminal end of the B-chain are reversed. This modification does not alter receptor binding, but blocks the formation of insulin dimers and hexamers. This allows larger amounts of active monomeric insulin to be immediately available for postprandial injections.1,2 Insulin aspart (NovoLog, Novo Nordisk) and Insulin glulisine (Apidra, Sanofi-Aventis) are other short acting insulin analogs that could be used as an alternative to regular insulin.1,2 Like insulin lispro, these analogues have slight modifications of the insulin structure needed to prevent the formation of hexamers; this leads to larger amounts of active insulin to be available to create a faster-acting insulin. Either insulin aspart or glulisine could potentially be used as an alternative to regular insulin. However, studies in dogs and cats have yet to been reported.   Finally, although not marketed as a short-acting insulin analog, insulin glargine (Lantus) has been reported to have an action profile similar to regular insulin in cats when administered intramuscularly (see below).   Insulin Glargine   Insulin glargine (Lantus, Sanofi-Aventis) is a long-acting synthetic insulin analogue developed for the human diabetic market to provide continuous basal insulin concentrations that inhibit hepatic glucose production.1,2 The therapeutic aim is to mimic the physiological pattern of insulin secretion of healthy subjects, and the basal insulin levels provided by these products are supplemented at meal times by administration of short-acting insulin preparations that act during the postprandial period. Glargine insulin differs from standard insulins because it has been genetically modified, by replacing an asparagine with glycine and adding 2 arginine amino acids to the c-terminal end of the molecule. This alters the pH solubility (isoelectric point) of the molecule, so that it is soluble at a pH 4 but insoluble at neutral pH (e.g., in the body). When glargine insulin is injected into the skin, it precipitates because of the pH change and forms insoluble microcrystals, which are slowly absorbed into the circulation. This constant release of small amounts of insulin prevents major peaks and troughs from developing. The formation of micro-precipitates and slow absorption are dependant on the acidity of glargine. Therefore, glargine cannot be mixed or diluted. 535
       
           
       
            ? Insulin glargine is efficacious for the long-term treatment of diabetes in cats and in considered the initial insulin of choice by many veterinarians.11,12 If improved diabetic control and remission is the goal, insulin glargine must be administered twice daily. In cats that present with diabetic ketoacidosis, glargine can be used in place of a short-acting insulin such as regular insulin. When glargine is administered intramuscularly or intravenously, it has a similar action profile to regular insulin and can be used in the treatment of cats with diabetic ketoacidosis.13 Giving insulin glargine by both the IM and SC route twice daily (70% of the dose given SC and 30% of the dose given IM) can also be used to improve control of the diabetic state in cats with insulin resistance. Information regarding the use of insulin glargine in diabetic dogs is limited. Initial pharmacological assessment in healthy dogs found that glargine administration resulted in an unpredictable serum insulin concentration response and failed to produce a significant glucose-lowering effect in 2 of 9 dogs after a single injection.14 However, a recent study found that insulin glargine administered subcutaneously twice daily is a valid method of treatment for naturally occurring diabetes in dogs, and that it is an alternative to other insulin preparations that have been shown to be effective in the treatment of canine diabetes.15 However, in that study, only 58% of dogs in the present study obtained good control of hyperglycemia, which is less than the reported 75% of dogs with good control in a similar study where a porcine insulin zinc suspension (lente insulin) was used.3 Therefore, although insulin glargine may be an acceptable insulin choice for some dogs with diabetes mellitus, the disease control success rate appears to be lower with glargine than with NPH or lente insulins. Certainly, if a more potent insulin preparation is needed (i.e., in a dog with insulin resistance), detemir insulin would be the insulin of choice, since determir appears to be at least 4-times more potent than the other insulin preparations which have been evaluated in the dog.16 Insulin Detemir   Insulin detemir (Levemir, Novo Nordisk) is another synthetic insulin analogue with long duration of action that is produced using recombinant DNA technology.1,2 In contrast to glargine, detemir's long duration of action is made possible through modification of the insulin molecule via addition of an acylated fatty acid chain. This modification facilitates reversible binding to plasma proteins, particularly albumin, from where it is released slowly into plasma. The modification also prolongs self-association in the injection depot, which prolongs absorption from subcutaneous tissue at the injection site and contributes to the long duration of action. In cats, detemir results in a similar action/duration profile and potency to insulin glargine.17,18 The remission rates and time to remission for both detemir and glargine are also comparable. A dosing protocol similar to glargine is used, but some cats will require less detemir than glargine (the median dose of detemir was 30% less than glargine in one study of diabetic cats).18   In dogs, insulin detemir and glargine are in no way comparable.14-16 Insulin detemir is a very potent, long-acting insulin preparation in dogs, and works much better than glargine in most problem diabetic dogs. In accord with that, we have had success with insulin detemir in dogs with brittle diabetes that were unresponsive to lente or NPH insulins or Humulin 70/30 insulins. In dogs, detemir is dosed initially at 0.1 U/kg BID, administered at time of feeding. This dose is approximately ¼ of that of NPH or Vetsulin.   Insulin Degludec   Insulin degludec (Tresiba, Novo Nordisk) is a new-generation, ultra-long-acting basal insulin analogue. This latest insulin analogue differs from other long-acting insulin preparations in having a longer half-life, flat time-action profile (less likely to cause hypoglycemia) and less day-to-day variability (less glycemic variability).19-21   Degludec is a neutral, soluble ultra-long-acting insulin that forms large soluble multihexamers at the subcutaneous injection site. Its molecular structure is similar to the human insulin amino acid sequence, apart from deletion of Threonine at position B30 and the addition of a 16-carbon fatty diacid attached to Lysine at position B29 via a glutamic acid spacer.    After SC administration, degludec results in the formation of a subcutaneous depot of soluble multihexamers that results in the slow release of insulin monomers into the systemic circulation. Insulin degludec has an onset of action of 30-90 minutes (similar to insulin glargine and insulin detemir). There is no peak in activity, due to the slow release into systemic circulation. The duration of action of insulin degludec is over 42 hours, unlike the 18 to 26 hours provided by current marketed long-acting insulins such as glargine and detemir.

BRAND NAME OF INSULIN:-Humulin R, Novolin R, Humulin R U-500 (Concentrated), ReliOn/Humulin R.

CHARACTERISTICS OF INSULIN:-

Insulin has 3 characteristics:

• Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
• Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose.
• Duration is how long insulin continues to lower blood glucose.