Endocrinology Book

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InsulinAka: Regular Insulin, Humulin, Novolog, Humalog, Aspart, Apidra, Glulisine, NPH Insulin, Lispro, Lente, Ultralente, Novolin

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  1. See Also
    1. Insulin Dosing
    2. Insulin Simulation
    3. Glucose Metabolism
  2. Insulin Selection
    1. New insulin anologues are preferred
      1. More consistent absorption than traditional insulin
      2. Bolus analogues have more rapid onset
      3. Basal agents release at more constant rate
      4. Only disadvantage is anologues double price
    2. Combination agents are discouraged unless noncompliant
      1. Reduces flexibility in meal and activity timing
  3. Agents: Bolus Insulins (Meal-time Insulin)
    1. Traditional Insulins
      1. Regular Insulin (Novolin R, Humulin R)
        1. Onset: 15 to 30 minutes
        2. Peak: 2.5 to 5 hours
        3. Duration: 6 to 8 hours
    2. Analogue Insulins (Rapid, consistent absorption)
      1. Glulisine (Apidra)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
        4. Similar to other bolus analogues
        5. FDA approved to take after meal
          1. Other analogues expected with same effect
      2. Lispro (Humalog)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
      3. Aspart (Novolog)
        1. Onset: 5 to 15 minutes
        2. Peak: 1 to 2 hours
        3. Duration: 3 to 5 hours
  4. Agents: Basal Insulins
    1. Traditional Insulins
      1. NPH Insulin, Novolin N, Humulin N, Humulin L (Lente)
        1. Onset: 1 to 2 hours
        2. Peak: 6 to 8 hours
          1. Peak time is higher risk of hypoglcemia
          2. Consider snack at 6 hours after dose
        3. Duration: 10 to 16 hours (Lente slightly longer)
        4. Humulin L (Lente) discontinued in U.S. in 2006
      2. Ultralente Insulin (extended insulin zinc suspension)
        1. Discontinued in U.S. in 2006
        2. Significant inconsistent effect even in same person
        3. Onset: 6-10 hours
        4. Peak: No peak
        5. Duration: 18 to 24 hours
    2. Analogue Insulins
      1. Detemir (Levemir)
        1. Onset: 1 to 2 hours
        2. Peak: No peak (flat action curve)
        3. Duration: 12 to 20 hours (varies by dosage)
      2. Glargine (Lantus)
        1. Onset: 1 hour
        2. Duration: 21 to 24 hours
        3. Peak: No peak (flat action curve mimics continuous Insulin Infusion)
  5. Combination Agents (Type II Diabetes if poor compliance)
    1. NPH 50/Regular 50
    2. NPH 70/Regular 30 (Humulin 70/30 or Novolin 70/30)
    3. NPL 75/Lispro 25 (Humalog Mix 75/25)
    4. NPH 70/Aspart 30 (Novolog Mix 70/30)
  6. Adverse Effects
    1. Hypoglycemia
      1. Increased risk when Hemoglobin A1C <7.4%
      2. Decreased risk with analogue insulins
    2. Weight gain (Excess of 4 kg over 10 years)
      1. Countered with Metformin in type 2 diabetics
      2. Countered with diet and Exercise
      3. Benefits of glucose control outweigh weight risks
    3. Lipohypertrophy
      1. Localized fat hypertrophy when sites not rotated
      2. Prevent by rotating injection sites (see below)
      3. Medical providers should examine injection sites
    4. Variable insulin absorption
      1. Insulin absorption varies by body site
        1. Abdomen (best absorption)
        2. Arms
        3. Thigh
        4. Buttocks (least absorption)
      2. Site rotation (prevents lipohypertrophy - see above)
        1. Rotate injections within same body region
          1. Avoids insulin absorption variability
        2. Rotate to widely different sites within region
          1. Example: Abdomen rotate to LUQ, RUQ, LLQ, RLQ
  7. References
    1. Lepore (2000) Diabetes 49:2142
    2. Mayfield (2004) Am Fam Physician 70(3):489

Humulin (C0020171)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSHD007328
EnglishHumulin, Humulin insulin
Parent ConceptsReason not stated concept (C1276325)
SourcesMSH, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Insulin (C0021641)

Definition (MSH)A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1).
Definition (CSP)protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose and is also an important regulator of protein and lipid metabolism; insulin is used as a drug to control insulin-dependent diabetes mellitus.
Definition (NCI)Human insulin protein (110 aa, 12 kDa) is encoded by the human insulin (INS) gene. This cytosolic protein, a heterodimer of disulfide-linked alpha and beta chains, is produced in pancreatic islet beta cells. Binding of insulin to its receptor stimulates glucose uptake, accelerates both glycolysis and the pentose phosphate cycle and increases glycogen synthesis in the liver. Insulin regulates protein and lipid metabolism. It also decreases blood glucose concentration by shuttling molecules into cells to be used for energy. Decreased expression of insulin protein causes familial hyperproinsulinemia.
Definition (NCI)A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04)
ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSHD007328
EnglishInsulin, Insulin preparation, Insulin product, Insulin regular, Regular insulin, Regular insulin preparation, Regular insulin product, Unmodified insulin preparation, Unmodified insulin product
Spanishinsulina, insulina regular, preparado de insulina, preparado de insulina cristalina de cinc, preparado de insulina cristalina de zinc, preparado de insulina no modificada, preparado insulinico, producto con insulina
Parent ConceptsPolypeptide Hormones (C0312439), Pancreatic Hormones (C0030292), Proinsulin (C0033362), peptide hormone (C0597192), Recombinant Insulin (C1533581), Insulin (C0021641), [HS500] BLOOD GLUCOSE REGULATION AGENTS (C0973565), Unclassified Ingredients (C1372954), Short-acting insulin (C0356365), Antidiabetics (C0935929), Drug allergen by structure (C1532645)
SourcesAOD, CSP, LCH, LNC, MSH, MTH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Novolin (C0028467)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSHD007328
EnglishNovolin
SourcesMSH
Derived from the NIH UMLS (Unified Medical Language System)


Insulin Lispro (C0293359)

Definition (NCI)A recombinant therapeutic agent which is chemically identical to or similar to endogenous human insulin. In lispro insulin, the amino acid proline at B-28 and the amino acid lysine at B-29 are reversed, resulting in the rapid dissolution of this insulin to a monomer that is absorbed rapidly after subcutaneous administration. Lispro insulin is equipotent to human insulin on a molar basis but its effects are faster and of shorter duration. Endogenous insulin, a pancreatic hormone composed of two polypeptide chains, is important in the normal metabolism of carbohydrates, proteins and fats, promoting glucose utilization and protein synthesis; it has anabolic effects on many types of tissues. (NCI04)
ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSHC091593
EnglishB28-Lys-B29-Pro-insulin, insulin LISPRO, INSULIN LISPRO RECOMBINANT, lispro, Lispro insulin, LYSPRO
Spanishinsulina lispro
Parent ConceptsRecombinant Insulin (C1533581), Insulin (C0021641), Unclassified Ingredients (C1372954), Short-acting insulin (C0356365), Regular Insulin, Human (C0795635), Human insulin analog product (C1305435), Insulin, Rapid-Acting (C0304868)
SourcesMSH, MTH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Humalog (C0528249)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSHC091593
EnglishHumalog
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


NovoLog (C0939412)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSHC071125
EnglishNovoLog
SourcesMSH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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