simplified presentation about different types of insulin done by two pharmacists working in alwahda derna hospital libya

1. Collected by
Abdul-Jaleel Mustafa
Mahmoud el-mabry

2. Definition:
Is a peptide hormone produced by beta cells in
the pancreas. it regulate the metabolism of the
carbohydrate and fats by promoting the
absorption of glucose from the blood to skeletal
muscle and fat tissue and by causing fat to be
stored rather than used for energy .insulin also
inhibit the production of glucose by liver

3. Structure:
Insulin consist of two polypeptide chain A & B chains
linked by disulfide bonds .
A chain consist of 21 Amino acids and B chain consist
of 30 amino acids(active form)

4. INSULIN SECRETION SOURCE (B-CELL)
B- Cell
Hormones
Description
Insulin Proinsulin (insulin+ c-peptide ) and active form
(insulin)
Amylin -Released with insulin in ratio of 1:100
-Amylin play a role in glycemic regulation by
slowing gastric emptying and promoting satiety
C-peptide - Secreted in bloodstream in equimolar quantities to
insulin
- C-peptide helps to prevent neuropathy and other
complication deterioration related to diabetes mellitus
(delay complication)
- C-peptide levels measured to diagnosis diabetes
(newly diagnosis)

5. Mechanism of action

6. Receptor type Tissue distribution
Glut -1 Is widely distributed in fetal tissues, In
the adult most cells (more in RBC &brain)
Glut-2 Liver .beta cells .hypothalamus .retina
.kidney .intestine.
Glut-3 Brain . placenta
Glut-4 Heart ,muscle ,fat
Glut-5 Intestine ,kidney, testis ,RBC

7. INSULIN THERAPY
Typeof insulin
A- Insulin short acting
1-INSULIN RAPID
Active
constituent
GLULISINE (ultra short) LISPRO ASPART
Onset time 10min to 20min 15min to 30min 15min to 30min
Peak time 30-90min 30-90min 30-90min
Duration 3-5 hours 3-5 hours 3-5 hours
Trade name APIDRA(SANOFI) HUMALOG (lilly) NOVORAPID PEN
NOVOLOG BOTT
(Novonordisck)
Notes Can be mixed(NPH)
Given (s/c , IV)
Can be
mixed(NPL,NPH)
Given (s/c , IV)
Can be
mixed(NPH,NPA)
Given (s/c ,Infusion
pump )

10. Active
constituent
REGULAR (rDNA) E.COLI
Onset time 30 min to 1 hour
Peak time 2 hours to 5 hours
duration 6 hours to 12 hours
Trade name HUMALIN R (LILLY)
ACTRAPID
NOVOLIN R
Notes Can be mixed
Given (s/c,IV)
2-INSULIN REGULAR

11. B-INSULIIN INTERMEDIATE ACTING
Active constituent NPH:NEUTRAL PROTAMINE HAGEDORN
NPL: NEUTRAL PROTAMINE LISPRO
NPA: NEUTRAL PROTAMINE ASPART
Onset time 3 HRS TO 8 HRS
Peak time 8 – 10 HRS
Duration 12-16 HRS
Trade name HUMILIN N (LIILY)
INSULRETARD (NOVO)
Notes - Given only S/C
- Can be mixed (NPH)
- Cloudy milky color

12. C -LONG ACTING INSULIN
Active
constituent
DETEMIR GLARGINE
(ultra long)
DEGLUDEC
(ultra long basal)
Onset time 3-8HRS 1-2 HRS 1-2 HRS
Peak time PEAKLESS PEAKLESS PEAKLESS
Duration 16-18HRS 24+ 42+
Trade name LEVEMIR PEN
(novonordisck)
LANTUS PEN
(SANOFI)
TRESIBA
(novonordisck)
Note - Can not be
mixed
- Given only s/c
- Can not be mixed
- Given only s/c
- Can not be
mixed
- Given only s/c

14. Onset and duration of action of human insulin
and insulin analogs. NPH

15. How to Switch Between Insulin Products
Insulin detemir (Levemir) to NPH • Convert unit-per-unit.
• NPH at bedtime (for type 2 patients
when combined with oral anti diabetes
meds). OR
• NPH twice daily (e.g., 50:50 or 2/3 in
AM and 1/3 before dinner or at
bedtime).
Insulin glargine (Lantus) to NPH • Convert unit-per-unit.
• NPH at bedtime (for type 2 patients
when combined with oral anti diabetes
meds). OR
• NPH twice daily (e.g., 50:50 or 2/3 in
AM and 1/3 before dinner or at
bedtime).

16. Regular human insulin (Humulin R,
Novolin R) to rapid-acting insulin
analog (insulin aspart [Novolog],
insulin glulisine [Apidra], insulin
lispro [Humalog])
• Convert unit-per-unit.
• Rapid-acting insulin analogs have
a faster onset of action and a
shorter duration of action than
human regular insulin.
Give rapid acting insulin analogs
about 10 minutes before meals or
with meals.

17. Mixing insulin in one syringe

19. Reference
Oxford handbook clinical pharmacy
Lippincott pharmacology
Atlas-1 drug
https://www.medicines.org.uk
http://www.humulin.com
http://www.novonordisk.com