Islets of Hope treatment options for persons with diabetes

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human insulin crystals
 Human Insulin Crystals

Article disclaimer

Sources
Wikipedia.com
Humalog.com
Lifeline Clinic


More Information
About Insulin

Insulin Reactions
What is insulin?
What is insulin used for?
Cautions
Side Effects of Insulin
Interactions
The right insulin therapy can reduce the risk of long-term complications
How is insulin manufactured?
Types of Insulin Available
The History of Insulin


Insulin Therapy

Conventional vs. Intensive
    Insulin Therapy

Insulin Delivery Devices


Diabetes Treatment & Management
Diabetes Type 1
Diabetes Type 2 
Pre-Diabetes
Gestational Diabetes
Diabetes Insipidus

Monitoring Your Blood Glucose

Hyperglycemia

Hypoglycemia'

Normoglycemia


Diabetes Medications
Listing by Drug Class
Listing by Name


Conventional Treatments
Pancreas Islet Cell Transplant
Pancreas (Organ) Transplant
Stress Management
Lifestyle Changes


Lantus (glarine) Insulin Unaffected by Exercise

"In people with insulin- dependent type 1 diabetes, exercise does not appear to increase the rate of absorption of insulin glargine (Lantus), a long-acting insulin analog, according to study findings."


type 2 diabetic woman  M. Sarah Rosenthal
The Type 2 Diabetic Woman:  The Type 2 Diabetic Woman is designed to address the unique physical and emotional aspects of this disease for women. Stressing the importance of good self-management, bestselling health writer M. Sara Rosenthal presents information on nutrition, exercise, self-testing, medications, sex, and pregnancy in a warm, supportive manner. The book focuses on how to work with your health-care team, how to make the right lifestyle changes, and how to prevent long-term complications.


type 2 diabetes the first year  Gretchen Becker
Type 2 Diabetes: The First Yea
r:  addresses the questions not always anticipated or answered by healthcare providers. For instance, she covers necessary and optional tests, diet, drugs, weight and stress management, and the emotional strain of the disorder. Her sections on insurance and paying medical bills are excellent. Internet diabetes expert Rick Mendoza has also contributed a chapter on online resources. Other useful features include a glossary, reading list, and further resources. This excellent volume should inspire patients to manage prudently their disease.


diabetes forecast magazine
Diabetes Forecast:  Helps people with diabetes and their families lead normal, healthy lives by providing information and support on all aspects of diabetes treatment, management and self care. Contains profiles of people with diabetes, recipes, diet and exercise articles.   
  IOH Rating 5/5 


diabetes forecast - caring for the diabetic soul   
Diabetes Forecast
Caring for the Diabetic Soul:
 This reassuring new book is a collection of articles from the award-winning Diabetes Forecast magazine. Each chapter offers practical suggestions for dealing with the emotional challenges of daily diabetes care. Whether readers want to discover how to balance the emotional ups and downs or offer support and care for the child with diabetes. Caring for the Diabetic Soul provides insight, guidance, and most of all, peace of mind.

islets of hope diabetes medical library                               main Treatment Options page
Diabetes teatment options
Types of insulin available    
             


Mini Site Index

Action of Commonly Prescribed Insulin (chart)
Content of Insulin
Description of Types of Injected Insulin Available
-- Animal insulin
--
Chemically and enzymatically modified insulins
--
Non-hexameric insulins
--
Aspart insulin
--
Lispro insulin
--
Shifted isoelectric point insulins
--
Glargine insulin
--
Detemir insulin
--
Inhaled Insulin

 

                                     Action of Commonly Prescribed Insulin

Name

Type

Onset(1)

Peak(1)

Duration(1)

Humalog (Lispro)

Rapid

5-15 minutes

30-75 minutes

2-3 hours

Apidra (glulisine)

Rapid

5-15 minutes

30-75 minutes

2-4 hours

Novolog (Aspart)

Rapid

10-20 minutes

1-3 hours

3-5 hours

Regular (R)

Short-Acting

30 minutes

2-5 hours

5-8 hours

NPH (N)

Intermediate

1-3 hours

6-12 hours

16-24 hours

Lente (L)

Intermediate

1-3 hours

6-12 hours

16-24 hours

Ultralente (U)

Long-Acting

3-5 hours

8-14 hours

18 hours

Glargine Lantus

Very Long-Acting

1 hour

Evenly for 24 hours

24-28 hours

NPH & Regular Mixed in either
50/50 mix, or
70/30 mix

Premixed

30-60 minutes

2-12 hours

up to 18 hours

For chart reprint permission contact Editor@isletsofhope.com

Important Note

(1) Insulin reacts differently in individuals and the above chart is intended only as a general guideline based upon insulin manufacturer information.  The peak and duration of insulin is affected by many things including individual response, time of day, exercise, stress, sickness, and content of a meal (high-fat meals can lead to hypoglycemia).

You may be more responsive to insulin at certain times of the day, and less responsive at others.  It is important to keep a log of when your blood glucose readings, food, activity level, and insulin dose and time in order for your doctor to help you determine the best daily care plan for your needs.


Content of Insulin

Rapid (or Very Fast-Acting)

  • Humalog (insulin lispro)
  • Apidra (insulin glulisine)
  • Novolog (aspart)

Fast-Acting (or Short) - Contains soluble insulin (neutral)

Intermediate (or Medium) -  Contains isophane insulin or insulin zinc suspension

  • Humulin L
  • Humulin N
  • Monotard 

Long-Acting - Contains insulin zinc suspension (Crystalline)

  • Humulin U
  • Ultratard 

Very Long-Acting - Contains

  • Glargine Lantus

Mixed long and short acting insulin (biphasic) - Contain a combination of insulin

  • Neutral and Isophane Insulin
  • Humulin 80/20 or 70/30
  • Mixtard 30/70 or 50/50
  • Penmix 10, 20, 30, 40, or 50  


Types of Injected Insulin

Animal insulins

Porcine (pig) insulin has only a single amino acid variation from the human variety; bovine (beef) insulin varies by three amino acids. Both are active on the human receptor and have roughly the same potency when used in humans.  Animal insulins cause more allergic reactions to people than human insulin, but agents added to synthetic insulin may still produce allergic reaction in some people.

Chemically and enzymatically modified insulins

Before human recombinant analogues were available, porcine insulin was chemically converted into the same structure of human insulin. Chemical modifications of amino acid side chains, and the N-terminus and C-terminus to alter the ADME characteristics of the analogue were used. Novo Nordisk was able to enzymatically convert porcine insulin into human insulin by removing the single amino acid that varies from the human variety, and chemically adding the correct one.

Non-hexameric insulins

Unmodified human and porcine insulin tend to form hexamers in contact with zinc in the bloodstream.  Insulin in the form of a hexamer will not bind to its receptors, so the hexamer has to slowly equilibrate back into its monomers to be biologically useful. Hexameric insulin is not readily available for the body when insulin is needed in large does, such as after a meal.  Zinc combinations of insulin are used for slow release of basal insulin. (Basal insulin is the amount the body needs for basic metabolic function). Non-hexameric insulins were developed to be faster acting and replace the injection of normal unmodified insulin that comes after a meal.

Aspart insulin

Novo Nordisk manufactures insulin aspart (marketed as Novolog®; a rapid-acting insulin analogue).  Insulin aspart is manufactured through recombinant DNA technology so that the amino acid, B28, which is normally proline, is substituted with an aspartic acid residue. The sequence is then inserted into yeast genome, and the yeast express the insulin analogue, which is then harvested from a bioreactor. This analogue also prevents the formation of hexamers to create a faster acting insulin.

Lispro insulin

Lilly manufactured the first insulin analogue, lispro, a rapid-acting insulin analogue (sold under the trade name Humalog®). Lispro insulin is engineered through recombinant DNA technology so that the penultimate lysine and proline residues on the C-terminal end of the B-chain are  reversed. This modification does not alter receptor binding, but blocks the formation of insulin dimers and hexamers. This allows larger amounts of active monomeric insulin to be available for postprandial (after meal) injections.

Shifted isoelectric point insulins

Normal, unmodified insulin is soluble at physiological pH. New analogues shift the isoelectric point so that it exists in a solubility equilibrium in which most is precipitated (the insulin separates from the solution) in the bloodstream.  More becomes soluble and the small amount dissolved in the bloodstream is excreted by the kidney. These insulin analogues are used to replace the basal level of insulin, and are effective over a period of 24 hours (i.e. Lantus, also called the "poor man's pump, see "Glargine insulin" below).

Glargine insulin

Aventis developed glargine as a longer lasting insulin analogue, and markets it under the trade name Lantus®. It was created by modifying three amino acids. Two positively charged arginine molecules were added to the C-terminus of the B-chain, and they shift the isoelectric point from a pH of 5.4 to 6.7, making glargine more soluble at a slightly acidic pH and less soluble at a physiological pH. Replacing the acid-sensitive asparagine at position 21 in the A-chain by glycine is needed to avoid deamination and dimerization of the arginine residue.   This simply means that insulin separates from the solution under more ideal circumstances in the body and has a longer acting period.  

These three structural changes and formulation with zinc result in a prolonged action when compared with regular human insulin. When the pH 4.0 solution is injected, most of the material precipitates and is not bioavailable. A small amount is immediately available for use, and the remainder is sequestered in the bloodstream. As the glargine is used, small amounts of the precipitated material will move into solution in the bloodstream, and the basal level of insulin will be maintained over a 24 hour period. The onset of action of subcutaneous (injected under the skin) insulin glargine is slower than NPH human insulin but acts over a longer period of time.

Glargine insulin cannot be mixed with other insulin types and it is often used to treat gestational diabetes.

Detemir insulin

Novo Nordisk created "detemir" and will market it under the trade name Levemir® as a longer lasting insulin analogue for maintaining the basal level of insulin.  It's potency is only about 80% that of other insulins so a person may require a larger dose on detemir.  

Inhaled Insulin

Inhaled insulin is comprised of 20% insulin molecules and 80% unknown molecules (will not reveal the makeup of its compound).  However, it is likely that remaining molecules are some sort of protein that will not trigger an autoimmune response by the body.  Currently, only Regular insulin can be delivered via inhalation and so it is still necessary to inject long-acting insulin.  

The inhaled insulin delivery system provides insulin as a spray or a dry powder inhaled through the mouth directly into the lungs where it passes into the bloodstream. Researchers also are investigating systems for delivering insulin intranasally (as a nose spray). Although serious side effects have not occurred during studies, more research is needed to examine the long-term safety of both inhaled and intranasal insulin treatments, especially for pediatric use.  Inhaled insulin received FDA approval in January of 2006.  

Inhaled insulin works similar to an asthma inhaler (but the delivery device is much bigger).  It is a dry powered form of insulin that passes into the blood stream when inhaled into the lungs.  Because only 8-12% of the insulin can be absorbed this way, you need to take more and that increases the cost (it is currently a very expensive method of delivery that may not be covered by insurance).

If you have asthma, a cold, allergies or other respiratory problems, absorption is uneven making inhaled insulin an undesirable choice of treatment for many, especially for pediatric use where children frequently have colds and may not be able to consistently sense hypoglycemia.

See Diabetes Mall for an informative article on Exubera (inhaled insulin) and other companies working on similar insulin delivery devices.

   

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Page Updated  07/15/2007