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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Insulins may be grouped as short-acting, rapid-acting, intermediate-acting, long-acting insulin analogues or mixtures of these. Short-acting (soluble) insulins are absorbed more slowly than expected as the insulin molecules form relatively stable hexamers.Rapid-acting insulin analogues have a faster onset of action because their altered amino acid sequences reduce hexamer formation.Intermediate-acting insulins have a slower absorption into the bloodstream due to the addition of a protein and/or zinc; the protein protamine is commonly used.Long-acting (basal) insulin analogues have a prolonged duration of action due to factors that further slow the absorption from the injection site.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
A vast array of mixed insulin preparations are available which are designed to allow the single injection of a mixture of short- and intermediate-acting insulin preparations. The proportion of short-acting insulin varies from 10 to 50% and should be selected according to individual requirements. Fixed mixtures are simple to use and are commonly administered via a pen device, where the appropriate dose is selected and then injected subcutaneously, using a short needle. The disadvantage of fixed mixtures is that they are less flexible. The proportion of short- and long-acting insulin cannot be varied according to day-to-day variations in routine; most commonly diet and exercise. An alternative is to draw up the intermediate-and short-acting components separately into a syringe, a technique known as free-mixing, which offers more day-to-day flexibility but is more time consuming, requires more thought by the family and cannot be administered via a pen.
Nursing care of the cardiac catheterisation patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Julie Parkinson, Jo-Anne M. Vidal, Eva Kline-Rogers
Insulin-treated patients on a morning list: Patients scheduled first on a morning list may be able to delay their insulin and breakfast until after their procedure, provided the procedure is short and they are capable of eating by 10:00 am.Patients scheduled for later procedures (morning list) may have a half-dose in the form of intermediate or long-acting insulin, although short-acting insulin should be avoided. Following procedures, a half dose of short-acting insulin can be administered prior to lunch.Patients should resume their usual insulin and diet in the evening.
Synthetic long-acting insulin analogs for the management of type 1 diabetes: an update
Published in Expert Opinion on Pharmacotherapy, 2021
Ulrik Pedersen-Bjergaard, Therese W. Fabricius, Birger Thorsteinsson
To improve basal insulin replacement therapy in type 1 diabetes beyond the current long-acting insulin analogues, several approaches may be relevant. Firstly, basal insulin can be administered as rapid-acting insulin in an insulin pump. This provides the opportunity to apply hybrid closed-loop technology, which can administer basal insulin based on CGM feedback, a step toward the artificial pancreas [76,77]. Alternatively, ultra-long-acting insulin analogues as the novel once-weekly insulin icodec may provide even flatter and more predictable action profiles, which may benefit at least some patients [74]. A more liver-specific insulin would potentially further restore metabolism by reducing peripheral hyperinsulinemia, which may also reduce the risk of hypoglycemia. In fact, insulin LY2605541, a pegylated insulin lispro showed increased liver specificity [78] and superior glucose lowering efficiency compared to glargine U100 together with a reduced risk of hypoglycemia [79]. The development program has, however, been stopped due to concerns about unwanted effects on the liver and lipid metabolism. The ultimate solution for a long-acting insulin is a glucose-sensitive insulin, which may provide efficient glucose control without promoting hypoglycemia [80].
Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care
Published in Annals of Medicine, 2021
Roopa Mehta, Ronald Goldenberg, Daniel Katselnik, Louis Kuritzky
Advice regarding missed or double doses depends on the pharmacologic characteristics of each basal insulin product (Table 1) [20,25–29]. In general, if the patient thinks they have missed a dose, they should test their FPG and contact their care team. Again, the flexibility and stable glucose-lowering action of long-acting insulin analogs help in this regard. For insulin degludec, for example, patients who realize they have missed a dose can inject it during waking hours the same day, as long as they ensure at least 8 h between consecutive injections [27]. If a double dose is taken, we suggest that patients should test their blood sugar frequently during the day, eat a snack and, in the night, wake up every 2–3 h to test glucose (with an extra snack if the reading is <126 mg/dL).
Clinical characteristics and patient treatment satisfaction with Humalog U-200 in patients with type 2 diabetes mellitus: an observational study
Published in Journal of Drug Assessment, 2020
Jil Mamza, Uchena Anyanwagu, Mohammed Alkharaiji, Iskandar Idris
Table S1 (see Supplementary Appendix 3) summarizes the baseline values of secondary care patient and clinical characteristics for nine patients whose medical care records were collected. All the patients were Caucasian with a mean age of approximately 60 ± 11) years, and comprised of predominantly men (89%, n = 8). The average HbA1c at baseline was 8.6% ± 1.3% and their average BMI was 39.7 ± 5.3) kg/m2 at baseline. Over half of the patients (56%) had a known diabetes complication at baseline and 22% had hypoglycemia unawareness. Specific complications recorded at baseline include CHD (22%), retinopathy (44%), nephropathy (56%) and neuropathy (44%). Thirty-three percent of patients received a intermediate and long-acting insulin, whereas 22% received a short-acting insulin therapy as their first insulin regimen. The remaining patients received biphasic insulin previously. Forty-four percent administered U-200 insulin three times daily on commencement. There was one patient recorded to have had U-200 insulin once a day and another one patient recorded to have had U-200 up to four times a day. Overall, the average daily dose of U-200 insulin was approximately 154.3 ± 104.1.