China
Africa
Explore chapters and articles related to this topic
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Isophane (or NPH) insulin is an intermediate acting insulin comprising a crystalline suspension of insulin in combination with protamine and zinc, which leads to a delay in absorption following subcutaneous injection, resulting in a later onset of action (between 1 and 3 hours), and a peak at between 6 and 8 hours. Total duration is between 12 and 16 hours.
Clinical Problems Associated with Diabetes Mellitus
Published in Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla, Heart Dysfunction in Diabetes, 2019
Grant N. Pierce, Robert E. Beamish, Naranjan S. Dhalla
Insulin was first used by Banting and Best in Canada to reduce blood sugar. The first pharmaceutical modification of insulin was carried out by Hagedorn in 193672 to slow the rate of absorption from the injection site. Insulin has no systemic biological effect until it is absorbed into the circulation from the s.c. injection site. The rate of absorption may be a critical factor to the diabetic patient depending upon the immediacy of the need for circulating insulin. Hagedorn’s modification of insulin absorption was achieved by adding fish-sperm protamine to the insulin solution. In its current form this type of insulin is referred to as NPH insulin (neutral protamine Hagedorn). The addition of zinc to the insulin preparation was found to further reduce the absorption rate73 and led to the commercial development of protamine zinc insulin (PZI) and the Lente insulins. Table 4 shows the various types of commercial preparations of insulin which are available and their rates of action.
Selected Botanicals and Plant Products That Lower Blood Glucose (Continued)
Published in Robert Fried, Richard M. Carlton, Type 2 Diabetes, 2018
Robert Fried, Richard M. Carlton
The average fall in blood sugar level at the peak effect of vegetable insulin was statistically significant. The onset of action was within 30 to 60 min, with the peak effect 6 h after the administration of the dose of plant insulin (Baldwa, Bhandari, Pangaria et al. 1977). This effect is similar to that of long-acting (NPH) insulin, which has an onset at 1½ to 2 h with a peak effect from 4 to 12 h after administration. However, curiously, no administration dosages could be found in the Baldwa et al. report.
Efficacy and safety of insulin detemir versus glargine in patients with diabetes: a systematic review and meta-analysis
Published in Expert Review of Clinical Pharmacology, 2022
Soheila Rezaei, Ali Taheri, Saeed Taheri, Sara Kasirzadeh, Behzad Fatemi, Mende M Sorato
Insulin detemir and insulin glargine are two basal insulin analogs. These treatments are administered subcutaneously and have durations of action of approximately 24 hours at usual doses [9]. Insulin detemir has a shorter half-life compared with insulin glargine. Insulin glargine is only approved to be used once a day, while insulin detemir is approved to be administered once a day or in divided doses twice a day [10,11]. There have been concerns with the level of health gain of long-acting insulin analogs versus neutral protamine Hagedorn (NPH) insulin, leading to calls for disinvestment at considerably higher prices [12]. However, these long-acting insulins can offer several benefits over the NPH insulin with their distinct pharmacokinetic and pharmacodynamic profiles. Various randomized controlled trials (RCTs) have compared the efficacy and safety of insulin detemir and insulin glargine with NPH insulin. In these trials, insulin detemir and insulin glargine caused less weight gain and fewer episodes of hypoglycemia than NPH insulin when used as add-on therapy to oral glucose-lowering medications [13–15]. Similarly, recent systematic review and meta-analysis studies suggest patient benefits for long-acting insulin analogs [16–18], leading to increased use across Europe [19]. Currently, price is the main impediment to increased use of long-acting insulins. However, the availability of biosimilars and the promotional efforts by the originator are leading to reductions in the cost of treatment [19].
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
The evolution of long-acting insulin started in the 1930ʹties [2] when protamine insulin was first created [8] and, in the 1940ʹties, followed by Neutral Protamine Hagedorn (NPH) insulin [9]. NPH insulin was the dominating long-acting insulin preparation for more than 50 years. The main drawbacks associated with NPH insulin are substantial inter- and intra-patient variability, marked site- and dose-dependent effect variation, and variability associated with the magnitude of resuspension before injection [10,11]. Furthermore, the peak 2–8 hours after injection imposes a challenge for obtaining optimal fasting glucose control without promoting considerable risk of nocturnal hypoglycemia [2]. All these limitations, combined with the inherent ability of insulin therapy to cause weight gain, stimulated the development of the new long-acting insulin analogs glargine, detemir, and degludec, which were introduced on the market after the millennium.
Strategies for implementing effective mealtime insulin therapy in type 2 diabetes
Published in Current Medical Research and Opinion, 2018
Mark Peyrot, Timothy S. Bailey, Belinda P. Childs, Gérard Reach
Progress in new insulin formulations is another important factor affecting post-mealtime glycemic control. True (peak-less) basal insulins can make mealtimes more flexible than with NPH insulin use (because one does not have to eat after an injection75). Recent studies suggest that these newer basal insulin formulations lead to fewer episodes of severe hypoglycemia and nocturnal hypoglycemia100,101. Newer mealtime insulins are engineered to have faster action profiles, with the promise of better action when administered with food compared with current mealtime insulins, which should be given prior to eating102. The development of concentrated insulins also provides the option of smaller insulin reservoirs (or longer duration of use) and delivery devices (for pens and pumps), which is particularly relevant for those with T2D who need large amounts of insulin daily75. Lower insulin dose volumes also have an additional perceived benefit to patients—that of taking a lower total insulin volume, which has been found to influence patient satisfaction103,104.