Insulin preparations

1. Insulin Preparations

2. 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.

3. 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.

4. Insulin Injections Are divided into 4 major categories namely Rapid acting Short acting Intermediate Acting Long Acting

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Long Acting Insulins Glargine (Lantus) Differs from Human insulin that asparagine at position A21 is replaced by GL ycine and an additional 30 B -a-L- ARG inine-30 B -b-L-argin INE A clear solution that is the only true 24-hour insulin available

12. Long Acting Insulins Glargine (Lantus) Onset:2 hours;duration:24 hours

13. 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

14. 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

15. Insulin Combinations Pre-mixed Novolin 70/30-contains 70 % NPH and 30 % Regular Insulin Humulin 50/50-contains 50 % NPH and 50% Regular insulin

16. 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)

17. 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

18. 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

19. 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

20. Portable Pen Injector

21. Continuous Subcutaneous Insulin Infusion (CSII) Device