Human insulin 1

2 ( insulin analogue)

(rapid acting) (prandial
insulin) Insulin Lispro (.. 1996) Insulin Aspart (.. 2000)
24 basal insulin Insulin Glargine(.. 2000) Insulin Detemir (..
2005) delivery system insulin pump inhale insulin

4 (1 2)
1. rapid-acting insulin (insulin analogue)
amino acid insulin lispro( proline lysine 28
29 carboxy terminal B-chain) insulin aspart ( aspartic acid proline 28
B-chain) insulin glulisine ()
- 15-30
15 15 prandial insulin
- IV, SC., IM, CSII(continuous subcutaneous insulin
infusion or insulin pump therapy)
- insulin lispro insulin aspart
> 2
- early postprandial hyperglycemia late postprandial hypoglycemia
HA1C regular insulin
2. Short-acting insulin regular insulin
30-60

3. Intermediate-acting insulin
2
3.1 NPH (Neutral Protamine Hagedorn Isophane insulin) protamine
2-4
3.2 Lente insulin (Zinc)
NPH insulin 3-4
 1
Preparation Trade name Timing of Action
Onset Peak Duration
Rapid-acting insulin
Lispro Humalog 15-30 30-90 3-5
Aspart Novorapid
Short acting insulin
Regular Humulin R 30-60 1-2 5-8
Actrapid HM
Intermediate acting insulin
NPH (isophane) Humulin 2-4 6-10 10-16
Insulatard
Lente (insulin zinc suspension) Monotard 3-4 6-12 12-18
Long acting insulin
Glargine Lantus 1-2 Less peak 24
Detemir Levemir 1-2 Less peak 20-22
Pre-mixed insulin
70%NPH / 30%Regular Humulin 70/30 30-60 Dual 10-16
Mixtard30
75% protaminated Lispro / 25% Lispro Humalog mix 25 15-30 Dual 10-16
70% Protaminated aspart / 30% aspart Novomix 30 15-30 Dual 10-16

2 time-action profiles (subcutaneous injection) insulin aspart,

insulin lispro, regular insulin, NPH insulin, insulin detemir insulin glargine
 4. Long-acting insulin ultralente ( )
24 24 insulin glargine insulin
detemir

- 24 insulin
glargine asparagines 21 A chain glycine arginine 2 carboxyl
terminal B chain isoelectric point pH 5.4 6.7 (
) physiologic pH (pH 7.0) insulin detemir
threonine 30 B chain myristic fatty acid
carbon 14 amino group Lysine 29 B chain insulin
detemir albumin long-chain fatty acid binding site albumin
pH neutral
-
basal insulin NPH
- NPH
(symptomatic nocturnal hypoglycemia) (symptomatic overall
hypoglycemia) HbA1C
(severe hypoglycemia)
-
conventional basal insulin (NPH)
- insulin detemir
basal insulin
-
insulin glargine IGF1 receptor human insulin 6-8
5. premixed insulin regular
insulin NPH insulin, lispro neutral protamine lispro(NPL) aspart neutral protamine aspart
70:30 premixed analogue
nocturnal hypoglycemia HbA1C
premixed human insulin
 2 (Insulin analogue)

2 ( 4)
3
1. basal insulin


1.1 intermediate-acting insulin: NPH lente
1.2 continuous subcutaneous insulin infusion (CSII)

1.3 long-acting insulin analogue: insulin glargine detemir 1-2

2. prandial insulin

prandial insulin regular insulin, insulin lispro insulin aspart
3. correction-dose insulin steroid

2
1. Once daily insulin regimen ( 2
) intermediate-acting insulin (NPH) long acting insulin (insulin
glargine detemir)
pre-mixed insulin 70/30
 2. Flexible multiple-insulin regimen multiple dose insulin injection (MDI)
regular insulin insulin analogue
intermediate-acting insulin
3. Split-and-mixed insulin regimen
2 (conventional insulin treatment)
intermediate-acting insulin regular insulin insulin analogue
4. Split-and-mixed insulin program with bedtime intermediate insulin)
intermediate-acting insulin regular insulin insulin analogue
regular insulin insulin analogue intermediate-acting insulin

5. Continuous subcutaneous insulin infusion (CSII) Insulin pump therapy

basal prandial insulin
rapid acting insulin analogue
6. Intravenous insulin infusion
insulin
analogue
1. organ transplantation
2. Acute diabetic complication DKA, hyperosmolar hyperglycemic state
3. septic shock, acute myocardial infarction, stroke
4.
5.
6.
hypoglycemia, hypokalemia
potassium monitor
7. Inhaled insulin
dry powder
Exubera Pfizer pranial insulin insulin analogue
insulin analogue regular insulin
10 peak 50 30-90 inhaled insulin
(needle phobia) extensive lipodystrophy
FDA approved Exubera 1 2 1
inhaled insulin short acting prandial insulin subcutaneous basal insulin
2 inhaled insulin intermediate long
acting insulin Inhaled insulin approved
 Exubera 6
passive smoker, asthma,
bronchitis, emphysema inhaled insulin
(unpredictable)
inhaled insulin (lung function test)
inhaled insulin 6
New drugs to treat diabetes
Amylin analog
Pramlintide
Amylin
gastric emptying time
pramlintide analogue amylin
HbA1C
subcutaneous
conventional prandial insulin 50%
basal prandial insulin 1 ( 15-60 g )
2 ( 60-120 g ) monitor
hypoglycemia unawareness gastroparesis

Incretin Mimetics
Exenatide
Incretin
glucose-dependent insulinotropic polypeptide (GIP) glucagons-like
peptide1 (GLP-1) ( glucose dependent
70 mg/dL )
gastric emptying time
proliferation -cell
Exenatide incretin mimetics GLP-1 FDA approve exenatide
secretagogue (sulfonylurea), metformin, sulfonylurea
metformin, thiazolidinedione thiazolidinedione metformin
subcutaneous 5-10 g 1
insulin dependent end-stage renal disease
creatinine clearance < 30 mL/min/1.73m2 pancreatitis exenatide

Suggesting readings
1. Hirsch IB. Insulin analogues. N Engl J Med 2005 352:2;174-83.
2. Hirsch IB, Bergenstal RM, Parkin CG, Wight E, Buse J B. A real-world approach to insulin therapy in
primary care practice. Clinical Diabetes 2005; 2:23:78-86.
3. Skyler, JS. Insulin Treatment, In therapy for and related disorders, fourth edition. American Diabetes
Assoiation, 2004. pp 207-223
4. K, Jeitler K, Berghold A, Ebrahim SH, Gratzer TW, Plank J, et al. A Long-acting insulin analogues
versus NPH insulin (human isophane insulin) for type 2 diabetes (Review). The Cochrane
Collaboration
5. Lisa K. Insulin-pharmacoogy, type of regimens and adjustments. Endotext Chapter 13
6. Siebenhofer A, Plank J, Berghold A, Jeitler K, Horvath K, et al. Short acting insulin analogues versus
regular human insulin in patients with diabetes mellitus (Review). The Cochrane Collaboration
7. AACE Diabetes Mellitus Guideline, Endocr Pract. 2007;13(suppl 1) 16-34