Insulins

simplified presentation about different types of insulin done by two pharmacists working in alwahda derna hospital libya

1. INSULIN Collected by Abdul-Jaleel Mustafa Mahmoud el- mabry

2. Insulin Definition : Is a peptide hormone produced by beta cells in the pancreas. it regulate the metabolism of the carbohydrate and fats by promoting the absorption of glucose from the blood to skeletal muscle and fat tissue and by causing fat to be stored rather than used for energy .insulin also inhibit the production of glucose by liver

3. Structure : Insulin consist of two polypeptide chain A & B chains linked by disulfide bonds . A chain consist of 21 Amino acids and B chain consist of 30 amino acids(active form)

4. I nsulin secretion source (b-cell) B- Cell Hormones Description Insulin Proinsulin (insulin+ c-peptide ) and active form (insulin) Amylin -Released with insulin in ratio of 1:100 -Amylin play a role in glycemic regulation by slowing gastric emptying and promoting satiety C-peptide - Secreted in bloodstream in equimolar quantities to insulin - C-peptide helps to prevent neuropathy and other complication deterioration related to diabetes mellitus (delay complication) - C-peptide levels measured to diagnosis diabetes (newly diagnosis)

5. Mechanism of action

6. Receptor type Tissue distribution Glut -1 Is widely distributed in fetal tissues, In the adult most cells (more in RBC &brain) Glut-2 Liver .beta cells .hypothalamus .retina .kidney .intestine. Glut-3 Brain . placenta Glut-4 Heart ,muscle ,fat Glut-5 Intestine ,kidney, testis ,RBC

7. INSULIN THERAPY Type of insulin A- Insulin short acting 1-INSULIN RAPID Active constituent GLULISINE (ultra short) LISPRO ASPART Onset time 10min to 20min 15min to 30min 15min to 30min Peak time 30-90min 30-90min 30-90min Duration 3-5 hours 3-5 hours 3-5 hours Trade name APIDRA(SANOFI) HUMALOG ( lilly ) NOVORAPID PEN NOVOLOG BOTT (Novonordisck ) Notes Can be mixed(NPH) Given (s/c , IV) Can be mixed(NPL,NPH) Given (s/c , IV) Can be mixed(NPH,NPA) Given (s/c ,Infusion pump )

8. Active constituent REGULAR ( rDNA ) E.COLI Onset time 30 min to 1 hour Peak time 2 hours to 5 hours duration 6 hours to 12 hours Trade name HUMALIN R (LILLY) ACTRAPID NOVOLIN R Notes Can be mixed Given (s/ c,IV ) 2-INSULIN REGULAR

9. B-INSULIIN INTERMEDIATE ACTING Active constituent NPH:NEUTRAL PROTAMINE HAGEDORN NPL: NEUTRAL PROTAMINE LISPRO NPA: NEUTRAL PROTAMINE ASPART Onset time 3 HRS TO 8 HRS Peak time 8 – 10 HRS Duration 12-16 HRS Trade name HUMILIN N (LIILY) INSULRETARD (NOVO) Notes - Given only S/C - Can be mixed (NPH) - Cloudy milky color

10. C -LONG ACTING INSULIN Active constituent DETEMIR GLARGINE (ultra long) DEGLUDEC (ultra long basal) Onset time 3-8HRS 1-2 HRS 1-2 HRS Peak time PEAKLESS PEAKLESS PEAKLESS Duration 16-18HRS 24+ 42+ Trade name LEVEMIR PEN (novo nordisck) LANTUS PEN (SANOFI) TRESIBA (novo nordisck) Note - Can not be mixed - Given only s/c - Can not be mixed - Given only s/c - Can not be mixed - Given only s/c

11. Onset and duration of action of human insulin and insulin analogs. NPH

12. How to Switch Between Insulin Products Insulin detemir ( Levemir ) to NPH • Convert unit-per-unit . • NPH at bedtime (for type 2 patients when combined with oral anti diabetes meds). OR • NPH twice daily (e.g., 50:50 or 2/3 in AM and 1/3 before dinner or at bedtime). Insulin glargine ( Lantus ) to NPH • Convert unit-per-unit. • NPH at bedtime (for type 2 patients when combined with oral anti diabetes meds). OR • NPH twice daily (e.g., 50:50 or 2/3 in AM and 1/3 before dinner or at bedtime).

13. Regular human insulin ( Humulin R , Novolin R ) to rapid-acting insulin analog (insulin aspart [ Novolog ], insulin glulisine [ Apidra ], insulin lispro [ Humalog ]) • Convert unit-per-unit. • Rapid-acting insulin analogs have a faster onset of action and a shorter duration of action than human regular insulin. Give rapid acting insulin analogs about 10 minutes before meals or with meals.

14. Mixing insulin in one syringe

15. Reference Oxford handbook clinical pharmacy Lippincott pharmacology Atlas-1 drug https:// www.medicines.org.uk http:// www.humulin.com http:// www.novonordisk.com