Understanding Different Types of Insulin ALAA KHOJAH

• Diabetes is affecting millions of ppl yearly, it might be a familiar disease,, but have u ever imagined how diabetic ppl struggle having it from regularly checking blood sugar to injecting insulin.

• And although it’s a familiar disease which we always hear about I realized that I still have missing points in it.

• And I’ve notice that when me and my friends saw one of our friends injecting her self with insulin and this caused a lot of questions in my friends’ minds and all the Qz were directed to the pharmacist which was ME :p

• today we hope to clarify the different types of insulins available in our pharmacy

Struggle

Outline

• Insulin• Site of injection• Types of insulin• Insulin interactions• Adverse reactions of insulin

Insulin

• Peptide pancreatic hormone secreted by the beta cells of the islets of Langerhans that is essential especially for the metabolism of carbohydrates and the regulation of glucose levels in the blood.

Insuline Indications • All patients with type 1 diabetes• Type 2 diabetes .1- During pregnancy.2- High dose of glucocorticoid therapy .3- perioperative/intensive care setting .4- Acute infections or other serious illnesses.5- post myocardial infarction.6- Ketoacidosis or severe hyperglycemia (blood sugars over 500).7- failure to achieve ideal glycemic control with two or three agent .

8- inability to tolerate or contraindication to oral antiglycemic agent .

Characteristics of Insulin

Insulin may categorized by differences in:• Onset (how quickly they act).• Peak (how long it takes to achieve maximum

impact).• Duration (how long they last before they wear

off).• Concentration.• Rout of administration.

Types of Insuline

There are three main groups of insulin: • Rapid-acting.• Short -acting • Intermediate-acting .• Long-acting.

Rapid Acting Insulin

Rapid acting insulin

Rapid-acting insulin is often called mealtime insulin because its action curve most closely resembles the body’s normal release of insulin at mealtimes. They act very quickly to minimize the rise in blood sugar which follows each meal.

Includes:(Insulin Aspart, insulin Lyspro, Insulin Glulisine) which have an onset of action of 5 to 15 minutes, peak effect in 1 to 2 hours and duration of action that lasts 4-6 hours. NOTE :With all doses, large and small, the onset of action and the time to peak effect is similar, The duration of insulin action is, however, affected by the dose ,few units may last 4 hours or less, while 25 or 30 units may last 5 to 6 hours.

Rapid acting insulin

Insulin Aspart • Brand Name : NovoRapid FlexPen®• Formulation :solution for injection 100 U/ml .• Rout of Administration : SC

Rapid acting insulin

Insulin Lispro• Brand name: Humalog®• Formulation:10 ml vial (100 U/ml) solution. • Rout of administration :SC

Short Acting Insulin

• It may also called (regular or neutral insulin).• Usually taken before meals.• Not as quick to act as rapid acting insulins and therefore may be

more appropriate in certain people.Includes :(Actrapid ,humiline S , Velosulin , Hypurin neutral) .It gives an immediate (15 to 30 minutes) onset of action that reaches a peak of action in 2 to 4 hours. The duration of action is 6 to 8 hours.NOTEThe larger the dose of regular the faster the onset of action, but the longer the time to peak effect and the longer the duration of the effect.

Short acting insulin

• Brand Name : Actrapid®• Formulation : 100 IU/ml 10 ml solution for

injection .• Rout of administration : SC, i.m, i.v.

Basal (Background) Insulin

Some types of insulin work continuously, up to 24 hours, which is similar to how a normal pancreas produces insulin.

Continuously acting insulin is called background or basal insulin. Basal insulin is slowly absorbed and is long lasting, which means active from 10 to 24 hours..

Long Acting Insulin

Long-acting insulin:• Is absorbed slowly, has a minimal peak effect,

and a stable plateau effect that lasts most of the day.

• Is used to control the blood sugar overnight, while fasting and between meals

1. Insulin Glargine

• (LANTUS)• Clear• Given SC only

2. Insulin Detemer

• (LANTUS)• Clear• Given SC only

The insulin effect plateaus over the next few hours and is followed by a relatively flat duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin glargine.

Intermediate acting insulin• Is absorbed more slowly, and lasts longer• Is used to control the blood sugar overnight,

while fasting and between meals• This type of insulin is often combined with

rapid- or short-acting insulin.

NPH

• (INSULATARD)• Turbid (cloudy appearance)• Given SC only

NPH has an onset of insulin effect of 1 to 2 hours, a peak effect of 4 to 6 hours, and duration of action of more than 12 hours.

Very small doses will have an earlier peak effect and shorter duration of action, while higher doses will have a longer time to peak effect and prolonged duration.

Pre-Mixed Insulin

1. Pre-mixed insulin which is NPH (long acting)pre-mixed with regular insulin (short acting) (MIXTARD) (ACTRAPHANE)

The two insulin types will normally be combined in the same syringe. NPH and fast-acting insulin bind when mixed, so they should not be combined until it is time to inject.

(Actraphane)(Mixtard)• Cloudy • Given SC only.• Contains 70/30:

70 percent NPH insulin and 30 percent regular insulin

2. insulin Aspart (rapid acting) + crystalized protamine (intermediate acting)(NOVOMIX)

Graph illustrating the time action curves of different insulins

Where to inject insulin

Adverse reactions to insuline

• Mainly: Lipodystrophy at the site of injection• Hypoglycemia .• Somogyi effect (hypoglycemia followed by

rebound hyperglycemia).• Hypersensitivity reaction .• Insulin resistance.

Changes at the injection site??

Lipodystrophy• When too often injecting at the same site,

fatty tissue under the skin at this site may shrink (lipoatrophy) or thicken (lipohypertrophy).

• Changing the site with each injection may help to prevent such skin changes

• Injection at this site might affect the absorption of insulin.

Adverse effects of injection

• Pain can be overcome by rubbing the area before injecting and ???

• Lipodystrophy change injection site• Bleeding compressing the area

Drug Interaction • Anabolic steroids ,salicylates , alcohol

and MOIs inhibitor may increase the hypoglycemic effect of insulin.

• Corticosteroid ,sympathomimetic drug, thiazide diuretic and dextrothyroxine sodium may reduce the effect of insulin.

• B-adrenergic blocker may prolong the hypoglycemic effect of insulin and may mask signs and symptoms of hypoglycemia.

References

• http://www.diabetes.co.uk/insulin/rapid-acting-insulin.html

• http://www.medicinenet.com/insulin/article.htm• http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/

insert_C.aspx• http://www.ghc.org/healthAndWellness/?item=/

common/healthAndWellness/conditions/diabetes/insulinTypes.html

• http://www.diabetesvic.org.au/type-2-diabetes/medication-and-insulin/types-of-insulin

THANK YOU