INSULIN AND GLUCAGON

Hi today we are going to discuss about the relationship between insulin and glucagon.

Metabolism is just the flow of energy throughout the body. Energy enters our body when we eat food, and that food is then absorbed in three different forms. It can be absorbed as amino acids, so, things that make up proteins, so, you'd imagine meat would have a lot of amino acids. Or they can be absorbed as fats, so these are lipids, or fatty acids and so your greasy, fried food is pretty rich in fats. Or they can be absorbed in carbohydrates, or I'll just write "carbs" here, which you have a lot of in ice cream or other sweet things.

Each of these things deliver energy into your GI tract. Your stomach, and your intestines, which can then be absorbed and sent elsewhere for use. Now carbohydrates are one of the main currencies for energy, so let's focus on that, and we'll do so by starting with glucose, which is the most basic form of carbohydrates. In fact, it's considered a simple sugar. Now, there are two main hormones that control the availability of glucose throughout the body. And they're at a constant tug of war with each other. One of them, which you've heard of probably is called "insulin."

Insulin regulates that storage of glucose, as we'll talk more about in a minute, and the other guy on the end of the rope, is a hormone called "glucagon." Glucagon regulates the release of glucose from storage. And it's pretty important that we have enough glucose available in the blood. Because, for example, the brain uses about 120 grams of glucose per day. And that's a lot, because it comes out to be about 60 to 70% of all the glucose that we eat in a day. So you can see why it's really important to have enough glucose available for your essential organs to use. And thankfully, we have these two hormones to help regulate the amount of glucose in our blood. So now let's take a look at how these hormones regulate the amount of glucose in our blood. And let's do that on this graph. So let's say this axis represents time, so over time, we'll see some changes, and this axis over here, the Y axis, will represent the concentration of glucose in our blood. So that's the concentration of glucose. And most commonly, that will be represented in milligrams per deciliter. Milligrams per deciliter. Now, the body likes to keep the amount of glucose in the blood to be no lower than about 70 milligrams per deciliter, and no higher than about 120 milligrams per deciliter. This is sort of the range that I would consider to be the sweet spot. Because if we go any higher than 120, then we end up having a condition that's called "hyper," hyper meaning "a lot of," "glycemia." "Hyperglycemia," which just means "a lot of glucose "in the blood." If we have hyperglycemiafor a long period of time, that can lead to what's referred to as "eye, nerve, and kidney disease." Eye, nerve, and kidney disease. And we can go into a lot more detail about how this happens, but, just understand that having a lot of glucose in your blood can cause changes to these structures to make them not work as well. And unfortunately this is a fairly common problem. Because another term for eye, nerve and kidney disease is "diabetes."

And in fact, if you have a person who's been fasting overnight to come in for a blood test, and you notice that they have more than 126 milligrams per deciliter of glucose on two different occasions, that's grounds for diagnosis of diabetes. On the other hand, if we have very little glucose on our blood, or not enough, that condition is referred to as "hypoglycemia." "Hypo" meaning, "less or low," and then "glycemia" of course meaning "glucose." And some of the things that you can start to notice, if you're hypoglycemic, is that you're tired, maybe you're lethargic, but if this persists, you can even go into a type of coma, or even die from having too little glucose in your blood. And in most people, we start to notice that we're feeling hypoglycemic when we get below 40 milligrams per deciliter. Now usually, our body's pretty good about making sure that the level of glucose in our blood stays within the sweet spot, or within this sweet range. And the way we accomplish this, is through the hormones I just mentioned. So let's imagine that you eat at this point of time right here. And naturally, the levelof glucose in your blood will rise, because you've introduced more glucose into your system by eating it. Eventually, your body will notice that your glucose levels are rising, and will counter that by releasing insulin to drive the amount of glucose in your blood down. And that's an important point, because insulin decreases the blood-glucose concentration by storing the glucose in another form. And we'll get into more detail about that in a second.

The other thing that could happen is that, you may have a decreasing amount of glucose in your blood. Which, as I mentioned here, is not a good thing to have happen either. What your body does to counter that, is release glucagon to increase the amount of glucose in your blood. And so it's important to remember here as well, that glucagon will increase the serum or the blood concentration of glucose by releasing it from storage. So glucagon does the opposite, it releases glucose from storage. So now that we know how the release of glucagon and insulin can affect blood-glucose levels, let's focus in and see how that happens. So let's start with insulin, and that does a number of things to glucose. But remember, that at the end of the day, all we're doing is storing it. Just remember, insulin causes storage. So, the first thing that insulin does to glucose, is cause it to undergo a process known as "glycolysis."  Glycolysis, which you may have heard of before. It's an irreversible process. It's irreversible, alright, irreversible down here. Because it converts glucose into ATP, which is the most basic unit of energy that we use in the body. And that's an important distinction. ATP is energy to be used anywhere in the body. Okay, instead of storing the energy of glucose in ATP, insulin can cause glucose to undergo what's called "glycogenesis." Glycogenesis, which just means" the formation of glycogen." So, glycogen. And glycogen is just a heavily-branched polymer, or molecule that has a whole bunch of glucose molecules stacked on top of it. And this is just energy to be stored in the short-term in mainly the liver, or muscle tissue. So mainly, liver or muscle. And this is a reversible process, because once we make glycogen, we can break it down and release glucose as well. Finally, the last thing insulin can cause glucose to do, is undergo "lipogenesis." Lipogenesis, which I think you can use the suffix to infer here that we are producing lipids, or fatty acids, so lipids or fatty acids, and this is an irreversible process. So this is irreversible, where we store glucose as lipid, and the key here is that we are taking the energy of glucose, and we are storing it long term. Long term, in what's called "adipose tissue." Adipose tissue, or just, the fatty layers within our body. So adipose tissue.

Now what about glucagon? What are the processes it uses to release energy or glucose into the blood stream? Let's put it this way. If we're releasing glucose into the blood stream, my question is, what are we releasing it from? Well, the first thing we can release it from, is glycogen. And we just talked about this. We can form glycogen using insulin. Or, if there's a lot of glucagon around, we can have what's called "glycogenolysis." Which just means "the breaking down "or the cutting down of glycogen." Now, this is a reversible process, cause we can always go and take glucose to make glycogen again. The other thing we can release glucose energy from, is, or rather I should say, are, amino acids. Amino acids can undergo a process known as "gluconeogenesis." So "gluco" meaning "glucose", "neo" meaning "a new," and then "genesis," meaning "to create," or "the creation of." This is also a reversible process that will take amino acids, bunch them together with other things to convert them into glucose. Now finally, the last thing glucagon can do, is to take fatty acid, so fatty acid or your lipid, and instead of converting it to glucose, glucagon will take the fatty acid, and turn it into these things that are called "ketone bodies." Ketone bodies. And it does so through a process known as "keto," short for "ketone," "genesis," meaning "to generate ketone bodies." Now this is an irreversible process. And it's kind of a funky thing that happens within the body, because it's what we do when we're in our starvation mode.

When we're not getting the right amount of nutrients of some reason or another. And the reason why this is sort of a last resort, is because ketone bodies are very unique, in that they are energy, forms of energy to be used only, only by the heart and brain. Ketone bodies don't really supply energy anywhere else. So that's why it's sort of a last minute starvation mechanism to provide energy where it's most critically needed to help us survive. So you can sort of see here that there's a tug of war game that goes on between insulin and glucagon. In fact, insulin itself, when it's released into the blood, will inhibit the release of glucagon. Which just goes to show you how opposite their end goals really are. And there's a lot more to talk about how insulin is released, or how glucagon is released and where it comes from, this is a great overview of what they end up doing in the body.

DIABETES MELLITUS AND INSULIN

Hi, today we will be discussing about the relationship between diabetes mellitus and insulin.

We can break down food into many different types of nutrients. One of the most important nutrients our body needs is a sugar called glucose, which is the fuel that powers the cells of our body. Glucose is transported throughout the body by blood and requires careful regulation, since too much glucose in the blood can lead to disastrous consequences, such as diabetes mellitus. Read this article to learn more about the symptoms, cause, and treatment of this disease.

Let’s talk about blood glucose regulation first. The body has many ways to increase or decrease the amount of glucose in the blood. Some ways to increase blood glucose include eating a meal, synthesizing glucose from scratch, or releasing glucose from storage, while some ways to decrease blood glucose are to transport glucose into cells, which either use up glucose for energy or store it. Throughout the day, the body is constantly making slight adjustments to keep blood glucose levels at an optimal range. These slight adjustments are controlled by the hormones insulin and glucagon, but in this article, we’ll focus on insulin. Insulin is released into the bloodstream when blood glucose is high, such as after a meal. It signals to cells to take in glucose for energy or storage. It also prevents more glucose from being synthesized or released from storage. Therefore, the overall effect of insulin is to decrease blood glucose levels. Diabetes mellitus, or simply diabetes, occurs when this insulin signalling pathway is broken. Without proper functioning of insulin, blood glucose levels skyrocket. Despite glucose being a very important source of fuel for the body, too much of it in the blood is extremely damaging. In the short term, high blood glucose leads to the hallmark symptom of diabetes: glucosuria, or glucose in the urine. In fact, the term “mellitus” means “honey” in Latin to reflect this symptom of sweet-tasting urine. How does this occur?

At the kidneys, glucose is filtered out of the blood and into the urine, but is later transported back into the blood since the body does not want to lose this valuable source of fuel. This reabsorption uses proteins which have a maximum rate of transport. When there is too much glucose in the blood, more of it is filtered into the urine. Even at their maximum transport rate, the proteins cannot transport all of the glucose out of the urine, leading to glucosuria. This causes excess urination, since the presence of glucose in the urine draws in more water by osmosis. Excess thirst and dehydration are a consequence of this since more water is lost through urine. In addition, since cells cannot take up glucose for energy without insulin, the body perceives itself to be “starving”, leading to both increased appetite and fatigue. In the long term, high blood glucose damages blood vessels in the eyes and kidneys, which is why diabetes is the leading cause of adult blindness and kidney failure. High blood glucose also damages nerves, leading to loss of sensation in the feet and hands. When those areas get injured, such as from cuts or from blood vessel damage, the person does not notice the injury, leading to infections and necrosis that eventually require amputation. Most importantly, the damage to blood vessels in the heart and brain can lead to high blood pressure, stroke, and heart attacks, which account for most of the deaths in diabetic patients.

Most diabetes cases can be divided into two types based on how the insulin signalling pathway is malfunctioning. Type 1 diabetes accounts for around 10% of diabetes cases, while Type 2 makes up most of the remainder. The last few percentage points are attributed to rarer forms of diabetes that you can check out in the video description. Type 1 diabetes is caused by a lack of insulin production. In the pancreas, there are special clusters of endocrine cells called the islets of Langerhans. One type of endocrine cell in these islets is the beta cell, which produce and release insulin. In Type 1 diabetes, the beta cells are destroyed by the immune system. Therefore, the body can no longer produce insulin and blood glucose levels rise uncontrollably, leading to the symptoms mentioned earlier. Scientists believe both genetic mutations and environmental factors, such as infections, may play a role in triggering this autoimmune attack. An additional symptom of Type 1 diabetes is rapid weight loss, as fat cells, or adipocytes, begin to break down fats into another type of energy molecule known as ketone bodies. Large amounts of these ketone bodies are released into the blood, which can be taken up by other cells as an alternative source of fuel. However, ketone bodies are slightly acidic molecules, so excessive amounts of these molecules can acidify the blood. This is known as diabetic ketoacidosis, which is a life-threatening condition if untreated. However, when most people think of “diabetes”, they are probably imagining the more common Type 2 diabetes associated with obesity, ahigh sugar and fat diet, and a lack of exercise. These three lifestyle factors, as well as genetic factors, dramatically increase the risk of developing Type 2 diabetes. Unlike Type 1 diabetics, Type 2 diabetics continue to produce insulin. However, their cells have become resistant to insulin, meaning that more insulin is required to achieve the same effect of lowering blood glucose. 

To compensate for insulin’s ineffectiveness, beta cells will produce even more insulin. However, when insulin resistance becomes so severe that the insulin required by the body exceeds the maximum amount of insulin produced by beta cells, symptoms of high blood glucose begin to appear. Weight loss and diabetic ketoacidosis from fat breakdown also occur in some cases of Type 2 diabetes. Furthermore, in some cases the continued overproduction takes a toll on the beta cells, which eventually die and causes a lack of insulin production, further worsening the problem. The cause of insulin resistance is still not well understood; however, factors such as high insulin levels from excessive sugar consumption and fat around the liver and pancreas are being investigated as possible causes of insulin resistance. It is important to note that it is very difficult to “cure” diabetes as of now. Doctors are only able to make living with diabetes tolerable, as long as medications are taken and lifestyle changes occur. Current treatment depends on the type of diabetes. Since the high blood glucose of Type 1 diabetes is caused by a lack of insulin, simply administer insulin during periods of high blood glucose, such as after a meal. However, this is easier said than done. Insulin is a protein and will get degraded in the stomach if taken orally. Therefore, Type 1 diabetics must inject insulin directly into the bloodstream, usually just under the skin of their abdomen. The dose is also extremely important – too little and blood glucose levels remain high, but too much insulin will cause blood glucose levels to plummet, leading to coma or even death. On the other hand, decreasing high blood glucose in Type 2 diabetes is much more complicated. Insulin is only effective in around 30% of patients as cells are already insulin resistant, so other methods of decreasing blood glucose are required. Many diabetic drugs have been developed which target the mechanisms of blood glucose regulation mentioned in the beginning of this video. These drugs can decrease glucose absorption in the intestines after a meal, decrease synthesis of new glucose, or increase insulin sensitivity which leads to more glucose uptake by cells. For example, the drug metformin is the first line treatment to Type 2 diabetes because it can activate certain metabolic pathways to both decrease glucose synthesis and increase glucose uptake by cells by increasing insulin sensitivity. However, despite our best efforts, diabetes is the 6th leading cause of death worldwide, with 3 people dying from diabetes complications every minute. Therefore, the best treatment of diabetes is to prevent diabetes from occurring in the first place. Though no prevention method is known for Type1 diabetes, frequent exercise and a healthy diet drastically reduces the risk of the much more common Type 2 diabetes. Currently, it is estimated that 400 million adults, which is around 10% of the worldwide adult population, is living with diabetes, although this number is expected to increase in the future. If more people become aware of and avoid the lifestyle choices associated with diabetes, we can slow down or even reverse this trend. 

Furthermore, Type 2 diabetes in particular develops slowly and silently over time, leading scientists to suspect that almost half of the worldwide diabetic population is undiagnosed, which is why it is so important to educate the public about the causes and symptoms of this disease. It is also important to note that diabetes is an extremely complex and not fully understood disease that scientists are still finding new information about everyday. So if you want to learn more about diabetes, like new treatments and research, check out the links in the description below.

Thanks for reading.

WHY IS INSULIN SO EXPENSIVE. WHAT YOU CAN DO TO REDUCE IT'S COST!!!

Hi today we are going to discuss “why insulin is so expensive?”

When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. Banting’s co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it. Their drug, which many of the 30 million Americans with diabetes rely on, has become the poster child for pharmaceutical price gouging.

The cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled. 

Insulin is a widely sold drug of which most forms are now off-patent, so why it is incredibly expensive? 

Some of the reasons are:

1. Only 3 Companies Control 90% of the Global Insulin Market

The ‘big three’ insulin producers – Eli Lilly, Novo Nordisk and Sanofi – dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish. In some countries, notably China and India, there are domestic insulin companies that can help drive down the price. This means we need more companies in markets like the USA to help bring prices down.

2. No Generic Insulin

When it comes to the question of generic insulin, we are faced with another complicated issue. Insulin is a therapeutic biological product (or 'biologic'), rather than a chemically synthesized molecule. This means it cannot be made as generic in the same way as other drugs. Creating what is called a biosimilar is a lot more complicated and expensive than just duplicating a chemical molecule. There is little market incentive to produce biosimiliars because it costs nearly as much as making new drug, and companies must go through all the approval stages and trials that a new drug is required to go through. Not to mention, current biosimilar insulins on the market – primarily produced by the ‘big three’ – have only reduced the price by about 10-15%.

3. Pay-for-Delay Schemes & Lawsuits

A ‘Pay for delay’ agreement is a patent dispute settlement in which a generic (in the case of insulin, a biosimilar) manufacturer acknowledges the original patent of a pharmaceutical company and agrees to refrain from marketing its product for a specific period of time. In return, the company receives a payment from the patent-holder. This means it is actually legal for one insulin producer to pay another one not to enter the market. If Pay for delay schemes don’t work, the ‘big three’ can still sue other players, prolonging processes and pushing players out of the market because of legal fees and time-wasting. All of these are win-wins for companies, and lose-lose for patients.

4. Patents

Why aren’t we seeing more companies making insulin? There are many reasons for this, but patent evergreening is a big one. Patents give a person or organization a monopoly on a particular invention for a specific period of time. In the USA, it is generally 20 years. Humalog, Lantus and other previous generation insulins are now off patent, as are even older animal based insulins. So what’s going on? Pharmaceutical companies take advantage of loopholes in the U.S. patent system to build thickets of patents around their drugs which will make them last much longer (evergreening). This prevents competition and can keep prices high for decades. Recently found that Sanofi, the maker of Lantus, is no exception. Sanofi has filed 74 patent applications on Lantus alone, that means Sanofi has created the potential for a competition-free monopoly for 37 years.

5. Politics

Companies are not in the habit of throwing money away, and they are not in the habit of staying out of politics. Eli Lilly, Novo Nordisk, and Sanofi collectively rake in several billions of dollars in profits. That’s not millions, but billions. We know they spend millions on marketing, but they also spend millions on lobbying politicians and donating to our decision-makers so that they keep quiet about price gouging. Chances are, they do. Not to mention, the revolving door between pharma companies and US Government positions. Our current secretary of Health and Human Services was previously an Eli Lilly executive. Obviously, his interests are not with people, but with power. This is why independent patient voices are so important.

6. Pharma Marketing Schemes

Physicians in the United States and some other countries are allowed to collect fees from pharmaceutical companies for talks, advice, and more. Supposedly, these are to compensate physicians for their expertise and time. However, they can create loyalty to a company and may influence prescribing habits – a belief shared by some pharmaceutical salespeople. In some countries like India, physicians are allowed to sell and profit off insulin directly through patients, or through pharmacies they themselves own, cutting out middlemen and the retail pharmacies. Thus, they lose the incentive to find the lowest price insulin for their patients. Insulin companies also focus on ‘insulin-starts’, or the insulin the physician diagnosing patients begins with. As patients are reluctant to change, a number of marketing and financial incentives are employed to influence this decision.

7. Payment for Influence 

Many major key opinion leaders, influencers, and patient advocacy organizations take pharma cash. For example, the two biggest diabetes organizations – The American Diabetes Association and The Juvenile Diabetes Research Foundation – have accepted huge sums from insulin manufacturers. Other groups were actually created by money from the ‘big three’, like the World Diabetes Foundation which is funded by Novo Nordisk, and other supposed advocacy groups that are actually doing pharma’s bidding, or at least are highly influenced by them. If this issue is important to you, check the funders of an organization you want to support, and if it’s not transparent, you can ask if they take industry money.

8. Manufacturing insulin is expensive

Producing insulin is more expensive than producing many other drugs. Insulin is a large complex molecule, and to create it manufacturers use recombinant DNA technology to engineer insulin-producing bacteria. In pharmaceutical terms, insulin’s size and complexity deem it a biologic. Because insulin is a biologic, any “generic” versions (termed biosimilars for biologic drugs) are subject to much more stringent–and expensive–approval processes by the FDA.

Because of the expense of producing insulin, even when biosimilar versions are produced, they only reduce costs for the drug by about 20%, compared to an average of 80% reduction for standard generics.

So what can be done?

How to reduce the expense of insulin

The expense of insulin has led some people to cut down their insulin intake, which can be extremely dangerous. Rather than risking your health, try these strategies to reduce costs.

1.  If you have insurance, make sure your brand of insulin is on the formulary.

For example, while CVS Caremark dropped Lantus, they still cover Basaglar, Levemir, and Tresiba.

2.  Ask your doctor about switching insulins. 

Human insulin is a fraction of the cost of analog insulin, and biosimilar Basaglar provides a modest cost savings.

If left with any doubt or query comment in comment in comment section below.

DIFFERENT TYPES OF INSULIN AND THEIR USES

Today we are going to discuss about the different types of insulin available and what are there functions and uses.

Before discussing about different types of insulin we must know why is insulin important for a diabetic person.

So let’s start:-

Insulin for diabetes

Insulin is a hormone our body makes to keep our blood glucose levels within the normal range. It is made by beta cells in the pancreas. Insulin's main job is to move glucose from our bloodstream into the body's cells to make energy. If you don’t have enough insulin, the glucose builds up in your bloodstream instead of providing energy for your body. 

With type 1 diabetes, the body does not make any insulin and therefore insulin has to be injected regularly every day to stay alive. With type 2 diabetes, the body does not make enough insulin, or the insulin that is made does not work well. Insulin injections are sometimes needed to manage blood glucose levels.

Starting on insulin

People with type 1 diabetes must inject insulin every day, often up to four or five times per day. They may use a pump to deliver insulin which means they insert a new cannula (very fine plastic tube) under the skin every two to three days. Sometimes, people with type 2 diabetes also need to begin using insulin when diet, physical activity and tablets no longer effectively control their blood glucose levels.

Having to start injecting insulin can be frightening. However, injecting insulin is much easier than most people imagine. There are different devices that can be used to make insulin delivery easy. Pen needles are very fine and so are cannulas. Often people needing insulin feel much better once they start having insulin.

If you need to start using insulin, your doctor or diabetes nurse educator can help with education and support. They will teach you about:

·        the type and action of your insulin

·        how, where and when to inject insulin

·        how to rotate injection sites

·        where to get your insulin and how to store it safely

·        how to manage low blood glucose

·        how to keep a record of your blood glucose levels and insulin doses

·        who will help you to adjust insulin doses.

Insulin doses usually don’t stay the same as your starting dose. Your doctor will help you to adjust your insulin. An important part of insulin adjustment is regular blood glucose monitoring and recording. 

It may take some time to safely reach the right dose of insulin for you. And because your insulin needs won’t necessarily remain constant throughout your life, you will need to see your diabetes health care team regularly for review.

When you start using insulin it is important to have a review to understand how carbohydrates and insulin work together.

If you have type 1 diabetes, learning how to count carbohydrates and matching your insulin to the food you eat is the ideal way to manage it. Depending on what you eat, your mealtime insulin doses may therefore vary from meal to meal and day to day.

Types of insulin

Rapid- and short-acting insulin helps reduce blood glucose levels at mealtimes and intermediate or long-acting insulin helps with managing the body’s general needs. Both help manage blood glucose levels.

Insulin is grouped according to how long it works in the body. The five different types of insulin range from rapid- to long-acting. Some types of insulin look clear, while others are cloudy. Check with your pharmacist whether the insulin you are taking should be clear or cloudy.

Before injecting a cloudy insulin, the pen or vial needs to be gently rolled between your hands to make sure the insulin is evenly mixed (until it looks milky). Don't use clear insulin if it appears cloudy.

Often, people need both rapid- and longer-acting insulin. Everyone is different and needs different combinations.

The five types of insulin are:

·        rapid-acting insulin

·        short-acting insulin

·        intermediate-acting insulin

·        mixed insulin

·        long-acting insulin.

Rapid-acting insulin

Rapid-acting insulin starts working somewhere between 2.5 to 20 minutes after injection. Its action is at its greatest between one and three hours after injection and can last up to five hours. This type of insulin acts more quickly after a meal, similar to the body's natural insulin, reducing the risk of a low blood glucose (blood glucose below 4 mmol/L). When you use this type of insulin, you must eat immediately after you inject.

The three rapid-acting insulin types currently available are: 

·        Fiasp and NovoRapid (insulin aspart)

·        Humalog (insulin lispro)

·        Apidra (insulin glulisine).

Fiasp – released in Australia June 2019 – is a new, rapid acting insulin with faster onset of action. It is designed to improve blood glucose levels after a meal.

Short-acting insulin

Short-acting insulin takes longer to start working than the rapid-acting insulins.

Short-acting insulin begins to lower blood glucose levels within 30 minutes, so you need to have your injection 30 minutes before eating. It has its maximum effect two to five hours after injection and lasts for six to eight hours.

Short-acting insulins currently available in Australia are:

·        Actrapid

·        Humulin R.

Intermediate-acting insulin

Intermediate-acting and long-acting insulins are often termed background or basal insulins.

The intermediate-acting insulins are cloudy in nature and need to be mixed well.

These insulins begin to work about 60 to 90 minutes after injection, peak between 4 to 12 hours and last for between 16 to 24 hours.

Intermediate-acting insulins currently available are:

·               Protaphane (a human isophane insulin).

·        Humulin NPH (a human isophane insulin)

Long-acting insulin

The long-acting insulins currently available are:

·        Lantus (glargine insulin) – slow, steady release of insulin with no apparent peak action. One injection can last up to 24 hours. It is usually injected once a day but can be taken twice daily.

·        Toujeo (glargine insulin) – this insulin has a strength of 300 units per ml so is three times the concentration of other insulin in Australia. It is given once a day and lasts for at least 24 hours. It should not be confused with regular Lantus which has a strength of 100 units per ml. Toujeo is given for safety by a disposable pen only. Toujeo gives a slower, steadier glucose profile especially during the night. 

·        Levemir (detemir insulin) –slow, steady release of insulin with no apparent peak action and can last up to18 hours. It is usually injected twice daily. 

Although these insulins are long-acting, they are clear and do not need mixing before injecting.

Mixed insulin

Mixed insulin contains a pre-mixed combination of either very rapid-acting or short-acting insulin, together with intermediate-acting insulin.

The mixed insulins currently available are:

·        rapid-acting and intermediate-acting insulin  

o   Ryzodeg 70:30 (70% long acting Degludec, 30% rapid Aspart)

o   NovoMix 30 (30% rapid, 70% intermediate Protaphane)

o   Humalog Mix 25 (25% rapid, 75% intermediate Humulin NPH)

o   Humalog Mix 50 (50% rapid, 50% intermediate Humulin NPH)

·        short-acting and intermediate-acting insulin  

o   Mixtard 30/70 (30% short, 70% intermediate Protaphane)

o   Mixtard 50/50 (50% short, 50% intermediate Protaphane)

o   Humulin 30/70 (30% short, 70% intermediate Humulin NPH).

I have discussed about different types of insulin and in next article we will be discussing about various devices to inject the insulin. So make sure you follow us for more updates.

In case you have any doubt or query feel free to comment in comment section below.