Summary of the function, the history, the options and halal status of insulin. based on CPG Diabetes Mellitus 5th edition , Malaysia what is insulin what happenned in Type 1 and Type 2 DM history of insulin production Chronology of insulin production human vs animal insulin insulin in Malaysia discussion about halal and haram concept in medicine

1. About Insulin:
Summary of the function, the history, the
options and halal status
DR NURDALILA BINTI SAHIDAN
Medical Officer Klinik Kesihatan Kuala Lumpur (KKKL)
EN LATIFFI BIN ABDUL AZIZ
Deputy Senior Manager/Pharmacist
Regulatory Compliance Department
Pharmaniaga
September 2020

2. Table Of Content
 What is Insulin
 What happenned in Type 1 DM
 What happenned in Type 2 DM
 History of Insulin Production
 Chronology of Insulin Production
 Insulin in Malaysia
 Definition of Halal and Haram
 Halal and Haram Concept in Medicine
 Conclusion

3. What Is Insulin ?
• hormone that made in an organ name pancreas
located behind the stomach specifically from beta cells
• It is use to convert glucose to energy for our body
• Glucose is a breakdown of carbohydrate from meal
that we consume
• Our body needs glucose for energy production

4. • However, glucose cannot directly enter
the cells in the body from the blood
stream
• Thus, insulin released by pancreas will
acts as a ‘key’ to allow the glucose from
the blood stream entering the cells in
body and be used for energy
• Therefore, insulin will regulates the level
of glucose in the body from getting too
high or getting too low

5. What happened in diabetes patient ?
i: Type 1 Diabetes
• formerly known as
insulin dependent
diabetes mellitus
• Pancreatic beta cells is
destroyed by the
body immune system
• Patient with Type 1
DM cannot produce
insulin
• They needs to take
insulin injection for
live

6. What happened in diabetes patient ?
i: Type 2 Diabetes
• can develop
due to insulin
resistance or
insulin
deficiency
• In insulin resistance,
the body did not
respond to insulin
the way it should
• Meanwhile in insulin
deficient, the body
simply does not
produce enough
insulin.

7. History of Insulin Production
 In the past insulin was extracted from bovine or porcine
 The first injection given to a diabetic patient was in 1922 in Canada,
where a team of Nobel Prize winning developers from the University of
Toronto had been working on a treatment for the then untreatable type
1 diabetes.
 Even though animal insulin are similar to human insulin, however their
composition is a little different. Some patients’ immune system produce
antibody toward the insulin making bovine/porcine insulin ineffective.
 Due to this problem the researchers keep finding ways to develop
human insulin. The researchers finally develop human insulin synthesis
with the help of recombinant DNA technology. The chronology as
follows

8. Chronology of Insulin Production
• This shot of bovine insulin, given to 14 year old Leonard Thompson, was the first use of animal
insulin in humans.
• Early animal insulin caused swellings and pain at the injection sites as the animal insulin contained
number of impurities.
1922 – LEONARD THOMPSON
• Through the 1930s and 1950s newer animal insulins were developed with different peak actions to
better stabilise blood sugars.
• In the 1970s, purification of animal insulins helped to reduce the allergic reactions which had
previously been associated with animal insulins.
1930S – 1970S
• Shortly after a new synthetic form of insulin, termed human insulin, was laboratory developed
from the 1980s onwards would start to replace animal insulin as the primary treatment of insulin
dependent diabetes
1980S ONWARDS

10. Insulin in Malaysia
( based on CPG DM 5th edition)
 Malaysia currently use human insulin derived by recombinant technology or
insulin analogue ( genetically modified human insulin)
 Both types of insulin further divided into their pharmacokinetic profiles:
Insulin Preparation
Prandial is administered pre-meal because of its short or rapid onset of
action in controlling postprandial glucose excursion. It is also used
in insulin pumps
Basal administered once or twice daily. The intermediate or long-acting
pharmacokinetic profile covers the basal insulin requirements in
between meals and night time
Premixed is biphasic insulin that incorporates both the short or rapid-acting
insulin with intermediate-acting insulin into a single preparation to
cover for both postprandial glucose excursion as well as basal
insulin needs

11. Insulin Regime
 An ideal insulin regimen should mimic the physiological insulin response to
meals and endogenous hepatic glucose production
 The choice of insulin regimen should be individualised, based on the
patient’s glycaemic profile, dietary pattern and lifestyle
 Basal bolus therapy using the combination of basal and prandial insulin
offers the most physiological insulin action

12.  At initiation, the insulin dose prescribed is usually low to avoid
hypoglycaemia. All patients prescribed insulin therapy should be advised to
perform self-monitoring of blood glucose (SMBG) and empowered to self-
adjust their insulin doses
 The insulin dose should be adjusted at least weekly to achieve glycaemic
targets. Optimisation of the insulin dose should be an interactive process
between the healthcare provider and the patient
 This can be done at the diabetic resource centre, via telephone calls or text
messages. It should be done within the first 3 months of starting insulin
 Often the insulin regimens started may need modification, which require
switching to more intensive insulin regimens for better glycaemic control.
This may entail increased number of injections

13. Barrier’s To Effective Insulin Therapy
 There are numerous barriers to effective insulin therapy. These include
patients and healthcare providers’ factors.
 The biggest barrier is compliance and this should be adequately
ascertained prior to any effort to intensify insulin therapy.

16. Definition of Halal Haram
 The word Halal derived from Arabic which simply means allowable or not
prohibited to be used in Islam. According to Al-Quran, all foods which are good
and clean are halal. Therefore, almost all food sources from plants and animals
are halal except animals which are haram to be consumed.
 Haram means not permitted or prohibited to be used in Islam. Some of the foods
that are prohibited in Islam include cadavers, blood, pigs, things that are
intoxicating and others. Apart from that, products that have been contaminated
with haram sources are also prohibited.

17. Halal Haram Concept In Medicine
 Medicines are used to ease, treat, cure or prevent illness and also to improve health.
Medicines can be found in many forms and consumed in various ways. If medicines
are taken as intended, by the will of Allah it can cure or control the illness.
 Medicines which are halal must fulfill the requirements as below :
 Does not contain substances from animals that are not halal or not slaughtered
according to Islamic law.
 Does not contain substances which are considered najis by Islamic law.
 Safe to be used, non-toxic, would not cause damage or intoxication and not harmful
to health.
 Not prepared, processed or manufactured using equipment contaminated
with najis according to Islamic law.
 Does not contain human body parts or products which are not allowed by Islamic law.

18.  In deciding the necessity of using medicine containing haram materials, the requirements to
ensure that those conditions are really an emergency needs to be met. Some examples of
requirements that have been set by ulama’ and used by National Fatwa Council Malaysia are:
1. An emergency really occurred and it is not something that is uncertain. In other words, it
already happened or exists where there is damage or illness to five general principles
(religion, life, intelligence, lineage and property) or the occurrence of damage has been
confirmed. This must be made based on strong conviction which is led by experience or
knowledge.
2. Someone in an emergency situation is against the order or prohibition of Islamic law, or there
is no requirement by the Islamic law to eliminate the harm except for things that is banned or
prohibited.
3. Efforts have to be made to ensure that the present halal materials could not prevent the harm
from occurring to patients.
4. The usage of haram materials is a necessity.
5. During treatment, the usage of haram materials must be recommended, ensured and
approved by doctors or Muslim health professionals who are fair, believed to practice its
religion and beliefs and also have knowledge in that field.

19. Conclusion
 Insulin commonly use in Malaysia is human insulin derived by recombinant
technology or insulin analogue ( genetically modified human insulin)
 Therefore it is Halal

20. Thank You