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Each of us has heard about such an unpleasant disease as diabetes mellitus, as well as about insulin, which is administered to patients as replacement therapy. The thing is that in patients with diabetes, insulin is either not produced at all, or does not perform its functions. In our article we will consider the question of insulin - what it is and what effect it has on our body. Is waiting for you an amusing trip to the world of medicine.

Insulin is...

Insulin is a hormone produced by special endocrine cells called islets of Langerhans (beta cells). The pancreas of an adult has about a million islets, whose function is to produce insulin.

Insulin - what is it from the point of view of medicine? This is a hormone of protein nature that performs extremely important necessary functions in the body. It cannot enter the gastrointestinal tract from the outside, as it will be digested, like any other substance of a protein nature. A small amount of background (basal) insulin is produced daily. After eating, the body supplies it in the amount that our body needs to digest the incoming proteins, fats and carbohydrates. Let us dwell on the question of what is the effect of insulin on the body.

Functions of insulin

Insulin is responsible for maintaining and regulating carbohydrate metabolism. That is, this hormone has a complex multifaceted effect on all tissues of the body, largely due to its activating effect on many enzymes.

One of the main and best known functions of this hormone is to regulate blood glucose levels. It is required by the body constantly, because it refers to the nutrients that are needed for the growth and development of cells. Insulin breaks it down to a simpler substance, facilitating its absorption into the blood. If the pancreas does not produce enough glucose, glucose does not feed the cells, but accumulates in the blood. This is fraught with an increase (hyperglycemia), which entails serious consequences.

Also, with the help of insulin, amino acids and potassium are transported.
Few people know the anabolic properties of insulin, surpassing even the effect of steroids (the latter, however, act more selectively).

Types of insulin

Distinguish types of insulin by origin and by action.

Fast-acting has an ultra-short effect on the body. This type of insulin begins its work immediately after administration, and its peak is reached after 1-1.5. Duration of action - 3-4 hours. It is administered immediately before or before a meal. Drugs with a similar effect include Novo-Rapid, Insulin Apidra and Insulin Humalog.

Short insulin has an effect within 20-30 minutes after application. After 2-3 hours, the concentration of the drug in the blood reaches its maximum point. In total, it lasts about 5-6 hours. An injection is given 15-20 minutes before meals. In this case, approximately 2-3 hours after the introduction of insulin, it is recommended to do "snacks". The time of eating should coincide with the time of maximum effect of the drug. Medications short action- drugs "Humulin Regula", "Insulin Aktrapid", "Monodar Humodar".

Intermediate-acting insulins act on the body for much longer - from 12 to 16 hours. It is necessary to make 2-3 injections per day, often with an interval of 8-12 hours, since they do not begin their action immediately, but 2-3 hours after the injection. Their maximum effect is achieved after 6-8 hours. Intermediate-acting insulins - preparations "Protafan" (human insulin), "Humudar BR", "Insulin Novomix".

And finally, long-acting insulin, the maximum concentration of which is reached 2-3 days after administration, despite the fact that it begins to act after 4-6 hours. Apply it 1-2 times a day. These are drugs such as Insulin Lantus, Monodar Long, Ultralente. This group can also include the so-called "peakless" insulin. What it is? This is insulin, which does not have a pronounced effect, acts gently and unobtrusively, therefore it practically replaces the “native” insulin produced by the pancreas for a person.

Varieties of insulins

human insulin - it is an analogue of the hormone produced by our pancreas. Such insulin and its genetically engineered "brothers" are considered more advanced than other types of animal-derived insulin.

Pork hormone is similar to the above, except for one amino acid in the composition. Can cause allergic reactions.

Bovine insulin is the least similar to human insulin. Often causes allergies, as it contains a protein alien to our body. The level of insulin in the blood of a healthy person has strict limits. Let's consider them in more detail.

What should be the level of insulin in the blood?

On average, in a healthy person, the normal level of insulin in the blood on an empty stomach ranges from 2 to 28 mcU / mol. In children, it is slightly lower - from 3 to 20 units, and in pregnant women, on the contrary, it is higher - the norm is from 6 to 27 μU / mol. In the event of an unreasonable deviation of insulin from the norm (level or low), it is recommended to pay attention to your diet and lifestyle.

Increasing the level of the hormone in the blood

Elevated insulin entails the loss of almost all of it, which negatively affects the state of health. It raises blood pressure, contributes to obesity (due to improperly transported glucose), has a carcinogenic effect and increases the risk of diabetes. If you have elevated insulin, you should pay attention to your diet, trying to eat as many foods with a low hypoglycemic index as possible (low-fat dairy products, vegetables, sweet and sour fruits, bran bread).

Decreased blood insulin

There are cases when insulin levels are low in the blood. What is it and how to treat? An excessively low amount of sugar in the blood leads to brain disorders. In this case, it is recommended to pay attention to foods that stimulate the pancreas - kefir, fresh blueberries, boiled lean meat, apples, cabbage and (the decoction is especially effective when taken on an empty stomach).

Through proper nutrition, you can normalize insulin levels and avoid complications, such as diabetes.

insulin and diabetes

There are two types of diabetes - 1 and 2. The first refers to congenital diseases and is characterized by the gradual destruction of pancreatic beta cells. If they remain less than 20%, the body ceases to cope, and replacement therapy becomes necessary for it. But when the islets are more than 20%, you may not even notice any changes in your health. Often, short and ultrashort insulin, as well as background (extended) insulin, are used in treatment.

The second type of diabetes is acquired. Beta cells with this diagnosis work "in good faith", but the action of insulin is impaired - it can no longer perform its functions, as a result of which sugar again accumulates in the blood and can cause serious complications, up to hypoglycemic coma. For its treatment, drugs are used that help restore the lost function of the hormone.

Patients desperately need insulin injections, but type 2 diabetics often do without drugs for a long time (years and even decades). True, over time, you still have to “sit down” on insulin.

Insulin treatment helps to get rid of the complications that develop when the body's need to receive it from the outside is ignored, and also helps to reduce the load on the pancreas and even contribute to the partial restoration of its beta cells.

It is believed that, having started insulin therapy, it is no longer possible to return to drugs (pills). However, you must agree, it is better to start injecting insulin earlier, if necessary, than to refuse it - in this case, serious complications cannot be avoided. Doctors say that there is a chance in the future to refuse injections for type 2 diabetes if insulin treatment was started on time. Therefore, carefully monitor your well-being, do not forget to stick to diets - they are an integral factor in good health. Remember that diabetes is not a death sentence, but a way of life.

New Research

Scientists continue to persistently look for a way to make life easier for patients with diabetes. In 2015, the United States introduced a new development - an insulin inhalation device that will replace syringes, making life easier for diabetics. This device is already available in American pharmacies by prescription.

In the same year (and again in the USA), the so-called “smart insulin” was introduced, which is injected into the body once a day, activating itself if necessary. Despite the fact that it has only been tested on animals so far and has not yet been tested on humans, it is clear that scientists made very important discoveries in early 2015. Let's hope that in the future they will delight diabetics with their discoveries.

Insulin is a life-saving drug that has revolutionized the lives of many people with diabetes.

In the entire history of medicine and pharmacy of the 20th century, perhaps only one group of medicines of the same importance can be distinguished - these are antibiotics. They, like insulin, very quickly entered medicine and helped save many lives.

World Diabetes Day is celebrated on the initiative of World Organization Health care every year since 1991 on the birthday of the Canadian physiologist F. Banting, who discovered the hormone insulin together with J. J. McLeod. Let's take a look at how this hormone is made.

How do insulin preparations differ from each other?

  1. The degree of purification.
  2. The source of receipt is porcine, bovine, human insulin.
  3. Additional components included in the solution of the drug - preservatives, prolongers of action and others.
  4. Concentration.
  5. solution pH.
  6. Possibility of mixing short and long-acting preparations.

Insulin is a hormone produced by special cells in the pancreas. It is a double-stranded protein with 51 amino acids.

About 6 billion units of insulin are used annually in the world (1 unit is 42 micrograms of a substance). The production of insulin is high-tech and is carried out only by industrial methods.

Sources of insulin

Currently, depending on the source of production, porcine insulin and human insulin preparations are isolated.

Pork insulin now has a very a high degree cleaning, has a good hypoglycemic effect, there are practically no allergic reactions to it.

Human insulin preparations fully correspond in chemical structure to the human hormone. They are usually produced by biosynthesis using genetic engineering technologies.

Large manufacturing firms use such production methods that guarantee that their products meet all quality standards. Large differences in the action of human and porcine monocomponent insulin (that is, highly purified) have not been identified; in relation to the immune system, according to many studies, the difference is minimal.

Auxiliary components used in the production of insulin

The drug vial contains a solution containing not only the hormone insulin itself, but also other compounds. Each of them plays a specific role:

  • prolongation of the action of the drug;
  • solution disinfection;
  • the presence of buffer properties of the solution and maintaining a neutral pH (acid-base balance).

Extending the action of insulin

To create long-acting insulin, one of two compounds, zinc or protamine, is added to a solution of regular insulin. Depending on this, all insulins can be divided into two groups:

  • protamine-insulins - protafan, insuman basal, NPH, humulin N;
  • zinc-insulins - insulin-zinc-suspensions mono-tard, tape, humulin-zinc.

Protamine is a protein, but allergic reactions to it are very rare.

To create a neutral environment for the solution, a phosphate buffer is added to it. It must be remembered that insulin containing phosphates is strictly forbidden to combine with insulin-zinc suspension (ICS), since zinc phosphate precipitates, and the effect of zinc-insulin is shortened in the most unpredictable way.

Disinfectants

Some of the compounds that, according to pharmaco-technological criteria, should already be introduced into the preparation have a disinfecting effect. These include cresol and phenol (both of which have a specific odor), as well as methyl parabenzoate (methylparaben), which has no odor.

The introduction of any of these preservatives causes the specific smell of some insulin preparations. All preservatives in the amount in which they are in insulin preparations do not have any negative effect.

Protamine insulins usually include cresol or phenol. Phenol cannot be added to ICS solutions, because it changes the physical properties of the hormone particles. These drugs include methylparaben. Zinc ions in solution also have an antimicrobial effect.

Thanks to such multi-stage antibacterial protection with the help of preservatives, the development of possible complications is prevented, which could be caused by bacterial contamination when the needle is repeatedly inserted into the vial with the solution.

Due to the presence of such a protection mechanism, the patient can use the same syringe for subcutaneous injections of the drug for 5 to 7 days (provided that only he uses the syringe). Moreover, preservatives make it possible not to use alcohol to treat the skin before injection, but again only if the patient injects himself with a syringe with a thin needle (insulin).

Calibration of insulin syringes

In the first preparations of insulin, one ml of the solution contained only one unit of the hormone. Later the concentration was increased. Most of the insulin preparations in vials used in Russia contain 40 units in 1 ml of solution. The vials are usually marked with the symbol U-40 or 40 units / ml.

For widespread use, they are intended just for such insulin and their calibration is carried out according to the following principle: when a person draws 0.5 ml of a solution with a syringe, a person gains 20 units, 0.35 ml corresponds to 10 units, and so on.

Each mark on the syringe is equal to a certain volume, and the patient already knows how many units this volume contains. Thus, the calibration of syringes is a graduation in terms of the volume of the drug, calculated on the use of U-40 insulin. 4 units of insulin are contained in 0.1 ml, 6 units in 0.15 ml of the drug, and so on up to 40 units, which correspond to 1 ml of solution.

In some countries, insulin is used, 1 ml of which contains 100 units (U-100). For such drugs, special insulin syringes are produced that are similar to those discussed above, but they have a different calibration.

It takes into account exactly this concentration (it is 2.5 times higher than the standard one). In this case, the dose of insulin for the patient, of course, remains the same, since it satisfies the body's need for a specific amount of insulin.

That is, if the patient previously used the U-40 preparation and injected 40 units of the hormone per day, then he should receive the same 40 units with injections of U-100 insulin, but inject it in an amount 2.5 times less. That is, the same 40 units will be contained in 0.4 ml of the solution.

Unfortunately, not all doctors, let alone diabetic patients, know about this. The first difficulties began when some of the patients switched to the use of insulin injectors (pen-syringes), which use penfills (special cartridges) containing U-40 insulin.

If you draw a solution labeled U-100 into such a syringe, for example, up to the mark of 20 units (that is, 0.5 ml), then this volume will contain as many as 50 units of the drug.

Each time, filling regular syringes with U-100 insulin and looking at the cut-off units, a person will gain a dose 2.5 times greater than that shown at this mark. If neither the doctor nor the patient notices this error in a timely manner, then there is a high probability of developing severe hypoglycemia due to a constant overdose of the drug, which often happens in practice.

On the other hand, sometimes there are insulin syringes calibrated specifically for the U-100 preparation. If such a syringe is mistakenly filled with the usual U-40 solution, then the dose of insulin in the syringe will be 2.5 times less than that written near the corresponding mark on the syringe.

As a result of this, a seemingly inexplicable increase in blood glucose is possible. In fact, of course, everything is quite logical - for each concentration of the drug, you must use a suitable syringe.

In some countries, such as Switzerland, there has been an elaborate plan to make a smart transition to U-100-labeled insulin preparations. But this requires close contact of all stakeholders: doctors of many specialties, patients, nurses from any department, pharmacists, manufacturers, authorities.

In our country, it is very difficult to implement the transition of all patients to only the use of U-100 insulin, because, most likely, this will lead to an increase in the number of errors in dose determination.

Combined use of short-acting and extended-acting insulins

In modern medicine, the treatment of diabetes mellitus, especially type 1, usually occurs using a combination of two types of insulin - short-acting and long-acting.

It would be much more convenient for patients if drugs with different durations of action could be combined in the same syringe and administered simultaneously to avoid double skin puncture.

Many doctors do not know what determines the possibility of mixing different insulins. This is based on the chemical and galenic (compositionally determined) compatibility of long-acting and short-acting insulins.

It is very important that when the two types of preparations are mixed, the rapid onset of action of short insulin does not stretch and disappear.

It has been proven that a short-acting preparation can be combined in one injection with protamine-insulin, while the onset of short-acting insulin is not delayed, because soluble insulin does not bind to protamine.

In this case, the manufacturer of the drug does not matter. For example, it can be combined with humulin H or protafan. Moreover, mixtures of these preparations can be stored.

With regard to zinc-insulin preparations, it has long been established that insulin-zinc suspension (crystalline) cannot be combined with short insulin, as it binds to an excess of zinc ions and transforms into extended insulin, sometimes partially.

Some patients first inject a short-acting drug, then, without removing the needle from under the skin, slightly change its direction, and inject zinc-insulin through it.

Very little scientific research has been carried out on this route of administration, so it cannot be ruled out that in some cases, with this method of injection, a complex of zinc-insulin and a short-acting preparation can form under the skin, which leads to a violation of the absorption of the latter.

Therefore, it is better to administer short insulin completely separately from zinc insulin, to make two separate injections into skin areas that are at least 1 cm apart from each other. This is not convenient, which cannot be said about the standard intake.

Combined insulins

Now the pharmaceutical industry produces combined preparations containing short-acting insulin together with protamine-insulin in a strictly defined percentage. These drugs include:

  • mixtard,
  • actrafan,
  • insuman comb.

The most effective are combinations in which the ratio of short and extended insulin is 30:70 or 25:75. This ratio is always indicated in the instructions for use of each specific drug.

Such drugs are best suited for people who follow a constant diet and have regular physical activity. For example, they are often used by elderly patients with type 2 diabetes.

Combination insulins are not suitable for so-called "flexible" insulin therapy, when it becomes necessary to constantly change the dosage of short-acting insulin.

For example, this should be done when changing the amount of carbohydrates in food, reducing or increasing physical activity, etc. At the same time, the dose of basal insulin (prolonged) remains practically unchanged.


Content:
Introduction
Chapter 1 Literature Review
1.1 Receiving insulin
1.2 Insulin preparations
1.3. Syringes, pens and insulin dispensers
1.4.Insulin injection technique………………………………………..
1.5. Factors affecting the absorption and action of insulin………..
1.6. Complications of insulin therapy………………………………………. .
1.7. Packaging of insulin
1.8. storage of insulin.
1.9. Modern ways of improving insulin therapy…..
Chapter 2. Experimental part
Conclusion
Literature

Introduction:
Insulin (from lat. insula - island) is a hormone of a peptide nature, formed in the beta cells of the islets of Langerhans of the pancreas. It has a multifaceted effect on the metabolism in almost all tissues.
The main function of insulin is to ensure the permeability of cell membranes for glucose molecules. In a simplified form, we can say that not only carbohydrates, but also any nutrients are ultimately broken down to glucose, which is used to synthesize other carbon-containing molecules, and is the only fuel for cellular power plants - mitochondria. Without insulin, the permeability of the cell membrane for glucose drops 20 times, and the cells die of starvation, and excess sugar dissolved in the blood poisons the body.
Impaired insulin secretion due to destruction of beta cells - absolute insulin deficiency - is a key link in the pathogenesis of type 1 diabetes mellitus. Violation of the action of insulin on tissues - relative insulin deficiency - has an important place in the development of type 2 diabetes mellitus.
The number of patients with diabetes worldwide is 120 million (2.5% of the population). Every 10-15 years the number of patients doubles. According to the International Diabetes Institute (Australia), by 2010 there will be 220 million patients in the world. There are about 1 million patients in Ukraine, of which 10-15% suffer from the most severe insulin-dependent diabetes (type I). In reality, the number of patients is 2-3 times higher due to latent undiagnosed forms.
The history of the discovery of insulin is associated with the name of the Russian doctor I.M. Sobolev (second half of the 19th century), who proved that the level of sugar in human blood is regulated by a special hormone of the pancreas.
In 1922, insulin isolated from the pancreas of an animal was first administered to a ten-year-old boy with diabetes. the result exceeded all expectations, and a year later the American company Eli Lilly launched the first preparation of animal insulin.

After receiving the first industrial batch of insulin in the next few years, a long way to isolate and purify it has been passed. As a result, the hormone became available to patients with type 1 diabetes.
In 1935, the Danish researcher Hagedorn optimized the action of insulin in the body by proposing a prolonged preparation.
The first insulin crystals were obtained in 1952, and in 1954 the English biochemist G. Senger deciphered the structure of insulin. The development of methods for purifying the hormone from other hormonal substances and insulin degradation products made it possible to obtain homogeneous insulin, called single-component insulin.
In the early 70s. Soviet scientists A. Yudaev and S. Shvachkin proposed the chemical synthesis of insulin, but the implementation of this synthesis on an industrial scale was expensive and unprofitable.
Subsequently, there was a progressive improvement in the degree of purification of insulin, which reduced the problems caused by insulin allergy, impaired kidney function, visual impairment and immune resistance to insulin. The most effective hormone for replacement therapy in diabetes mellitus was needed - homologous insulin, that is, human insulin.
In the 80s, achievements in molecular biology made it possible to synthesize both chains of human insulin using E. coli, which were then connected into a molecule of a biologically active hormone, and recombinant insulin was obtained at the Institute of Bioorganic Chemistry of the Russian Academy of Sciences using genetically engineered strains of E. coli.

The purpose of my work: The study of insulin preparations presented on our market, their advantages and disadvantages.
Tasks: Consideration of the technological process for obtaining insulin in industrial production.

Chapter 1 Literature Review
1.1 Getting insulin
Human insulin can be produced in four ways:
1) complete chemical synthesis;
2) extraction from human pancreas (both of these methods are not suitable due to uneconomical: insufficient development of the first method and lack of raw materials for mass production by the second method);
3) by a semi-synthetic method using an enzymatic-chemical replacement in position 30 of the B-chain of the amino acid alanine in porcine insulin with threonine;
4) in a biosynthetic way using genetic engineering technology. The last two methods make it possible to obtain highly purified human insulin.
Consider the biosynthetic production of insulin in terms of the advantages of this method.
So, the benefits of obtaining insulin biosynthetically.
Prior to the industrialization of the method of obtaining insulin using recombinant microorganisms, there was only one way to obtain insulin - from the pancreas of cattle and pigs. Insulin obtained from the pancreas of cattle differs from human insulin by 3 amino acid residues, and insulin obtained from the pig gland, only by one amino acid residue, that is, it is closer to human insulin. However, with the introduction of proteins that differ in structure from human proteins, even in such a slight expression, allergic reactions may occur. Such insulin, as a foreign protein, can also be inactivated in the blood by the resulting antibodies.
In addition, to obtain 1 kilogram of insulin, 35 thousand heads of pigs are required (if it is known that the annual need for insulin is 1 ton of the drug). On the other hand, the same amount of insulin can be obtained biosynthetically by biosynthesis in a 25 cc fermenter using the recombinant microorganism Escherichia coli.
The biosynthetic method for producing insulin began to be used in the early 80s.
(eighties).
Let us dwell on the scheme for obtaining recombinant insulin (Eli Lilli-Eli-Lilli, United States of America):
1. stage By chemical synthesis, nucleotide sequences were created that encode the formation of A and B chains, that is, synthetic genes were created.
2. stage. Each of the synthetic genes is introduced into plasmids (a gene synthesizing chain A is introduced into one plasmid, a gene synthesizing chain B is introduced into another plasmid).
3. stage. Enter the gene encoding the formation of the enzyme betagalactosidase. This gene is included in each plasmid in order to achieve vigorous replication of the plasmids.
4. stage. Plasmids are introduced into the cell of Escherichia coli - Escherichia coli and two cultures of the producer are obtained, one culture synthesizes the A-chain, the second B-chain.
5. stage. Place two cultures in the fermenter. Galactose is added to the medium, which induces the formation of the enzyme betagalactosidase. In this case, plasmids actively replicate, forming many copies of plasmids and, consequently, many genes that synthesize A and B chains.
6. stage. Cells lyse, secrete A and B chains, which are associated with betagalactosidase. All this is treated with cyanogen bromide and the A and B chains are cleaved from betagalactosidase. Then produce further purification and isolation of A and B chains.
7. stage. Oxidize cysteine ​​residues, bind and produce insulin.

The insulin obtained in this way is human insulin in its structure, which minimizes the occurrence of allergic reactions from the very beginning of therapy.
To obtain purified human insulin, the hybrid protein isolated from biomass is subjected to chemical-enzymatic transformation and appropriate chromatographic purification (frontal, gel-permeating, anion-exchange).
Recombinant insulin was obtained at the Institute of the Russian Academy of Sciences using genetically engineered strains of E. coli, the method consists in the synthesis of its biological precursor proinsulin, and allows not to carry out separate synthesis of A and B chains of insulin. For the production of the pro-insulin moiety in E. coli. a plasmid is introduced (it is obtained by embedding natural or foreign DNA - this is how a recombinant RNA molecule is obtained). The plasmid provides the synthesis of a recombinant protein, which is a leader sequence and a protein fragment, as well as human proinsulin with a methionine (amino acid) residue between them. The proinsulin part of the molecule is separated by treatment with cyanogen bromide in acetic acid (cleavage is selective - according to the methionine residue). The mixture (proinsulin moiety and leader sequence) is separated chromatographically. At the next stage, in the obtained sequence of proinsulin, the correct mutual arrangement of chains A and B is carried out, which is performed by the central part - peptide C. At the next stage, the C-binding peptide is isolated by the enzymatic method. After a series of chromatographic purifications, including ion exchange, gel and HPLC, I obtain human insulin of high purity and natural activity.
The quality control of genetically engineered insulin involves the control of additional indicators characterizing the stability of the recombinant strain and plasmid, the absence of foreign genetic material in the preparation, the identity of the expressed gene, etc.

1.2 Insulin preparations
Insulin preparations differ in the source of their receipt. Pig and bovine insulin differs from human insulin in amino acid composition: bovine - in three amino acids, and pork - in one. Not surprisingly, adverse reactions occur much more frequently with bovine insulin than with porcine or human insulin. These reactions are expressed in immunological insulin resistance, insulin allergy, lipodystrophy (changes in subcutaneous fat at the injection site).
Despite the obvious disadvantages of bovine insulin, it is still widely used around the world. Nevertheless, the disadvantages of bovine insulin in immunological terms are obvious: in no case is it recommended to prescribe it to patients with newly diagnosed diabetes mellitus, pregnant women or for short-term insulin therapy, for example, in the perioperative period. The negative qualities of bovine insulin are also preserved when mixed with porcine insulin, so mixed (pork + bovine) insulins should also not be used for the treatment of these categories of patients.
Human insulin preparations are completely identical in chemical structure to human insulin.
The main problem of the biosynthetic method for obtaining human insulin is the complete purification of the final product from the slightest impurities of the used microorganisms and their metabolic products. New quality control methods ensure that biosynthetic human insulins from the above manufacturers are free from any harmful impurities; thus, their degree of purification and hypoglycemic efficiency meet the highest requirements and are practically the same. These insulin preparations do not have any undesirable side effects depending on impurities.

Insulin preparations, depending on the onset and duration of action, are divided into the following groups:
1) insulins of fast and ultrashort action;
2) short-acting insulins ("simple" insulins);
3) insulins of average duration of action ("intermediate" insulins);
4) long-acting insulins;
5) "mixed" insulins - a combination of insulins of different duration of action.
The number of insulin preparations with different names is several dozen, and new names of various foreign insulins are added annually, and in last years and domestic pharmaceutical companies

Fast-acting and ultra-short-acting insulins

Rapid and ultrashort acting insulins currently include three new drugs - lispro (Humalog), aspart (Novo Rapid, Novolog) and glulisin (Apidra). Their peculiarity is in a faster onset and end of action compared to conventional, “simple” human insulins. The rapid onset of the glucose-lowering effect of new insulins is due to their accelerated absorption from subcutaneous fat. Features of new insulins allow to reduce the time interval between their injections and food intake, reduce the level of postprandial glycemia and reduce the incidence of hypoglycemia.
The onset of action of lispro, aspart and glulisin occurs in the range from 5 to 10-15 minutes, the maximum effect (peak of action) is after 60 minutes, the duration of action is 3-5 hours. These insulins are administered 5 to 15 minutes before a meal or just before it. It has been found that the administration of insulin lispro immediately after a meal also provides good glycemic control. However, it is important to remember that administering these insulins 20 to 30 minutes before a meal can lead to hypoglycemia.
Patients switching to the introduction of these insulins, it is necessary to control the levels of glycemia more often, until they learn to correlate the amount of carbohydrates consumed and the dose of insulin. Thus, the doses of drugs are set in each case individually.
If only humalog (insulin lispro), novo rapid or novolog (insulin aspart), or apidra (insulin glulisin) are used, they can be administered 4 to 6 times a day, and in combination with long-acting insulins - 3 times a day. Exceeding a single dose of 40 units is allowed in exceptional cases. These vial-based insulins can be mixed in the same syringe with longer acting human insulin preparations. In this case, fast-acting insulin is drawn into the syringe first. It is desirable to make an injection immediately after mixing. These insulins, produced in cartridges (special sleeves), are not intended for preparation of mixtures with any other insulins.

It is important!
New high-speed insulins are convenient for patients leading an active lifestyle, their use is recommended for acute infections, emotional stress, an increase in the amount of carbohydrates in food, when taking drugs that promote hyperglycemia (thyroid hormones, corticosteroids - prednisone, etc.), with intolerance to others insulin preparations or postprandial hyperglycemia, which does not respond well to the action of other insulins. It should be emphasized again that fast-acting insulins should be used in direct connection with food intake.
HUMALOG® (HUMALOG®)

Short-acting human insulin analog
Active ingredient "Insulin lispro" (Insulin lispro)

Composition and form of release
1 ml solution for injection contains insulin lispro 40 or 100 IU; in vials of 10 ml and cartridges of 1.5 and 3 ml (only 100 IU / ml).

pharmachologic effect
DNA recombinant analogue of human insulin. It differs from the latter in the reverse sequence of amino acids at positions 28 and 29 of the insulin B chain.
The main action of the drug is the regulation of glucose metabolism. In addition, it has an anabolic effect. In muscle tissue, there is an increase in the content of glycogen, fatty acids, glycerol, an increase in protein synthesis and an increase in the consumption of amino acids, but at the same time there is a decrease in glycogenolysis, gluconeogenesis, ketogenesis, lipolysis, protein catabolism and the release of amino acids.
Indications
Diabetes mellitus type I and II.
Side effect associated with the main action of the drug: hypoglycemia
Allergic reactions: local allergic reactions are possible - redness, swelling or itching at the injection site (usually disappear within a few days or weeks); systemic allergic reactions (occur less often, but are more serious) - generalized itching, urticaria, angioedema, fever, shortness of breath, lowering blood pressure, tachycardia, increased sweating. Severe cases of systemic allergic reactions can be life-threatening.
Local reactions: lipodystrophy at the injection site.
Contraindications for use:

hypoglycemia;
- Hypersensitivity to the components of the drug.
To date, no adverse effect of insulin lispro on pregnancy or the health of the fetus / newborn has been identified.
Terms of dispensing from pharmacies

The drug is dispensed by prescription.
Terms and conditions of storage

List B. The drug should be stored out of the reach of children, in the refrigerator, at a temperature of 2 ° to 8 ° C; do not freeze. Shelf life - 2 years.
The drug in use should be stored at room temperature from 15 ° to 25 ° C; protect from direct sunlight and heat. Expiration date - no more than 28 days.

Short acting insulins

Short-acting insulins are used for combination therapy together (but not necessarily at the same time) with intermediate-acting and long-acting insulins, as well as for the treatment of diabetes mellitus in special situations - ketoacidosis, infections with high body temperature, operations, injuries, etc. These insulins, depending on the treatment plan, can be administered from 1-2 to 4-6 times a day. The onset of action of the introduced "simple" insulin after 15 - 60 minutes, the maximum effect (peak of action) - after 1.5 - 4 hours, the duration of action depends on the dose: at low doses (4 - 6 units) - within 4 - 5 hours, at high doses (16-20 units) - up to 6-8 hours.
Examples of short-acting human insulin preparations: akmpanug NM, berlinsulin N normal 1-40 (in 1 ml 40 U), berlinsulin N normal pen (in 1 ml 100 U; "pen" - injection device), insuman Rapid ChM, humulin regular, biosulin R.
Examples of porcine insulin preparations (monocomponent, i.e., highly purified) short-acting: insulin maxirapid VO-C, monosuinsulin MS.

Berlinsulin N Normal U-40
(Berlinsulin H Normal U-40)

Active substance
"Insulin soluble [human semi-synthetic]" (Insulin soluble *)

Composition and form of release
1 ml solution for injection contains human insulin 40 IU; in bottles of 10 ml, in a box of 1 pc.
Pharmacological action - hypoglycemic. It interacts with a specific plasma membrane receptor and penetrates into the cell, where it activates protein phosphorylation, stimulates glycogen synthetase, pyruvate dehydrogenase, hexokinase, and inhibits adipose tissue lipase and lipoprotein lipase. In combination with a specific receptor, it facilitates the penetration of glucose into cells, enhances absorption and promotes its conversion into glycogen. Increases the supply of glycogen in the muscles, stimulates the synthesis of peptides.
Indications
Diabetes mellitus type I and II (all forms), diabetic coma.
Contraindications
Hypersensitivity (relative contraindication), hypoglycemia.
Side effects
Hypoglycemia, lipodystrophy and redness of the skin at the injection site, allergic reactions.
Dosage and administration
The dosage is set individually. Usually injected s / c (in special cases - in / m) 10-15 minutes before meals 3-4 times a day. A single dose is 6-20 IU. In patients with diabetes mellitus with increased sensitivity to insulin and in children, this dose is reduced, in patients with slight sensitivity to insulin, it is increased. In diabetic coma, first Berlinsulin N Normal U-40 is administered intravenously at a dose of 0.1–0.3 U/kg, then a long-term intravenous infusion at the rate of 0.1–0.2 U/kg per hour.
Shelf life 2 years
Storage conditions
List B.: In a cool place, at a temperature of 2–8 ° C (do not freeze).

Intermediate-acting insulins

Intermediate-acting insulins are used as basic (basal) and are administered 1-2 times a day. These insulins are absorbed relatively slowly from the injection sites, and therefore their glucose-lowering effect begins after 1.5 - 2 hours. Hagedorn's neutral protamine insulin preparations, abbreviated "NPH", are used. Unlike insulin-zinxuspensin, NPH-insulin contains the protein protamine and insulin itself in equal (isophane) amounts, in which there is no excess of either insulin or protamine (isophane-insulin). This allows you to mix NPH-insulin with short-acting insulin in any ratio without changing their effect.
With the introduction of insulins of this group, the maximum effect occurs after 6-10 hours, and the total duration of action depends on the size of their dose: from 12-14 hours with the introduction of 8-12 IU, and up to 16-18 hours - with the introduction of large doses (more than 20 - 25 units).
Examples of intermediate-acting human insulin preparations: berlinsulin-N basal 1-40, insuman basal, protofan NM, biosulin H, humulin HPX, homofan 100. A new Russian drug based on a suspension of insulin and protamine is called brinsulmi-di ChSP.

Protafan HM (Protaphane HM)

Active substance
Insulin isophane [human genetically engineered] (Insulin- isophan )
Composition and form of release
1 ml suspension for injection contains biosynthetic human insulin 100 IU; in Penfill 3 ml cartridges for use with NovoPen 3, NovoPen 3 Demi and Innovo insulin syringe pens and NovoFine needles; in a blister pack of 5 pcs., in a box 1 pack.
Characteristic
Monocomponent biosynthetic human isophane-insulin suspension of medium duration of action.
pharmachologic effect
Pharmacological action - hypoglycemic. It interacts with a specific plasma membrane receptor and penetrates into the cell, where it activates the phosphorylation of cellular proteins, stimulates glycogen synthetase, pyruvate dehydrogenase, hexokinase, inhibits adipose tissue lipase and lipoprotein lipase. In combination with a specific receptor, it facilitates the penetration of glucose into cells, enhances its uptake by tissues and promotes its conversion into glycogen. Increases the supply of glycogen in the muscles, stimulates the synthesis of peptides.
Indications
Type I diabetes mellitus, type II diabetes mellitus (with resistance to sulfonylurea derivatives, intercurrent diseases, operations and in the postoperative period, during pregnancy).
Contraindications
Hypoglycemia, insulinoma.
Side effects
Hypoglycemic conditions, allergic reactions, lipodystrophy (with prolonged use).
Best before date
2.5 years
Storage conditions
List B.: In a place protected from light, at a temperature of 2–8 ° C (do not freeze). Must not be exposed to sunlight. The used vial can be stored at room temperature (not higher than 25 °C) for 6 weeks.

Long acting insulins

Long-acting insulins are used as basic (basal) insulins, they are administered 1, rarely 2 times a day. The onset of action is after 3-4 hours, the maximum effect is after 8-10 hours, the duration of action at low doses (8-10 units) is 14-16 hours, at high doses (20 units and more) - 24 hours. When injecting long-acting insulin in doses of more than 0.6 U per 1 kg of body weight per day, the drugs should be administered in the form of 2-3 injections in different places of the patient's body.
Examples of long-acting human insulin preparations: humulin U, ultratard NM, insuman basal GT, ultralente.
Insuman Basal GT (Insuman Basal GT)

Active substance
Insulin-isophane [human genetically engineered] (Insulin-isophan)
Composition and form of release
1 ml of neutral suspension for injections Insuman Basal contains human insulin (100% crystalline protamine insulin) 40 or 100 IU; in vials of 10 or 5 ml, respectively, in a carton pack of 5 pcs.
1 OptiPen cartridge (Insuman Basal 100 for OptiPen) contains 3 ml of neutral suspension of human insulin (100% crystalline protamine insulin) with an activity of 100 IU/ml; in a cardboard box 5 pcs.
Characteristic
It is identical in structure to human insulin and obtained by genetic engineering.
Pharmacological action - hypoglycemic.
Pharmacodynamics
It lowers the level of glucose in the blood, increases its uptake by tissues, enhances lipogenesis and glycogenolysis, protein synthesis, and reduces the rate of glucose production by the liver.
Indications
Type 1 diabetes mellitus in patients who have not previously received insulin, pregnant women; in case of intolerance to other insulin-containing drugs; labile form of diabetes mellitus against the background of a high titer of antibodies to insulin, transplantation of pancreatic islet cells. Type 2 diabetes mellitus with resistance to oral hypoglycemic agents, during surgical operations, with the addition of concomitant diseases, with the ineffectiveness of diet therapy during pregnancy.
Contraindications
Hypersensitivity, hypoglycemia.
Side effects
Associated with the effect on carbohydrate metabolism: hypoglycemia (pallor, sweating, palpitations, sleep disorders, tremors); neurological disorders (rare). Local reactions: lipodystrophy at the injection site (with prolonged use). Allergic reactions.
Treatment: oral glucose (if the patient is conscious). In case of loss of consciousness, intravenous glucose or glucagon is administered intramuscularly (s / c).
Dosage and administration
P / c, 45-60 minutes before meals. The injection site is changed each time. The dose is set individually: for adults receiving the drug for the first time, they start with a dose of 8–24 IU 1 time per day (for patients with high insulin sensitivity, 8 IU / day may be sufficient, with a reduced one - more than 24 IU / day). The maximum single dose is 40 IU (exceeding this dose is allowed only in exceptional cases).
Precautionary measures
Absolutely unacceptable in / in the introduction. When replacing insulins of animal origin with Insuman Basal, a dose reduction may be required.
Best before date
2 years
Storage conditions
List B.: At a temperature of 2–8 ° C (do not freeze).

In recent years, analogues of long-acting insulins glargine and detemir have been created, which are widely introduced into practice. Compared to conventional long-acting insulins, these insulins are characterized by a smooth glucose-lowering effect during the day without a maximum (peak) of action, a more significant decrease in fasting blood glucose, and a rare occurrence of nocturnal hypoglycemia. The increased duration of action of insulin glargine or detemir is directly due to the low rate of their absorption (absorption) from the site of subcutaneous injection in the shoulder, thigh or abdomen. Injection sites should alternate with each new injection of the drug. These new drugs, administered once a day for glargine or once or twice a day for detemir, have good prospects in insulin therapy.
Of these insulins, glargine under the brand name "Lantus" has already received the most widespread use, 1 ml of which contains 100 units of insulin glargine. Lantus is available in 3 ml cartridges (sleeves), 10 ml bottles and 3 ml Opti Set syringe pens. Lantus begins to act, on average, 1 hour after subcutaneous administration. The average duration of action is 24 hours, the maximum is 29 hours. However, the nature of the effect of Lantus on glycemia during the time of action of the drug can vary significantly both in different patients and in the same patient.
In type 1 diabetes, Lantus is used as the main insulin. In type 2 diabetes, Lantus can be used both as the only method of specific treatment, and in combination with other drugs that normalize blood glucose levels.

Mixed (combined) insulins

Mixed (combined) insulins are ready-made mixtures of insulins different duration actions. They are mainly used for insulin therapy for type 2 diabetes mellitus and for traditional (non-intensive) insulin therapy for type 1 diabetes.
Mixed insulins are produced under the name insulin L, berlinsulin N, insuman comb 25 GT, mixtard 30 NM, humulin M 3, etc. These insulins indicate the percentage of two short-acting and medium-acting human insulins, the latter based on isophane insulin (see. higher). So, insuman combo is produced with the designation 15/85, 25/75 and 50/50. This means, for example, that in a bottle of insuman comb 25/75 containing 1 ml of 40 units of insulin, there are 10 units of short-acting insulin (25% of 40 units) and 30 units (75% of 40 units) of intermediate-acting insulin.
The onset of action of combined insulins is approximately 30 minutes after administration, the total duration of action is 14-16 hours. The maximum glucose-lowering effect (peak) depends on the percentage of insulins: the more “simple” insulin, the earlier the peak of action occurs. So, for insulins 10/90 and 40/60 (respectively 10 and 40% of short-acting insulin), the maximum effect occurs, respectively, after 4-6 and 2.5-3 hours. Insulins 10/90, 15/85, 25/75 are administered 30-45 minutes before meals, and insulin 50/50 - 20-30 minutes before meals. Note that the indicated duration of action of ready-made mixtures of insulins is approximate; it depends on the dose, and on the individual characteristics of the person.
Ready-made mixtures of a fast-acting analog of insulin lispro (humalog) and an intermediate-acting insulin - humulin NPH were created in the ratios of 75/25 (75% and 25%) and 50/50, i.e. 50% each. The drugs are administered 5-15 minutes before meals 2 times a day and provide good glycemic control. It is desirable to introduce them with the Huma Pen Ergo syringe pen.
Note!
For patients with type 1 diabetes, it is preferable to use mixed insulins with a high content of short-acting insulin in conventional (non-intensive) insulin therapy, while doing 2 injections per day is enough.
For patients with type 2 diabetes, preparations with a low content of short-acting insulin, for example, 10-30% of “simple” insulin and 90-70% of intermediate-acting insulin, are optimal.

The newest mixed (combined) insulins include novo-mix 30 penfill, 1 ml of which contains 100 units of insulin, including 30% insulin acnapm soluble and 70% insulin acnapm protamine crystalline. The soluble insulin aspart, which is part of Novo-Mix 30, begins to act faster than conventional soluble human insulin, and the crystalline insulin aspart protamine has a medium duration of action. After subcutaneous administration of the drug, the effect develops in 10-20 minutes, the maximum effect is 1-4 hours after the injection. The duration of action is 24 hours. Novomix 30, called biphasic insulin aspart, should be administered immediately before meals, if necessary, immediately after meals. The dose is set individually based on blood glucose levels. The average daily dose ranges from 0.5 to 1 unit per 1 kg of body weight.
Novo-Mix 30 is more effective in reducing postprandial elevated blood glucose levels with a reduced risk of hypoglycemia compared to a 30/70 human insulin mixture. In addition, this drug presents ample opportunities for combination with taking glucose-lowering tablets. Thus, one injection of Novo-mix 30 before dinner in combination with metformin provides effective control of glycemic levels in type 2 diabetes mellitus.
Novo-mix 30 is not recommended for patients under 18 years of age due to the lack of clinical data on the safety and efficacy of the drug in this age group. Despite limited experience with the use of insulin aspart during pregnancy, the use of Novo-Mix 30 in pregnant women and breastfeeding mothers with diabetes is recognized as acceptable.
The rules for the use of novo-mix 30 penfill, which is available in cartridges (sleeves) of 3 ml, have been established. The administered drug should be at room temperature. Injections are made subcutaneously in the thigh or abdomen, if desired, in the shoulder or buttocks. Injection sites within the selected area should be changed to prevent the development of lipodystrophy.
Novo-mix 30 penfill cartridges are designed for use with Novo Nordisk insulin injection systems and Novo Fine needles. Cartridges should only be used in conjunction with insulin injectors that are compatible with them and allow the cartridge to work effectively and safely. Cartridges must be carefully checked. Do not use insulin if there are flakes in it after mixing, if solid white particles have stuck to the bottom or walls, creating the effect of a frosty pattern. Novo-mix 30 penfill cartridges are not designed to be refilled. If Novo-Mix 30 penfill and other insulin in a penfill cartridge are used at the same time, then two injection systems should be used to administer insulin - one for each type of insulin. After each injection, the needle should be removed due to the possibility of leakage of fluid from the cartridge due to temperature fluctuations, which can lead to a change in insulin concentration.

When calculating the dose of insulin, the following main factors are taken into account:
1) the level of glucose in the blood and urine;
2) time of day;
3) the amount of carbohydrates that is supposed to be eaten during the next meal after the injection;
4) physical activity before and after meals. These factors are designated as the main ones, because
they largely determine the calculation of the dose of insulin and take place in every patient with diabetes mellitus. However, many additional factors are known to influence insulin requirements and must be taken into account when calculating the dose of insulin in individual patients.

1.3. Syringes, pens and insulin dispensers:
Traditionally, insulin syringes are used for injections, at present they are plastic. The standard syringe used in Russia is still designed for 1 ml of insulin with a concentration of 40 units. The marking on the body of the syringe is applied in insulin units as on a regular ruler with the numbers 5, 10, 15, 20, 25, 30, 35, 40, as well as with a single step - divisions between the indicated numbers, corresponding to 1 Unit. Foreign insulin syringes can be 0.3, 0.5 and 2 ml in volume and with a concentration of mainly 100 U, less often 40 U. In Russia, there will be a transition to syringes designed according to the international standard for 100 units. For injections, it is better to use syringes with welded (non-removable) needles. Subject to hygiene rules, plastic insulin syringes can be reused for 2-3 days: it is enough to close the needle with a cap and store it in this form without sterilization measures. However, after 4 to 5 injections, due to the blunting of the needle, the introduction of insulin becomes painful. Therefore, with intensive insulin therapy, disposable syringes will correspond to the name "disposable".
Before injection, it is advisable to wipe the rubber stopper of the insulin vial with a cotton swab dipped in 70% alcohol. Vials with short-acting insulin, as well as long-acting insulin analogues (glargine, detemir), do not need to be shaken. Conventional slow-acting insulins are suspensions, that is, a precipitate forms in the vial, and it must be shaken well before taking insulin.
When dialing insulin into the syringe, pull the syringe plunger to the mark indicating the desired number of units of insulin, then pierce the rubber stopper of the insulin vial with a needle, press the piston and let air into the vial. Next, the syringe with the vial is turned upside down, holding them in one hand at eye level, the piston is pulled down to a mark slightly exceeding the dose of insulin. It is better to pierce the cork of the vial in its very center with a thick needle for conventional syringes, and then insert the needle of the insulin syringe into this puncture. If air bubbles have entered the filled syringe, flick the syringe with your fingers and carefully move the plunger to the desired dose mark.
The use of a mixture of different types of insulin at the right doses provides a more even effect on blood glucose levels than the separate administration of the same insulins at the same doses. However, when different insulins are mixed, their physicochemical changes are possible, which affect the action of insulins.
Rules for mixing different insulins in a syringe:
short-acting insulin is drawn into the syringe first, medium-acting insulin is second;
short-acting insulin and intermediate-acting NPH-insulin (isophane-insulin) after mixing can be used immediately and stored for later administration;
short-acting insulin should not be mixed with insulin containing zinc suspension, as excess zinc partially converts short-acting insulin into intermediate-acting insulin. Therefore, short-acting insulin and zinc-insulin are administered separately as two injections into skin areas spaced at least 1 cm apart;
when mixing fast (lispro, aspart) and long-acting insulins, the onset of action of fast insulin does not slow down. Slowdown is possible, although not always, when fast insulin is mixed with NPH insulin. A mixture of fast insulin with insulins of medium or long duration of action is administered 15 minutes before meals;
Intermediate-acting NPH insulin must not be mixed with long-acting insulin containing zinc suspension. The latter, as a result of chemical interaction, can pass into short-acting insulin with an unpredictable effect after administration;
long-acting insulin analogues glargine and detemir should not be mixed with other insulins.
Syringe pens consist of a sleeve (cartridge, cartridge) for insulin, a body, a mechanism for automatically triggering a piston, a needle put on the tip of the sleeve sticking out of the pen (after injection, the needle is removed), a cap for the pen when not in use and a case similar to the case ink pen. The pen has a release button and a mechanism that allows you to set the dose of insulin with an accuracy of 0.5 and 1 Unit.
The advantage of the pen is the combination of the syringe and the insulin container and the less time-consuming injection procedure than with a conventional syringe. The needles of the syringe pen are shorter, so injections are made at an angle of 75 - 90 °. The needles are so thin that they cause very little pain. Syringe pens can be carried in a pocket or bag, they are convenient for active people, as well as for patients with impaired vision - the dose is set by the clicks of the mechanism: 1 click is equal to 0.5 or 1 Unit.
Many types of syringe pens are produced (“Humapen”, “Plivapen”, “Optipen”, etc.), which usually have instructions in Russian. As an example, consider the Novo Pen 3 syringe pen, which allows you to:
- dispense with a set step of 1 unit;
- less often to change the sleeve due to its large volume (300 units);
- dose with high accuracy;
- inject quickly and discreetly;
- Accurately follow the doctor's prescriptions;
- use a complete set of insulins, including 5 ready-made mixtures.
The Novo Pen 3 pen has a "window" with a wide view and a scale that allows the patient to control the amount of insulin remaining and the homogeneity of the suspension. The Novo Pen 3 system uses 3 ml sleeves filled with both protofan insulin and premixed broad-spectrum insulins, which are color-coded for faster recognition. Changing the sleeve takes a few seconds.
The Novo Pen 3 Demi pen has all the advantages of the Novo Pen 3 syringe pen, but is designed specifically for those who need small doses of insulin and their fine adjustment. This pen has a minimum insulin dose of 1 unit and a dialing increment of 0.5 units. Novo Pen 3 Pen Mate is recommended for those who are afraid of injections even with the thinnest needles. In it, the needle, hidden in the body of the device, is automatically inserted into the subcutaneous fat after pressing the button, and this insertion occurs instantly and is almost imperceptible to the patient. As a result, daily repeated administration of insulin becomes psychologically less burdensome.
Injection pens are very popular in many countries. For diabetic patients in Russia, syringe pens have disadvantages: they are expensive, cannot be repaired if broken, the supply of penfill insulin for sleeves is organized worse than insulin in vials.
Insulin pump A convenient method of intensive insulin therapy is the use of insulin dispensers ("insulin pump") with continuous subcutaneous injection of insulin. In the United States, more than 200,000 diabetics use insulin dispensers instead of injections with a syringe or pen.
With the help of insulin dispensers, it is delivered to the body through a catheter installed subcutaneously and connected to an insulin reservoir and a memory unit. The latter contains information about the amount of insulin to be administered. The size of the dispenser is small - about the size of a cigarette pack.
The dispensers use ultra-short-acting and short-acting insulins. The dispensers have two modes of insulin administration: continuous supply in microdoses (basal rate), as well as a rate determined and programmed by the patient himself. The first mode reproduces the background secretion of insulin and replaces the administration of intermediate-acting insulins. The second regimen is administered to patients during meals (taking into account the amount of carbohydrates consumed) or at high blood glucose levels and replaces short-acting insulin in conventional insulin therapy. The dispenser does not measure the concentration of glucose in the blood and does not calculate the required dose of insulin. This should be done by the patient himself, he also replaces the catheter inserted subcutaneously every 2-3 days. Modern dispensers (for example, model 508 R sold in Russia) have an alarm system and, in case of malfunctions, report them to the patient with sound signals or vibration.
The advantages of using insulin pumps over insulin therapy via multiple injections are as follows:
- the use of only short-acting insulin and its intake in microdoses prevents the deposition of insulin in the subcutaneous tissue, which ensures better absorption of the drug and reduces the risk of hypoglycemia in case of "emissions" of insulin from an artificially created depot;
- the dispenser programs various basal (background) speeds of insulin administration depending on the time of day; this is important for patients with morning hypoglycemia;
- the introduction of small doses of insulin (depending on the dispenser step 0.05 - 0.1 U) is convenient for people with a very low need for insulin;
- continuous basal injection of insulin and the possibility of its additional administration by pressing a combination of buttons on the dispenser allows the patient to lead a more free lifestyle, not to depend on the time of insulin injections, main meals, snacks, that is, it improves the quality of life.
Improved control of carbohydrate metabolism with the use of insulin dispensers in patients with type 1 diabetes has been proven by many studies. According to the Endocrinological Research Center of the Russian Academy of Medical Sciences (2006), the use of insulin dispensers in the form of an insulin pump makes it possible to more effectively compensate for type 1 diabetes with a pronounced decrease in the level of glycated hemoglobin, and also improves the quality of life of patients. Metered insulin therapy for type 2 diabetes is less common.
Despite a number of advantages of insulin dispensers in providing compensation for diabetes, this method has its drawbacks:
- certain technical difficulties in the operation of the insulin dispenser limit the circle of patients who can use it on their own;
- insulin dispensers can only be used by well-trained and disciplined patients, since this type of insulin therapy requires more frequent monitoring of blood glucose levels - at the initial stage, when selecting basal rates, 6-10 times a day;
- a patient using an insulin dispenser must always have at hand a replaceable system (reservoir and catheter), insulin, as well as an insulin syringe or pen;
- high price dispensers of insulin still limits the possibility of their wider application. For example, the cost of the DANA Diabetcare II S insulin pump, which went on sale in 2007, with the function of auto-adjusting the dose of insulin, is 3300 euros.
Insulin injectors
Insulin injectors are suitable for people who are afraid of injections. Resembling pens, they seem to inject a small dose of insulin under the skin using pressure.
In July 2000, Equidyne launched the Injex 30 compact injector. A high-velocity jet delivers insulin under the skin.
A rough estimate showed that 50,000 people in the US use insulin injectors. Although older models are heavy and cumbersome to use, about one in ten injections is actually painful.
Although injectors are painful, many people prefer to use a needle-free means of injecting insulin. The choice of means of insulin administration depends mainly on individual needs and lifestyle.
And if you are really afraid of injections, then insulin injectors are just for you. If you're more concerned about the convenience of administering insulin, or if you frequently inject on the go, then a pen is probably the way to go.
Some companies are regular manufacturers of insulin injections.
etc.................

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