There are many classifications of commonly used insulin. Based on differences in source and chemical structure, insulin is divided into animal insulin, genetically recombinant human insulin and insulin analogs. According to the differences in action characteristics, insulin is further divided into ultra-short-acting, short-acting, intermediate-acting, long-acting and premixed insulin. With so many insulins available, how to differentiate and choose?

The first thing we need to know is that the reason insulin comes in multiple dosage forms and multiple sizes is to accommodate a variety of diabetic patients and different conditions. If you are a diabetic, it is important to distinguish between them before use.

Currently, most domestic animal insulin is porcine insulin. Human insulin has high purity and fewer adverse reactions, but is expensive. In recent years, a new class of widely used insulin analogs is marketed, which has similar ability to control blood glucose compared with our human insulin, but has greater advantages in simulating physiological insulin secretion and reducing the risk of hypoglycemia, and it is closer to the needs of our body. Currently, there are two major categories of commonly used insulin analogs: ultra-short-acting insulin and ultra-long-acting insulin. Ultra-short-acting insulin includes Mentholatum insulin (trade name: "Novozymes") and Lysine insulin (trade name: "Uloro"), which share the common feature of rapid onset of action within a short period of time, so it is necessary to eat as soon as possible after use to prevent hypoglycemia. Ultra-long-acting insulin includes insulin glargine (trade name "Lysol") and insulin detriment (trade name "Norpine"), which are characterized by once-a-day injections to lower blood glucose smoothly. In addition, there are many short-acting and intermediate-acting premixed insulins, such as insulin with "30R" and "50R" in its name.

The choice of insulin is mainly based on the patient's blood glucose profile. To control fasting blood glucose, basal insulin is needed, including long-acting insulin, intermediate-acting insulin, and long-acting insulin analogs; to control postprandial hyperglycemia, mealtime insulin injections are needed, including regular insulin, short-acting human insulin, and ultrashort-acting insulin analogs. In addition, it is also necessary to combine the patient's wishes and the economic cost of drugs to choose. For example, if the patient's blood glucose control is relatively stable and he/she wants to reduce the number of injections, then he/she can consider choosing premixed insulin, and the long-term cost of human insulin is lower than that of insulin analogs. When choosing the type of insulin, we need to take into account our own individual situation and listen to the advice of endocrinologists to choose the most suitable insulin for ourselves.

Shiyan People's Hospital Pharmacist-in-Charge Ke Jing, Member of the Pharmacy Network

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

insulin

Pancreatic islets are groups of cells scattered among the follicles of the pancreas, with a total weight of 1g, accounting for only 2% of the volume of the pancreas. Insulin is secreted by pancreatic β-cells, and normal people secrete about 25-50 units per day. The secretion is pulsatile, with a 24-hour rhythm, starting to rise in the morning, peaking in the afternoon, and then gradually declining, with a trough in the early morning. The glucose peak occurs after three meals a day, which stimulates the peak of insulin secretion accordingly, and the plasma insulin level at this time is 5-10 times that of fasting.

Insulin is the only hormone in the body that directly lowers blood glucose, and at the same time promotes the synthesis of glycogen, fats, and proteins, which are indispensable for human growth and the maintenance of normal metabolism.

Types of Diabetes

Insulin secretion in patients with type I diabetes is often completely lacking or severely lacking, and the sicker the patient is, the worse his islet function is and the less insulin he secretes.

Early manifestations of type II diabetes mellitus include a delayed beta-cell response to glucose stimulation, insufficient or absent insulin secretion in the first or early phase, and delayed peak insulin secretion in the second phase, resulting in elevated postprandial glucose as well as hypoglycemia before the next meal.

As the disease progresses, there is further deterioration of beta-cell function, which may also include a reduction in beta-cell numbers, manifested by a severe lack of insulin secretion.

What are the commonly used insulin preparations?

Insulin is the longest used, most experienced and most effective drug for lowering blood glucose, and the commonly used dosage forms and action characteristics are:

What is the goal of glycemic control when treated with insulin?

(1) For patients with type 2 diabetes mellitus who have shorter disease duration, longer life expectancy, no complications, and no combined cardiovascular disease, the glycemic control target can be controlled at fasting blood glucose 4.4-6.0 mmol/L, postprandial blood glucose < 8.0 mmol/L, and HbA1c < 6.5%, provided there is no hypoglycemia;

(2) For patients with type 2 diabetes who are at high risk of hypoglycemia, advanced age, hepatic and renal insufficiency, shorter life expectancy, and comorbidities with cardiovascular and cerebral vascular diseases, loose glycemic control targets are implemented, with fasting blood glucose of 8-10 mmol/L, postprandial blood glucose of 8-12 mmol/L, and HbA1c of < 7.5% or even 8.0% or higher.

How do I standardize my insulin injections?

The principle of insulin administration is "use early, use less, use close to the physiological state of human"; individualized administration based on the amount of meal, blood glucose, and the amount of medication, the initial dose should be small, and then gradually increase the dose according to the response. At the same time, it is important to avoid long-term application of high-dose oral sulfonylureas to reduce the excessive stimulation of β-cells.

1. To know the insulin content

Typically 10 ml per bottle, most contain 40 IU per 1 ml, but some contain 100 IU per 1 ml.

2. To learn to use different syringes

There are two types of syringes used for insulin, one is a 1ml ordinary syringe with a scale of "ml", which the injector has to convert according to the amount of insulin used. The other type of syringe is special for insulin islets (called "BD" needle), and its scale is "IU", which is made according to the insulin content of 40 IU per 1 ml, so the injector does not need to convert, which is more convenient. The "BD" needle is shorter and thinner, which makes it less painful for the patient, but it is not suitable for injecting insulin containing 100 IU per 1 ml.

3. To understand the insulin effect

The effects of insulin are indicated in large print, with rapid-acting insulin marked with an "R" or "S", intermediate-acting insulin marked with an "L" or "N", and long-acting insulin marked with a "U". R" or "S" for rapid-acting insulin, "L" or "N" for intermediate-acting insulin, and "U" for long-acting insulin.

4, to reasonably grasp the injection time

Generally 15-30 minutes after the injection of insulin meal is more appropriate, but the time of injection can be adjusted, such as high blood glucose before meals, injection and meal interval should be longer; preprandial blood glucose is low but not yet hypoglycemic, injection should be eaten as soon as possible after the injection.

5, to master the injection method

When injecting, clean the injection site with ethanol cotton ball, wait for the skin to dry, pinch up the skin of the injection site about 3cm with one hand, push the barrel piston to the bottom with the other hand, then relax the lifted skin and pull the needle out from the injection site without rubbing the injection site.

6, to pay attention to the injection site

The most suitable injection sites are the outer side of both upper arms, the outer side of the abdomen, the outer side of the thighs and the buttocks. Each time you inject, change the injection site, and the two injection points should be separated by more than 2cm to ensure the stable absorption of insulin.

7. Other considerations

When the blood sugar is high, you can choose to inject in the abdomen, inject a little deeper, and extend the time interval between meals appropriately; if you want to have a meal immediately after the injection, you can choose to inject in the abdomen, inject a little deeper; if you can't have a meal on time after the injection, you can choose to inject in the upper arm or buttocks, and inject a little shallower; if your blood sugar is normal at the time of the injection, you can choose to inject in any injection site, and have a normal meal; if your blood sugar is low at the time of the injection, you can choose to inject in the upper arm or buttocks, and inject a little shallower. It is advisable to eat as soon as possible after injection.

Q: What should a diabetic do in case of hypoglycemia?

Patients with mild-to-moderate hypoglycemia often begin with false sweating, panic, rapid heartbeat, dizziness, trembling (especially of the hands), hunger, and weakness of the lower limbs or the whole body. Some people also have nervousness, anxiety, fear, pallor, fear of cold, headache, elevated blood pressure; at the same time, there are visual impairment, diplopia, hearing loss, drowsiness, sudden personality changes (sometimes mistaken for mental illness); severe hypoglycemia is the loss of disorientation, slurred speech, coma, such as coma for more than 6 hours can cause irreversible brain tissue damage, or even death.

Emergency self-help after the occurrence of hypoglycemia, it is advisable to drink sugar water or eat sugar, chocolate, sweets and other sugary foods immediately, such as their own inability to self-help can be helped by friends and relatives to feed sugar water or food, mild to moderate hypoglycemia is generally relieved in 15 minutes after eating, such as not relieved to eat the above food and timely hospital static injection of glucose solution.

Knowledge Expansion

Hypoglycemia is the most common complication in patients with diabetes mellitus and is defined as a glucose concentration of less than 2.8 mmol/ (50 mg/dl) in venous blood. Its causative factor is:

(1) Improper use of insulin, excessive dosage or application of mixed insulin with inappropriate ratio of short and long acting, inappropriate injection site and depth;

(ii) Partial or even total loss of pancreatic islet function and unstable blood glucose;

(iii) Diabetic nephropathy;

④ Excessive exercise or alcohol consumption;

⑤ Oral hypoglycemic agents, especially glibenclamide, are prone to occur in reduced renal function or in the elderly;

(vi) Reduced or untimely eating.

The above answers were provided by PSM Drug Safety Cooperative Alliance Volunteer: Guangdong Pharmaceutical Society The First Affiliated Hospital of Guangzhou Medical University Zheng Boqiu!

Insulin is a medication that all diabetic patients are likely to use, and insulin needs to be used under the guidance of a medical professional.

The structure of most insulin on the market is basically very similar to the insulin secreted by the human pancreas, which can play 99% of the efficacy in terms of effect, and it is a good solution to the problem of insufficient insulin secretion in the diabetic population that leads to high blood glucose. However, after long-term use, there will be a small number of people with decreased sensitivity to generic insulin, which in turn affects the efficacy of the drug, so regular monitoring of blood glucose is very necessary.

In terms of treatment, there are two groups of people who are not suitable for treatment with insulin:

1,Insulin must be used in people with high blood sugar, not in people in a hypoglycemic state. If insulin is injected during hypoglycemia it is likely to cause a further drop in blood sugar, which can be life threatening in severe cases.

2. Most insulin belongs to biological agents, and if theAllergies to the ingredients in them are also not suitable for treatment with insulin。

Insulin injections may occur in two ways:

1,lipodystrophy. In some people, insulin injections may cause fat shrinkage or hyperplasia, which may improve with a change in the way the injections are given, without stopping the medication.

2,insulin allergyIf the allergic reaction is localized, it usually disappears after a few days. If the allergic reaction is only localized, it usually disappears after a few days. However, if the allergic reaction is generalized and more serious, it should be treated in a hospital in time.

Even though insulin can control blood sugar better, we still cannot ignore the role of diet and exercise in controlling blood sugar. Diet has a great impact on blood sugar level, if you consume too many carbohydrates at one time, it will cause a rapid spike in blood sugar, which is not conducive to blood sugar control. Exercise is good for improving the sensitivity of body cells to insulin, and more importantly, it can consume too much sugar in the body to maintain the normal level of blood sugar. Generally speaking, maintaining an appropriate amount of daily exercise can effectively reduce the amount of insulin used, and even control blood glucose in a more normal range without the use of insulin.

Insulin therapy is an important means of controlling hyperglycemia. Insulin therapy is the primary, if not essential, control measure for some patients with long duration of disease and poor glycemic control.

Insulin is more rejected by many diabetic patients. In addition to the fear of pain, fear of injections, the biggest worry is that once you use it, you can not quit, so many patients would rather take more medicine than use insulin.

Insulin itself is a hormone secreted by the human body, it is only that diabetic patients have insufficient endogenous insulin secretion, we use exogenous insulin subcutaneous injection to solve the problem of insufficient endogenous insulin secretion, so as to lower the blood glucose, so there is no so-called addiction and dependence. Once the optimal time for insulin therapy is missed, blood glucose cannot be controlled, which will lead to life-threatening chronic complications.

However, compared with oral medications, insulin therapy involves more aspects and is indeed more troublesome, such as learning to inject the medication, self-monitoring of blood glucose, protection against hypoglycemia, and stricter dietary and exercise control, which makes the patient's cooperation all the more important.

Based on my years of experience in serving my mom and dad, the choice of insulin is determined by the results of hospital tests, and the use of insulin should be injected according to the level of blood sugar. In general, blood sugar should be measured three days, five days or seven days, and in severe cases, three days or every day. With a blood sugar of ten points or more, it is time to inject insulin. The higher the point of blood sugar, the higher the amount of insulin to be injected. When your blood sugar does not come down to twenty points, you can take two shots a day. If it doesn't come down, you can take three injections a day. If it doesn't come down, get your doctor to prescribe insulin after the evening meal. The last word, as long as it is not taboo, can only use insulin to control blood sugar at about ten points. Remember, be diligent in measuring blood sugar and regulating insulin use. Otherwise, bad use of insulin can have side effects, and even life-threatening ones.