NEWS UPDATES-INSULIN OVERVIEW FOR PHARMACIST

INSULIN OVERVIEW

This is an article based on the latest news updates in the magazine on Tuesday dated 26/07/2016.

When a patient started his first dose of Insulin injection that is the starting point.

At first insulin doses must be based on titrating basal dosing (Insulin dosing to keep glucose level under control at fasting or sleep) and mealtime dosing. This course is followed by adjusting the dosage in due course over time according to the patient's weight gain or loss, changes in eating time, and the addition of other medication. Hence in overtime insulin doses must be adjusted according to the new requirements.

Insulin is active and distributed well if injected subcutaneously. The subcutaneous area is just below the skin and above the cutaneous(muscle).

The types of insulin are classified as per the duration of time it acts such as short-acting(Regular and semi lente)insulins duration is 4 to 8 hours, Intermediate-acting(Lente) and long-acting more than 12 hours (Ultra Lente).

Regular insulins are clear solutions whereas lente insulins are zinc-insulin combined suspensions and are cloudy in appearance. They cannot be given intravenously.

The possible common sites of Insulin Injection are the stomach, buttocks, thighs, and upper arms. The sites should be frequently rotated in order to avoid skin necrosis and lipodystrophy at the sites of injection. Lipodystrophy is common at the frequent continuous injection at a particular site without rotation which is featured by an edematous increase in the size of skin fat cells.

Types of basal insulin that can be used at fasting or sleep are Intermediate-acting insulins (NPH, Humulin-N, and Novolin-N) and long-acting insulins such as glargine(Lantus) and Levemir.

Methods of Use

1.Intermediate Acting:-

Taken once daily at bedtime

The peak occurs after 4 hours at Pre-Dawn

Acting up to 18 hours

2.Long-Acting:-

Acting on 24 hours.

Lowers glucose levels evenly

In order to control the rapid jump of glucose after meals, a bolus injection of short-acting or rapid-acting insulin must be given as follows:-

1.Glustin, Lispro, and Aspart (Rapid Acting):-

To be taken at mealtime

The peak at one hour

The effect lasts for 4 hours

2.Humulin-R, Novolin-R, and Insulin Pump velsolin (Short Acting):-

Start to work in 30 minutes

Peak attain in 3 hours

Effect for up to 6 hours.

Premixed insulins contain a mixture of intermediate and short-acting insulin in one bottle or pen as follows:-

1.Humulin 70/30

2.Novolog 70/30

3.Humulin 50/50

4.Humalog mix 75/25

Should be taken 2 to 3 times before meals.

In U.S insulin is usually available as 100 units per ml. A 10 ml vial contains 1000 units/vial.

Insulin syringes are available as 1/3 ml which can hold 30 units;1/2 half ml which can hold 50 units and 1 ml syringe which can hold 100 units.

In recent days there is a preparation that contains >100U are available in the market to those who need higher requirements of insulin such as Toujeo {Insulin glargine(rDNA origin} a once-daily long-acting basal insulin contains 300 U /ml.

For patients with high insulin receptor resistance, a super-concentrated U 500 is also available in the market.

Varieties of Delivery Systems

1.needle / Syringes

2.Needled Pens(Reusables and Disposables)

3.Insulin Pump

4.Needle-free jet Injectors (The instrument using high pressure to push a fine spray of insulin through the skin)

3.Insulin Inhaler