Insulin

Some of the insulin preparations in common use are listed in Table 35.7. The best control is achieved by twice-daily injections of short- and intermediate-acting insulin. Increasingly, younger diabetics are managed with a background once-daily ultra-long-acting preparation coupled with a pen injector delivering small doses of short-acting insulin. The type of preparation must be noted, and if a change is made in the type of insulin (bovine, porcine, human) the dose must be adjusted, because increased sensitivity to the latter two may lead to hypoglycaemia. Insulin with the human sequence of amino acids is produced biosynthetically (chain recombinant DNA technology using bacteria, CRB) or semisyn-

Tabk 35.7 Newer insulin preparations

Proprietary name

"IVpe and source

Onset <h>

Peak action 00

Duration of action (h)

Dosage

Humulin S

Short-acting, soluble, CRB

0.5

1-3

5-7 *

Human Velosulin

Short-acting, soluble, EMP

«.5

1-3

8 }

l.i.d. alone or b.d. +■ intermediate preparation

Actrapid MC

Short acting, soluble, porcine

0.5

2-5

8 J

Humulin 1

Intermediate, isophane, CRB

1.0

2-8

18-20

b.d. + short-acting preparation

Insulatard

Intermediate, isophane, porcine

1.5

4-12

24

b.d. + short-acting preparation

Semitard

Insulin zinc suspension amorphous semi-lenie, porcine

1.5

5-10

b.d. + short-acting preparation

Humulin M2

Mixed 20% soluble, 80% isophane, CRB

0.5

1-8

14-16

b.d.

Mixtard 30/70

Mixed 30% soluble, 70% isophane, porcine

0.5

4-8

24

b.d.

Monotard MC

Long-acting, insulin zinc suspension, 30% amorphous, 70% crystalline, lente, porcine

2.5

7-15

22

daily or b.d.

Humulin Zn

Long-acting, insulin zinc suspension, crystalline CRB

3.0

6-14

20-24

daily or b.d.

CRR, chain recombinant DNA technology using bacteria; EMP, enzyme modification of porcine material.

CRR, chain recombinant DNA technology using bacteria; EMP, enzyme modification of porcine material.

thetically (by enzyme modification of porcine material, EMP) from purified porcine insulin. The biosynthetic preparations are less expensive than purified porcine preparations and may become the principal commercial preparations. Insulin with the human sequence is associated with a less severe degree of antigenicity and is thus the preparation of choice for newly diagnosed diabetics and for patients requiring short-term therapy (e.g. in the perioperative period).

In well-controlled diabetics, it is not necessary to change to a short-acting insulin regimen on the day before surgery, provided that the dose of the intermediate- or long-acting insulin is not excessive (40 units of long-acting or 24-unit evening dose of intermediate insulin); all too often a change of regimen results in poorer control.

The poorly controlled diabetic

Whether the patient is normally insulin-dependent or not, elective surgery should be delayed until improved control is achieved by administration of short-acting insulin three times daily. If surgery is urgent, a glucose, insulin and potassium regimen (Table 35.8) should be instituted to achieve rapid blood glucose control.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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