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