General,Recommendations,and,In health General Recommendations and Insulin


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When the blood sugar is no longer controlled by the maximum recommended amount of an oral medication, there is no other recourse than to administer insulin. If more of the oral agent is taken than is recommended, it is very possible that the person could become quite sick. InsulinBefore insulin was discovered, a child who had diabetes could expect to live only about two years from the time of diagnosis. Insulin was first chemically removed from the pancreas of animals, but human insulin may now be made by biologic engineering using recombinant-DNA technology. As biologically engineered human insulin is now readily available, less and less of the animal-derived insulin (highly purified pork or beef or a pork/beef mix) is being used and will be taken off the market soon. Like oral hypoglycemic agents, insulin is available in rapidacting, short-acting, intermediate-acting, and long-acting forms . Lente (L) is a premixed, crystalline, intermediate-acting insulin. The long-acting form, Ultralente (U), contains a smaller number of crystals, but they are larger in size. Lente insulin is a mixture of the two types (30 percent Semilente and 70 percent Ultralente), but because of the slower onset of the Lente insulin, Lente is often mixed with short-action (or rapid-action, or Regular) insulin to get a quicker early action along with later action. When a protein called protamine is attached to a short-acting insulin, it becomes NPH (Neutral Protamine Hagedorn [N]), an intermediate-acting insulin. The newer insulin (called designer or "tailored" insulin) will have some of the proteins in the insulin chain changed in their sequence. This will result in a change of the time action of insulin. The major side effects that can occur when taking insulin are as follows: low blood sugar hypoglycemia (also called insulin reaction or insulin shock) hypertrophy (an enlarged area that results from receiving the shot in the same place for too long) atrophy (a sunken area, as a response to the insulin and its diluting agent; has been observed less frequently with the advent of human insulin) Other side effects may be a rash at the site of the injection or a rash all over the body. However, these and other side effects are seldom noted with the use of the purified human insulin. In the United States, insulin is available in a concentration of 100 units per 1 cc, called U100. For special purposes, such as research, U400 and U500 are available. Most other countries are currently in the process of converting their available insulin into the U100 form. (Note: Some U40 or U80 insulin may be available in other parts of the world.) If a child or adult is extremely sensitive to insulin changes, then the insulin may be diluted to U50 (a 1:1 dilution) or U25 (a 1:3 dilution-one part insulin with three parts diluting fluid). This allows changes in the insulin dosage in X- to Yz-unit changes rather than I-unit changes. The syringes, such as the 50-unit syringe (or the 25- or 30-unit syringe), allow the careful measuring of single unit changes. Therefore, diluting insulin may not be needed except for infants. As with your meal plan, the insulin is spaced throughout the day to enable your body to handle your food intake in relation to your activity pattern. Therefore, the time action of the insulin is very important. When you look at a chart or read about the time action of insulin, notice whether it is concerned with the pharmacokinetic or therapeutic (effective) action of insulin. The pharmacokinetic action (also called the pharmacologic action) of insulin is the response of the body to the insulin from the time it enters the body until it is no longer measurable in the body. The therapeutic (effective) duration of action of the insulin is the time a certain amount of insulin will keep your blood-sugar level within the normal range . The former is important to scientists but the latter is shorter and more important to the patients. To keep your blood-sugar and insulin levels within the normal range, you must know how the insulin performs therapeutically . Two companies, Eli Lilly and Novo-Nordisk Pharmaceuticals, are currently producing insulin in the United States. They, as well as other professionals in the field, are recognizing that there is seldom a case when one dose of insulin will cover the 24-hour needs of the person who has diabetes. Especially with human insulins, the three-dose program is being used more frequently. Twenty-four-hour control of the blood-glucose level is the goal. If less is achieved, problems are more apt to occur. The body normally produces a small amount of insulin continuously-basal insulin-and a burst of insulin with each intake of food. It is this pattern that needs to be duplicated with injectable insulin if control over the whole 24-hour period is to be achieved. must observe: (1) The insulin is gone in 3 to 4 hours so some longer acting insulin is needed to provide a background insulin to fill the gaps. This can be 1 or 2 shots a day of NPH or Lente insulin or can be Ultralente. Sometimes we even mix regular insulin with the Humalog to fill a gap in its coverage. (2) This insulin is gone in 3 to 4 hours so it may be gone by the next meal. Thus a pre-meal blood sugar may not be measuring the action of the Humalog insulin but may be measuring the effect of the background insulin. With this insulin, as the package insert says, you must measure the blood sugar 2 hours after the meal to determine the action and adjust the dose of the Humalog. With these caveats, this is an excellent insulin and can add better convenience, more physiologic control, less low blood sugars, and much more flexibility to your insulin program and to your life. Article Tags: Blood Sugar, Human Insulin, Lente Insulin, Time Action, Side Effects

General,Recommendations,and,In

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