insulin preparations
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Insulin Preparations
What is insulin?
Is a hormone secreted by the pancreatic beta cells that facilitates the uptake of glucose into skeletal muscle and adipose tissue by increasing the number of glucose transporters ( GLUT 1 and GLUT 4) that facilitate glucose diffusion into these targeted cells.
What is insulin
A protein that contains 51 amino acids When the supply of, or response to, insulin is
adequate, the disease is known as Type 1(IDDM or juvenile-onset) and Type 2 (NIDDM or adult onset) Diabetes respectively.
Insulin Injections
Are divided into 4 major categories namelyRapid actingShort actingIntermediate ActingLong Acting
Rapid Acting Insulin
Insulin Aspart (Novolog) Same with the regular Human insulin except that
proline was replaced by Aspartic acid in position B28
Onset :15 min; duration: 2-4 hours
Rapid Acting Insulin
Insulin Lispro (Humalog) B28 Lys and B29 Proline Human insulin analog
where in the usual B28 Proline and B29 Lysine is reversed
Onset:15 mins;duration:2-4 hours
Rapid Acting Insulin
Insulin glulisine is another insulin analogue, with asparagine
at position B3 replaced by lysine, and lysine at B29 replaced by glutamic acid
Same with other rapid acting insulins
Short Acting Insulins
Regular Insulin (Humulin or Novolin) The only insulin that is approved to be
administered via IV route Comes from Pork(porcine), beef(bovine) or
Human pancreas or genetically engineered using rDNA technology from certain microorganisms(E.coli)
Onset:30-60 min;duration:6 to 8 hours
Intermediate Acting Insulin
Isophane Insulin Suspension or Neutral Protamine Hagedorn (NPH) (Humulin N and Novolin N)
A sterile suspension of Zinc Insulin crystals and Protamine sulfate—a protein from the sperm of a fish (Onchorynchus Fam. Salmonidae)
Onset:1 to 2 hours; duration:10 to 16 hours
Intermediate Acting Insulin
Insulin Zinc Suspension (Lente) A sterile suspension of insulin modified by the
addition of Zinc chloride It has an advantage of fewer allergic reactions
than NPH Onset:1 to 2 hours:duration:10 to 16 hours
Long Acting Insulins
Glargine (Lantus) Differs from Human insulin that asparagine
at position A21 is replaced by GLycine and an additional 30B-a-L-ARGinine-30B-b-L-arginINE
A clear solution that is the only true 24-hour insulin available
Long Acting Insulins
Glargine (Lantus) Onset:2 hours;duration:24 hours
Long Acting Insulins
Extended Insulin Zinc suspension(Ultra Lente)
A sterile suspension of insulin modified by the addition of Zinc chloride
Onset:4 to 8 hours:duration:36 hours
Long Acting Insulins
Insulin detemir is another long-acting insulin analogue that may have some benefit over isophane insulin.
It is a neutral soluble human insulin analogue in which the terminal amino acid at B30 has been replaced by myristic acid, a 14-carbon fatty acid chain.
Duration: up to 24 hours
Insulin Combinations
Pre-mixed Novolin 70/30-contains 70 % NPH and 30 %
Regular Insulin Humulin 50/50-contains 50 % NPH and 50%
Regular insulin
Insulin Combinations
Mixtures of insulin are being prepared prior to administration if the pre-mixed combinations of insulin are not suitable for the patient or not available
A combination of either a rapid or short acting insulin and an intermediate or long acting insulin is being used (except Insulin Glargine which should not be used in combination with any other types of insulin)
Insulin Combinations
Guidelines in mixing insulin prior to administration If not specified in a doctor’s order, use insulin of
same concentration Use proper syringe to measure insulin in units or
mL Do not contaminate the contents of one vial with
the contents of another vial
Insulin Combinations
Always draw the short acting or regular insulin, which is clear, first, then follow it with the intermediate or long acting insulin (cloudy)
Never mix a short acting insulin with a Lente or Ultralente
Never mix a phosphate-buffered insulin(isophane) with a lente or Ultralente
Insulin administration
Almost always being administered via SC route usually in the arm, thigh or abdomen
Administered by using an insulin syringe or a tuberculin syringe
Can also be administered by a portable pen injector, which contains a cartridge that holds the insulin or a continuous subcutaneous Insulin infusion (CSII) device, commonly know as an insulin pump
Portable Pen Injector
Continuous Subcutaneous Insulin Infusion (CSII) Device