1. important points:
1.1. There are only injected forms of insulin (IV/SC) bcoz insulin is broken down in stomach if taken orally (bcoz it's polypeptide)
1.2. 1&2 are universal types (used in both type I & II diabetes)
1.3. 1&2 are the only types used IV in emergency (due to their fast duration of action)
1.4. 3&4 should ONLY used in Type 1 diabetes.
2. Long acting insulin
2.1. Glargine & Detemir
2.1.1. Slow onset & long duration
2.2. Clear solution
2.2.1. BUT forms percipitate at injection site.
2.3. Slow onset of action 2 h
2.4. Given S.C
2.5. Maxinum effect after 4 - 5 h
2.6. Produce broad plasma concentration plateau (low continuous insulin level)
2.6.1. => reduced risk of hypoglycemia !!
2.7. prolonged duration of action (24 h)
2.8. Once daily
2.9. Should not be mixed with other insulin
3. Intermediate acting insulins
3.1. isophane (NPH)
3.1.1. Turbid suspension at natural pH
3.1.1.1. bcoz it's turbid we don't give it IV (only S.C)
3.1.2. Given S.C only
3.1.3. Onset of action 1-2 h
3.1.4. Peak seum level 5 - 7 h
3.1.5. Duration of action 13 - 18 h
3.1.6. Not used in emergency (DKA)
3.1.7. used as mixture with short or ultra-short
3.1.7.1. to avoid frequent injections in pt. who has post-prandial hyper-glycemia so he need short or ultra-short + he also need intermeidate or long acting for controling the blood glucose throughout the day.
3.2. Lente insulin
3.2.1. Turbid suspension at neutral pH
3.2.2. Given S.C
3.2.3. Onset of action (1 - 3 h)
3.2.4. Peak serum level 4 - 8 h
3.2.5. Duration of action 13 - 20 h
3.2.6. Lente and NPH insulin are equivalent in activity.
3.2.7. But Lentile canNOT be mixed with other fast acting insulin
3.2.8. Not used in emergency (DKA)
3.2.9. New Node
3.3. Slow onset & intermediate duration
4. Ultra-Short acting insulins
4.1. Lispro, Aspart & Glulisine
4.1.1. Very Fast onset & short duration
4.2. Features:
4.2.1. Clear solutions at neutral pH
4.2.1.1. So we can give it IV
4.2.2. Mono-meric analogue
4.2.2.1. so when we inject it Subcetanosuly it absorbed rapidly into the blood & its biologically active "ready to bind to receptors"
4.2.3. Fast onset of action (0 -15 min)
4.2.3.1. so pt. inject it and start to eat immediately
4.2.4. Short duration of action (3 - 5 hours)
4.2.4.1. which is good bcoz we don't need the insulin to act for long time, bcoz if it act for long time there's a risk of hypoglycemia !!
4.2.5. Rout: S.C (5 to 15 min before meal)
4.2.6. Peak 30-90 min after injection
4.2.7. 2 to 3 times/day
4.2.7.1. depedning on the number of meals
4.3. Uses:
4.3.1. Control post-prandial hyper-glycemia (s.c)
4.3.2. Emergency diabetic ketoacidosis (i.v)
5. Short acting insulins (regular insulin)
5.1. Regular insulin & Humulin R (Human insulin Recombinant DNA)
5.1.1. Fast onset & short duration
5.2. Features:
5.2.1. Clear solutions at neutral pH
5.2.2. Hexameric anaglogue
5.2.2.1. So when we give it S.C It takes time to be converted into monomeric , so that it get absorbed into blood and bind to receptors.
5.2.3. Onset of action 30-45 min (s.c)
5.2.3.1. So pt. need to inject it 30 to 45 min before eating !!
5.2.4. Peak 2 - 4 hours
5.2.5. Duration 6 - 8 hours
5.2.5.1. this long diration is disadvantage, bcoz the insulin will stay in the blood for long time & the glucose already has been uptaken by the cells => there's risk of hypoglycemia !!
5.3. Uses:
5.3.1. Control post-prandial hyper-glycemia (s.c)
5.3.2. Emergency DKA (i.v)
5.3.3. Pregnancy
5.3.3.1. in pregnancy we could use both short or ultra-short, bcoz they are Recombinant DNA, so does not cause teratogencity to the fetus.
5.3.3.2. pregnant diabetic women taking oral hypoglycemic drug should switch to insulin,
5.3.3.2.1. Regular insulin is the best drug for pregnant woment !