Treatment of diabetes are different insulins developed over the years with different modes of action available.
Insulin is classified according to different criteria such as origin, species used, profile of action or duration of action. The insulin treatment in type 1 diabetes requires a dose of long-acting insulin to cover the basic needs as well as short-acting insulin at meals.
For the conventional insulin injection with a syringe, both U40 (corresponding to 40 IU / ml) and U100 (equivalent to 100 IU / ml) insulin syringes are used (U or IU are each international units, an internationally agreed dose size in insulin). For insulin pumps and the pen U100 insulins are used.
Today, diabetics are usually treated with human insulin. This is human insulin that is produced by genetic engineering in general. Pork and beef insulin are still being sold. Their effect is that of human insulin. There are pork and beef insulin but may cause frequent insulin allergy and fat depositt changes at the injection sites. Newer insulin are genetically engineered insulin analogues with a modified molecular structure and a different activity profile.
1. Regular insulin (regular insulin)
Regular insulin was the first insulin to treat diabetes. Regular insulin, in contrast to the insulin analogues, are not chemically modified human insulin with delayed onset of action.
Normal insulin is fast acting and can cause a rapid rise in insulin in the blood. With subcutaneous (under the skin) injection, the onset can be after 30 minutes, the maximum effect is achieved after 2 hours. The total duration of action is 4-6 hours. At a higher dose, the duration of action can be prolonged.
In general, insulin is injected subcutaneously. For the treatment of diabetic coma, it is injected intravenously injected insulin instead of subcutaneously. By subcutaneous injection of regular insulin, it should be given about 30 minutes before the meal so that it can contribute to and after the meal.
2. Fast-acting insulin analogues
The insulin lispro and aspart are genetically engineered insulin analogues (chemically modified insulins) with a very short onset of action of 10 minutes and a short duration of action.
These insulins are based much more on the workings of the body’s own insulin as the insulin is above normal. Therefore, the rapid-acting insulin analogues lead to lower blood sugar levels after eating, to a reduction in HbA1c levels and a reduction in the number of severe hypoglycemia. The maximum effect is reached after 1 hour. Moreover, the duration of action of subcutaneous injection is shorter than that of regular insulin, it is 2-3 hours.
Insulin
The onset of insulin may be delayed by the substances such as protamine, zinc or sulfur. Delayed insulin must be injected subcutaneously(under the skin).
Insulin can be used in conventional and intensified conventional insulin therapy and in the combination treatment of insulin with oral antidiabetic agents.
3. NPH insulin (neutral protamine Hagedorn insulin)
By connecting the substance of insulin protamine with the so-called NPH insulin (named after its inventor, Hans Christian Hagedorn) a delayed and prolonged effect can be achieved. They are the standard insulin to cover the basic needs of food-independent insulin and are also called Intermediate.
The onset of NPH insulin starts approximately 2 hours after the injection. The maximum effect is reached after about 4-6 hours and the duration of action is 8-12 hours.
NPH insulin is to be mixed with normal (old) insulin or with rapid-acting insulin analogues (insulin compound).
4. Zinc delayed insulins (lente insulin)
Through the combination of insulin molecules with zinc ions, crystalline insulins (Ultratard) are produced. This has a duration of 12-36 hours. Most of these insulin cover basal insulin needs with only one injection a day. However, these crystalline suspensions are greatly absorbed by the body, so that the treatment does not ensure adequate security.
A disadvantage is the long duration of action of this insulin to the flexibility of the user.
Another delayed zinc insulin is the amorphous insulin Semilente. Its onset of action is faster and the duration of action is longer than that of NPH insulin. Therefore, it can be used if there are NPH insulin at night.
5. Surfing-insulin
The combination of insulin with the synthetic surfing can produce delay insulin. Previously this insulin was used frequently.
In particular, due to the injection sites, increasingly occurring lipo atrophy and lipo dystrophy can be observed. This insulin is now given only rarely.
6. Mixtures of normal (old) insulin with longer-acting insulin (mixed insulins)
A mixture of short and medium long-acting NPH insulin is beneficial especially if the treatment is under the scheme of conventional insulin therapy with 2-3 daily injections. Thus, both the number of required injections should be reduced, and the amount of insulin to be adapted to the needs of the metabolism.
By mixtures of normal (old) or rapid-acting insulin analogues with NPH insulin, the diabetic can have a better control of sugar. The injection is given as that of the pure NPH insulin (subcutaneously) under the skin.
7. Long-acting insulin analogue
The long-term insulin glargine was developed only a few years.
The duration of action is 16-30 hours, so that usually only one injection per day is necessary.
In contrast to NPH insulin glargine produced no peak levels (temporary sharp increase in blood concentration after insulin administration). Therefore, even when administered at bedtime, there is reduced the risk for nocturnal hypoglycemia than NPH insulin. It is therefore preferred for people with diabetes to have NPH insulin at night.