What is insulin made from (production, production, production, synthesis). Human insulin instructions for use

Actrapid HM, Actrapid HM penfill, Berlinsulin N normal pen, Berlinsulin N normal U-40, Insuman rapid, Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Composition and release form

Soluble neutral human biosynthetic insulin. Solution for injection in a bottle (in 1 ml - 40 units, 100 units).

pharmachologic effect

It is a neutral solution of insulin identical to human insulin. Refers to insulins short acting. Reduces blood glucose levels, enhances its uptake by tissues, lipogenesis, glycogenogenesis, protein synthesis, and reduces the rate of glucose production by the liver.

The onset of action of the drug is 20-30 minutes after administration. The maximum effect develops between 1 and 3 hours. Duration of action is 6-8 hours.

The action profile of human neutral soluble insulin is dose dependent and reflects significant inter- and intrapersonal variations. Absorption from the injection site is faster than porcine neutral soluble insulin.

Indications

, : stage of resistance to oral hypoglycemic agents, partial resistance to oral hypoglycemic agents ( combination therapy), intercurrent diseases, operations (mono- or combination therapy), pregnancy (if diet therapy is ineffective).

Diabetic ketoacidosis, ketoacidotic and hyperosmolar coma, with upcoming surgical intervention, allergy to insulin preparations of animal origin, insulin lipoatrophy, insulin resistance due to high titer of anti-insulin antibodies, during transplantation of pancreatic islet cells.

Application

The dose is determined by the doctor individually. When used as monotherapy, the drug is prescribed 3-6 times a day. Enter subcutaneously, intramuscularly or intravenously. When transferring patients from highly purified porcine insulin to human insulin, the dose is not changed.

When switching from bovine or mixed (porcine/bovine) insulin, the dose should be reduced by 10%, except in cases where the initial dose is less than 0.6 U/kg. It is advisable to hospitalize patients receiving 100 units or more per day while changing insulin. The drug is administered with a pen syringe only subcutaneously.

The insulin dose must be adjusted according to following cases: with changes in the nature and diet, heavy physical activity, infectious diseases, surgical interventions, pregnancy, dysfunction thyroid gland, Addison's disease, hypopituitrism, renal failure and diabetes in people over 65 years of age.

When prescribing insulin for the first time, changing its type, or in the presence of significant physical activity or mental stress, the ability to concentrate, the speed of mental and motor reactions may decrease.

Side effect

Hypoglycemia (somewhat more often than with the use of insulin preparations of animal origin), AR - much less often. Transient disturbances refraction - usually at the beginning of insulin therapy.

Ideal hormonal levels- this is the basis for full development human body. One of key hormones The human body is insulin. Its deficiency or excess leads to negative consequences. Diabetes mellitus and hypoglycemia are the two extremes that become constant unpleasant companions of the human body, which ignores information about what insulin is and what its level should be.

Hormone insulin

The honor of creating the first works that laid the path to the discovery of the hormone belongs to the Russian scientist Leonid Sobolev, who in 1900 proposed using the pancreas to obtain an antidiabetic drug and gave the concept of what insulin is. More than 20 years were spent on further research, and after 1923, industrial insulin production began. Today the hormone is well studied by science. It takes part in the processes of carbohydrate breakdown, being responsible for metabolism and fat synthesis.

Which organ produces insulin?

The insulin-producing organ is the pancreas, where conglomerates of B cells are located, known to the scientific world as the islets of Lawrence or pancreatic islets. The specific mass of cells is small and amounts to only 3% of the total mass of the pancreas. Insulin is produced by beta cells; the hormone has a subtype called proinsulin.

What subtype of insulin is is not completely known. The hormone itself, before taking its final form, enters the Golgi cell complex, where it is refined to the state of a full-fledged hormone. The process is completed when the hormone is placed in special granules of the pancreas, where it is stored until a person eats food. The resource of B cells is limited and is quickly depleted when a person abuses simple carbohydrate foods, which is the cause of the development diabetes mellitus.

Action

What is the hormone insulin? It is the most important regulator of metabolism. Without it, glucose entering the body with food will not be able to enter the cell. The hormone increases the permeability of cell membranes, as a result of which glucose is absorbed into the cell body. At the same time, the hormone promotes the conversion of glucose into glycogen, a polysaccharide that contains a reserve of energy that is used by the human body as needed.

Functions

The functions of insulin are varied. It ensures the functioning of muscle cells, influencing the processes of protein and fat metabolism. The hormone plays the role of a brain informant, which, based on receptor data, determines the need for fast carbohydrates: if there is a lot of it, the brain concludes that the cells are starving and reserves need to be created. The effect of insulin on the body:

1. It prevents important amino acids from being broken down into simple sugars.
2. Improves protein synthesis - the basis of life.
3. Prevents proteins in muscles from breaking down, prevents muscle atrophy - anabolic effect.
4. Limits the accumulation of ketone bodies, an excessive amount of which is fatal to humans.
5. Promotes the transport of potassium and magnesium ions.

The role of insulin in the human body

A deficiency of the hormone is associated with a disease called diabetes mellitus. Those suffering from this disease are forced to regularly inject additional insulin doses. The other extreme is an excess of the hormone, hypoglycemia. This disease leads to increased blood pressure and a decrease in the elasticity of blood vessels. The increase in insulin secretion is enhanced by the hormone glucagon, produced by the alpha cells of the islets of Langerhans in the pancreas.

Insulin-dependent tissues

Insulin stimulates the production of protein in muscles, without which muscle tissue is unable to develop. The formation of adipose tissue, which normally performs vital functions important functions, impossible without the hormone. Patients who have advanced diabetes are faced with ketoacidosis, a form of metabolic disorder in which shock intracellular starvation occurs.

Blood insulin level

The functions of insulin include maintaining the required amount of glucose in the blood, regulating the metabolism of fats and proteins, transforming nutrients before muscle mass. At normal level substances the following occurs:

• protein synthesis to build muscles;
• the balance of metabolism and catabolism is maintained;
• stimulates the synthesis of glycogen, which increases endurance and regeneration of muscle cells;
• Amino acids, glucose, and potassium enter the cells.

Norm

Insulin concentration is measured in µU/ml (0.04082 mg of crystalline substance is taken as one unit). Healthy people have an indicator equal to 3-25 such units. For children, a reduction to 3-20 µU/ml is allowed. In pregnant women, the norm is different - 6-27 µU/ml; in elderly people over 60 years old, this figure is 6-35. A change in the norm indicates the presence serious illnesses.

Elevated

Long-term excess normal indicators insulin risks irreversible pathological changes. This condition occurs due to a drop in sugar levels. You can understand that insulin concentration is exceeded by the following signs: trembling, sweating, rapid heartbeat, sudden attacks hunger, nausea, fainting, coma. The following indicators influence the increase in hormone levels:

• intensive physical exercise;
• chronic stress;
• diseases of the liver and pancreas;
• obesity;
• impaired cell resistance to carbohydrates;
• polycystic ovary syndrome;
• failure of the pituitary gland;
• cancer and benign tumors adrenal glands

Reduced

A decrease in insulin concentration occurs due to stress, intense physical activity, nervous exhaustion, daily consumption large quantity refined carbohydrates. Lack of insulin blocks the flow of glucose, increasing its concentration. As a result, you feel intense thirst, anxiety, sudden bouts of hunger, irritability, and frequent urination. Due to similar symptoms of low and high insulin Diagnosis is carried out by special studies.

What is insulin for diabetics made from?

The issue of raw materials for the production of the hormone worries many patients. Insulin in the human body is produced by the pancreas, and is obtained artificially the following types:

1. Pork or bovine - animal origin. Animal pancreases are used for production. The raw pork preparation contains proinsulin, which cannot be separated; it becomes a source of allergic reactions.
2. Biosynthetic or modified pork - a semi-synthetic drug is obtained by replacing amino acids. Among the advantages are compatibility with the human body and the absence of allergies. Disadvantages - shortage of raw materials, complexity of work, high price.
3. Genetically engineered recombinant – otherwise called “ human insulin", because it is completely identical to the natural hormone. The substance is produced by enzymes of yeast strains and genetically modified E. coli.

Instructions for using insulin

The functions of insulin are very important for the human body. If you are diabetic, you have a doctor's referral and a prescription, which gives the medicine free of charge at pharmacies or hospitals. In case of urgent need, it can be bought without a prescription, but the dosage must be observed. To avoid overdose, read the instructions for using insulin.

Indications for use

According to the instructions included in each package of the insulin drug, the indications for its use are type 1 diabetes mellitus (also called insulin-dependent) and in some cases type 2 diabetes mellitus (non-insulin-dependent). Such factors include intolerance to oral hypoglycemic agents and the development of ketosis.

Insulin administration

The doctor prescribes the medication after diagnosis and blood tests. To treat diabetes mellitus, drugs of different durations of action are used: short and long. The choice depends on the severity of the disease, the patient’s condition, and the speed of onset of action of the drug:

1. The short-acting drug is intended for subcutaneous, intravenous or intramuscular injection. It has a quick, short-term sugar-lowering effect; it is administered 15-20 minutes before meals several times a day. The effect occurs after half an hour, maximum - after two hours, in total it lasts about six hours.
2. Long-term or prolonged action - has an effect lasting 10-36 hours, allowing you to reduce the daily number of injections. Suspensions are administered intramuscularly or subcutaneously, but not intravenously.

To facilitate administration and adherence to dosage, syringes are used. One division corresponds to a certain number of units. Rules for insulin therapy:

• store medications in the refrigerator, and those started at room temperature; warm the medication before administering, because cool has a weaker effect;
• it is better to inject a short-acting hormone under the skin of the abdomen - injected into the thigh or above the buttock acts more slowly, even worse - in the shoulder;
• a long-acting medicine is injected into the left or right thigh;
• give each injection in a different zone;
• when making insulin injections, cover the entire area of ​​the body part - this way you can avoid pain and compaction;
• step back at least 2 cm from the last injection site;
• do not treat your skin with alcohol, this destroys insulin;
• if liquid flows out, the needle was inserted incorrectly - you need to hold it at an angle of 45-60 degrees.

Side effects

When drugs are administered subcutaneously, lipodystrophy may develop at the injection site. Very rarely, but allergic reactions occur. If they occur, it is required symptomatic therapy and replacement of the product. Contraindications for use are:

• acute hepatitis, liver cirrhosis, jaundice, pancreatitis;
• nephritis, urolithiasis disease;
• decompensated heart defects.

Insulin price

The cost of insulin depends on the type of manufacturer, type of drug (short/long period of action, raw materials) and packaging volume. The price of 50 ml of the drug Insulinum is approximately 150 rubles in Moscow and St. Petersburg. Insuman with a pen syringe costs 1200, Protafan suspension has a price of about 930 rubles. How much insulin costs is also affected by the pharmacy level.

Video

Formula, chemical name: no data.
Pharmacological group: hormones and their antagonists/insulins.
Pharmachologic effect: hypoglycemic.

Pharmacological properties

Human insulin is a medium-acting insulin preparation that is obtained by recombinant DNA technology. Human insulin regulates the concentration of glucose in the blood, the deposition and metabolism of carbohydrates, fats, and proteins in target organs (skeletal muscles, liver, adipose tissue). Human insulin has anabolic and anti-catabolic properties. IN muscle tissue there is an increase in the content of glycerol, glycogen, fatty acids, increased protein synthesis and increased amino acid consumption, but at the same time there is a decrease in gluconeogenesis, lipolysis, glycogenolysis, ketogenesis, protein catabolism and amino acid release. Human insulin binds to the membrane receptor (a tetramer that consists of 4 subunits, 2 of which (beta) are immersed in the cytoplasmic membrane and are carriers of tyrosine kinase activity, and the other 2 (alpha) are located extramembranely and are responsible for binding the hormone), forms an insulin receptor complex, which undergoes autophosphorylation. This complex in intact cells phosphorylates the threonine and serine ends of protein kinases, which leads to the formation of phosphatidylinositol glycan and triggers phosphorylation, which activates enzymatic activity in target cells. In muscles and other tissues (except the brain) it promotes the intracellular transport of glucose and amino acids, slows down protein catabolism, and stimulates synthetic processes. Human insulin promotes the accumulation of glucose in the liver in the form of glycogen and suppresses glycogenolysis (gluconeogenesis). Individual differences in insulin activity depend on the dose, injection site, patient physical activity, diet, and other factors.
The absorption of human insulin depends on the method and site of administration (thigh, abdomen, buttocks), insulin concentration, and injection volume. Human insulin is distributed unevenly throughout tissues; does not penetrate breast milk and through the placental barrier. Degradation of the drug occurs in the liver under the action of insulinase (glutathione-insulin transhydrogenase), which hydrolyzes the disulfide bonds between chains A and B and makes them available to proteolytic enzymes. Human insulin is excreted by the kidneys (30 - 80%).

Indications

Diabetes mellitus type 1 and 2, requiring insulin therapy (with resistance to oral hypoglycemic drugs or during combination treatment; intercurrent conditions), diabetes mellitus during pregnancy.

Method of use of human insulin and dose

The method of administration of the drug depends on the type of insulin. The doctor sets the dose individually depending on the glycemic level.
Subcutaneous injections are performed in the anterior area abdominal wall, hips, shoulders, buttocks. Injection sites should be rotated so that the same site is used no more than about once a month. When administering insulin subcutaneously, care must be taken not to get into the blood vessel. Patients must be educated correct use devices for administering insulin. Do not massage the injection site after injection. The temperature of the administered drug should be at room temperature.
Reducing the number of daily injections is achieved by combining insulins of different durations of action.
If allergic reactions develop, it is necessary to hospitalize the patient, identify the component of the drug that is an allergen, and prescribe adequate therapy and insulin replacement.
Discontinuation of therapy or use of inadequate doses of insulin, especially in patients with type 1 diabetes mellitus, can lead to hyperglycemia and diabetic ketoacidosis (conditions that are potentially life-threatening for the patient).
The development of hypoglycemia when using the drug is facilitated by overdose, physical activity, poor diet, organic lesions kidneys, fatty infiltration of the liver.
The insulin dose should be adjusted if there is a violation functional state pituitary gland, adrenal glands, thyroid gland, kidneys and/or liver, Addison's disease, hypopituitarism, diabetes mellitus in patients over 65 years of age. Also, changing the insulin dose may be necessary if you increase the intensity of physical activity or change your usual diet. Ethanol intake (including low-alcohol drinks) can cause hypoglycemia. Ethanol should not be taken on an empty stomach. For some concomitant diseases(especially infectious), conditions that are accompanied by fever, emotional stress may increase the need for insulin.
Symptoms that are precursors to hypoglycemia when using human insulin in some patients may be less pronounced or different from those that were observed in them when using insulin of animal origin. When blood glucose levels are normalized, for example, when intensive treatment insulin, all or some of the symptoms that are precursors of hypoglycemia may disappear, about which patients should be informed. Precursor symptoms of hypoglycemia may become less pronounced or change with prolonged diabetes mellitus, diabetic neuropathy, or the use of beta-blockers.
For some patients, dosage adjustments may be necessary when switching from animal insulin to human insulin. This may occur as early as the first injection of human insulin or gradually over several weeks or months after the transfer.
The transition from one type of insulin to another must be carried out under strict medical supervision and monitoring of blood glucose levels. Change in activity trademark(manufacturer), type, species (human, animal, human insulin analogues) and/or production method (DNA recombinant insulin or insulin of animal origin) may lead to the need for dose adjustment.
When using insulin drugs simultaneously with drugs of the thiazolidinedione group, the risk of developing edema and chronic heart failure increases, especially in patients with pathology of the circulatory system and the presence of risk factors for chronic heart failure.
With hypoglycemia, the patient may experience a decrease in the speed of psychomotor reactions and concentration. This can be dangerous when these abilities are especially necessary (for example, operating machinery, driving vehicles, etc.). Patients should be advised to take precautions to prevent the development of hypoglycemia when performing potentially dangerous species activities that require speed of psychomotor reactions and increased attention (including control vehicles, work with mechanisms). This is especially important for patients with absent or mild symptoms that are precursors of hypoglycemia, as well as with frequent development of hypoglycemia. In such cases, the doctor must evaluate the advisability of the patient performing such activities.

Contraindications for use

Hypersensitivity, hypoglycemia.

Restrictions on use

No data.

Use during pregnancy and breastfeeding

During pregnancy, it is especially important to maintain good glycemic control in women receiving insulin treatment. During pregnancy and breastfeeding, it is necessary to adjust the insulin dose to compensate for diabetes mellitus. Insulin requirements generally decrease during the first trimester of pregnancy and increase during the second and third trimesters of pregnancy. Insulin requirements may decrease sharply during and immediately after childbirth. Women with diabetes should inform their doctor about pregnancy or planning one. Women with diabetes may need to adjust their insulin dose and/or diet during breastfeeding. Human insulin was not mutagenic in in vitro and in vivo genetic toxicity studies.

Side effects of human insulin

Hypoglycemia (pallor of the skin, increased sweating, lethargy, tremor, trembling, perspiration, nausea, vomiting, tachycardia, palpitations, hunger, agitation, anxiety, paresthesia in the mouth, headache, drowsiness, insomnia, fear, depressed mood, irritability, unusual behavior, uncertainty of movements, confusion, speech and vision disturbances, loss of consciousness, coma, death), post-hypoglycemic hyperglycemia (Somogyi phenomenon), insulin resistance ( daily requirement exceeds 200 units), swelling, blurred vision, allergic reactions(itching, skin rash, generalized itching, shortness of breath, difficulty breathing, dyspnea, increased sweating, increased heart rate, hypotension, anaphylactic shock), local reactions(swelling, itching, pain, redness, post-injection lipodystrophy, which is accompanied by impaired insulin absorption, development pain when atmospheric pressure changes).

Interaction of human insulin with other substances

The hypoglycemic effect of human insulin is reduced by glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisolone and others), amphetamines, adrenocorticotropic hormone, fludrocortisone, calcium channel blockers, estrogens, baclofen, heparin, levothyroxine sodium, oral contraceptives, thyroid hormones, nicotine, thiazide and others diuretics (hydrochlorothiazide, indapamide and others), amprenavir, danazol, isoniazid, diazoxide, lithium carbonate, chlorprothixene, sympathomimetics, a nicotinic acid, beta-adrenergic agonists (for example, ritodrine, salbutamol, terbutaline and others), tricyclic antidepressants, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, phenothiazine derivatives. It may be necessary to increase the dose of biphasic insulin [human genetically engineered] when used together with these drugs.
The hypoglycemic effect of human insulin is enhanced by metformin, sulfonamides, repaglinide, androgens, oral hypoglycemic drugs, testosterone, anabolic steroid, bromocriptine, disopyramide, guanethidine, monoamine oxidase inhibitors, angiotensin II receptor antagonists, carbonic anhydrase inhibitors, fluoxetine, carvedilol, fenfluramine, angiotensin-converting enzyme inhibitors (captopril, enalapril and others), tetracyclines, octreotide, mebendazole, ketoconazole, clofibrate, those phylline, quinidine, chloroquine , non-steroidal anti-inflammatory drugs, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol and others) (mask the symptoms of hypoglycemia, including tachycardia, increased blood pressure), ethanol and ethanol-containing drugs. It may be necessary to reduce the dose of biphasic insulin [human genetically engineered] when used together with these drugs.
Beta-blockers, clonidine, reserpine can hide the symptoms of hypoglycemia.
Against the background of atenolol (unlike non-selective beta-blockers), the effect increases slightly; it is necessary to warn the patient that with the development of hypoglycemia, tachycardia and tremor may be absent, but irritability, hunger, nausea should persist, and sweating even increases.
The concentration of human insulin in the blood is increased (due to accelerated absorption) by nicotine-containing drugs and tobacco smoking.
Against the background of octreotide, reserpine, a change in the hypoglycemic effect (both strengthening and weakening) is possible, requiring adjustment of the insulin dose.
Against the background of clarithromycin, the rate of destruction slows down and in some cases the effect of insulin may be enhanced.
Against the background of diclofenac, the effect of the drug changes; at sharing Blood glucose levels need to be monitored.
Against the background of metoclopramide, which accelerates gastric emptying, changes in the dose or mode of insulin administration may be required.
Human insulin is pharmaceutically incompatible with solutions of other drugs.
If necessary, use other medicines In addition to human insulin, you should consult your doctor.

Overdose

With an overdose of human insulin, hypoglycemia develops (lethargy, increased sweating, pallor of the skin, palpitations, tachycardia, hunger, tremor, trembling, perspiration, nausea, vomiting, paresthesia in the mouth, drowsiness, headache, anxiety, agitation, insomnia, fear , irritability, uncertainty of movements, depressed mood, unusual behavior, confusion, speech and vision disturbances, loss of consciousness) varying degrees severity, up to hypoglycemic coma and fatal outcome. Under certain conditions, such as over a long period of time or with intensive control of diabetes mellitus, the warning symptoms of hypoglycemia may change.
Treatment: mild hypoglycemia can be stopped by ingesting glucose, sugar, foods rich in carbohydrates; adjustment of the dose of insulin, physical activity or diet may be required; for moderate hypoglycemia, intramuscular or subcutaneous administration of glucagon is necessary, followed by ingestion of carbohydrates; at severe conditions hypoglycemia accompanied neurological disorders, convulsions, coma, intramuscular or subcutaneous administration of glucagon is required or/ intravenous administration concentrated 40% dextrose (glucose) solution, after regaining consciousness, the patient must be given food that is rich in carbohydrates to prevent the re-development of hypoglycemia. Continued carbohydrate intake and patient monitoring may be required as hypoglycemia may recur.

The role of insulin in the body cannot be overestimated. Any degree of insulin deficiency is fraught with serious endocrine disease– diabetes mellitus. Just 40 years ago, diabetics lived no more than 10-15 years.

Modern medicine uses the most suitable soluble human genetically engineered insulin to normalize blood glucose levels. Thanks to this drug, diabetes has ceased to be a death sentence, giving patients a chance for a full and long life.

Why is insulin called “genetically engineered”?

Some patients are frightened by the term “genetically engineered,” reminding them of the “evil GMOs.”

In fact, it is the invention this drug has saved millions of lives of people with diabetes.

In the beginning, doctors used insulin isolated from animals (mainly pigs and cows). However, this hormone was not only foreign to humans, but also quickly entered the bloodstream, causing glucose surges and causing a lot of complications.

Soluble insulin was developed taking into account all the needs of a diabetic patient, negating various allergic reactions. After its action ends, it breaks down into regular amino acids and is excreted from the body.

Basic pharmacological properties

Soluble human insulin is a short-acting insulin replacement drug.

Together with the receptor cell membrane the drug forms an insulin receptor complex that stimulates intracellular processes:

1. Secretion of enzymes for the complete processing and absorption of glucose by tissues;
2. Increased intracellular transport and absorption of glucose;
3. Reducing the rate of glycogen formation in the liver;
4. Stimulates the production of proteins and fats.

When administered subcutaneously, the medicine begins to act within 20-30 minutes, reaching its maximum within 1-3 hours, lasting about 5-8 hours.

This drug is distributed differently in tissues: for example, it does not penetrate the placental barrier and does not pass into breast milk. After the end of its action, human insulin is excreted through the kidneys (about 80%) after its destruction by insulinase.

Indications for use

Doctors usually prescribe soluble insulin in the following cases:

Contraindications

This drug is usually well tolerated by the body, as it does not differ from the natural pancreatic enzyme.

Insulin is contraindicated for use when:

• Decreased blood glucose levels (hypoglycemia);
• Increasing the body's sensitivity to insulin.

Adverse reactions

Despite being well tolerated, insulin may cause side effects when used as:

Sometimes the start of taking the drug goes in parallel with the body’s adaptive reaction in the form of edema or visual impairment. These symptoms usually resolve after several weeks of treatment.

Combination with other drugs

When human insulin is used with certain drugs, its hypoglycemic effect is enhanced or weakened.

The hypoglycemic effect may be enhanced when taking insulin with:

Nicotine and alcohol enhance the sugar-lowering properties of insulin.

The hypoglycemic effect of the drug can be reduced by its interaction with:

Also, in combination with insulin, the following drugs can reduce or enhance the hypoglycemic effect:

Application and dosage selection

The dose and method of administration of human insulin is always determined individually by an endocrinologist, taking into account the required blood glucose and urine levels of the patient.

This drug is administered for diabetes in several ways: subcutaneously (SC), intramuscularly (IM) or intravenously (IV). More often, insulin is administered subcutaneously. The following zones are used for this:

The drug is usually administered intravenously when acute conditions caused by diabetes: ketoacidosis, diabetic coma.

It is recommended to administer insulin 15-30 minutes before meals, 3 times a day. Sometimes 5-6 are allowed single administration drug.

The insulin dose is usually calculated in the proportion of 0.5-1 units per 1 kg of weight. If more than 0.6 mg of insulin per kg of body weight is administered, the drug must be administered at least 2 times a day. Average daily dose is about 30-40 units (8 units in children).

Pregnant women are usually prescribed a dose of 0.6 units per kg of weight. Injections are usually performed 3-5 times a day, in accordance with the number of meals.

Often insulin fast acting combined with longer-acting insulin.

Rules for administering insulin

Even experienced diabetics make mistakes when administering insulin.

Most important rules Insulin therapy consists of:

1. Check the shelf life and storage conditions of the drug: it should not be subjected to overheating or hypothermia.
2. Storing spare insulin bottles in the refrigerator. It is enough to keep the opened bottle in a dark place at room temperature.
3. Verify the dosage of the drug with the instructions and doctor’s recommendation.
4. Release the air from the syringe before injection. It is not necessary to wipe the skin with alcohol. Infection during insulin therapy is extremely rare, and alcohol reduces the effect of the medicine.
5. Choosing right place for introduction. For short-acting insulin, this area is the abdomen. When injected into the shoulder or gluteal fold, the drug acts more slowly.
6. Prevention of complications at the injection site in the form of using the entire surface area. To administer short-acting insulin, the entire abdomen is used: from the top of the costal edges to the inguinal fold, with the lateral surfaces of the torso. It is important to retreat about 2 cm from the old injection sites, inserting the syringe at an angle of 45-60 degrees, so that the medicine does not leak out.
7. Before administering the medicine, it is better to take the skin into a fold with a large and index fingers. If the medicine enters a muscle, it will reduce its activity. After inserting the needle, you need to hold the syringe for about 5-10 seconds.
8. It is better to administer short-acting insulin into the stomach 20 minutes before meals. In other places the medicine is administered half an hour before meals.

Trade name of the drug

Insulin is produced in the form of an injection solution and sold in pharmacies.

Genetically engineered human insulin can be produced under the following brand names:

• Biosulin;
• Actrapid;
• Actrapid NM;
• Gensulin;
• Vozulim;
• Penfill.

Thanks to modern genetic technologies, artificial (recombinant) human insulin was created. He is the one active substance drugs: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mixtard. These drugs differ from the original in the reverse sequence of amino acids, which adds new properties to them (for example, a longer two-phase effect), which is extremely important for patients with diabetes.

Adverse reactions

Despite good tolerability, of this medicine Side effects may occur such as:

Sometimes, at the beginning of taking the drug, manifestations occur in the form of various visual disturbances (double vision, blurred vision, etc.) or the appearance of edema. But they are an adaptive reaction of the body and disappear after several weeks of treatment.

Overdose

It happens that the administration of insulin in some cases leads to hyperglycemia.

The main symptoms of hyperglycemia are manifestations in the form of:

At the onset of similar symptoms, the patient should immediately take some easily digestible carbohydrate food (usually candy, a lump of sugar or sweet tea).

If your health worsens, the patient should urgently call " ambulance" Typically, doctors inject glucagon or a 40% dextrose solution into the muscle (intravenously). Delay in this case is extremely dangerous and can lead to coma or death.

Complications

Long-term treatment with insulin can lead to various complications. The main ones are.

Insulin is vital medicine, he produced real revolution in the lives of many people with diabetes.

In the entire history of medicine and pharmacy of the 20th century, it is possible to single out, perhaps, only one group of medications that are of the same importance - antibiotics. They, like insulin, very quickly entered medicine and helped save many human lives.

Diabetes Day is celebrated at the initiative of the World Health Organization 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 look at how this hormone is obtained and made.

How do insulin preparations differ from each other?

1. Degree of purification.
2. The source of production is pork, bovine, or human insulin.
3. Additional components included in the drug solution are preservatives, action prolongers and others.
4. Concentration.
5. pH of the solution.
6. Possibility of mixing short-acting and long-acting drugs.

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

About 6 billion units of insulin are consumed annually in the world (1 unit is 42 mcg of the 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, pork insulin and human insulin preparations are isolated.

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

Human insulin preparations fully comply with chemical structure human hormone. They are usually produced by biosynthesis using genetic engineering technologies.

Large manufacturing companies use production methods that ensure that their products meet all quality standards. There were no significant differences in the action of human and porcine monocomponent insulin (i.e., highly purified), in relation to immune system, according to many studies, the difference is minimal.

Auxiliary components used in the production of insulin

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

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

Prolonging the action of insulin

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

• protamine insulins – protafan, insulin basal, NPH, humulin N;
• zinc insulins – insulin-zinc suspension mono-tard, lente, humulin-zinc.

Protamine is a protein, but adverse reactions in the form of an allergy to it are very rare.

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

Disinfectant components

Some of the compounds that, according to pharmacotechnological criteria, should already be included in the drug have a disinfecting effect. These include cresol and phenol (both of which have specific smell), and also methyl parabenzoate (methylparaben), which has no odor.

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

Protamine insulins usually contain cresol or phenol. Phenol cannot be added to ICS solutions because it changes physical properties hormone particles. These drugs include methylparaben. Also antimicrobial action possess zinc ions in solution.

Thanks to this multi-stage antibacterial protection with the help of preservatives, the development of possible complications, the cause of which could be bacterial contamination during repeated administration needles into a bottle with a solution.

Due to the presence of such a protection mechanism, the patient can use subcutaneous injections the same syringe for 5 to 7 days (provided that he is the only one using 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 insulin preparations, one ml of solution contained only one unit of the hormone. Later the concentration was increased. Most of insulin preparations in bottles used in Russia contain 40 units in 1 ml of solution. The bottles are usually marked with the symbol U-40 or 40 units/ml.

For widespread use are intended precisely for such insulin and their calibration is carried out according to the following principle: when a person draws 0.5 ml of solution with a syringe, a person draws 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 calibration according to the volume of the drug, designed for 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, which 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). In this case, the dose of insulin for the patient naturally remains the same, since it satisfies the body’s need for a specific amount of insulin.

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

Unfortunately, not all doctors, and especially those with diabetes, know about this. The first difficulties began when some of the patients switched to using insulin injectors (pen-syringes), which use penfills (special cartridges) containing U-40 insulin.

If you fill such a syringe with a solution labeled U-100, for example, to the level 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 insulin U-100 and looking at the unit cutoffs, a person will take a dose 2.5 times greater than the one 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 drug. 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 the one written near the corresponding mark on the syringe.

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

In some countries, such as Switzerland, there was a carefully thought out plan according to which a competent transition to insulin preparations labeled U-100 was carried out. But this requires close contact of all interested parties: doctors of many specialties, patients, nurses from any departments, pharmacists, manufacturers, authorities.

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

Combined use of short-acting and long-acting insulins

IN modern medicine 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 of different durations the actions could be combined in one syringe and administered simultaneously to avoid double puncture of the skin.

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

It is very important that when mixing two types of drugs, the rapid onset of action of short-acting insulin is not prolonged or disappears.

It has been proven that a short-acting drug can be combined in one injection with protamine insulin, and the onset of short-acting insulin is not delayed because there is no binding soluble insulin with protamine.

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

Regarding zinc-insulin preparations, it has long been established that insulin-zinc suspension (crystalline) cannot be combined with short-acting insulin, as it binds to excess zinc ions and is transformed into long-acting 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 research has been done using this route of administration. scientific research, therefore, we cannot exclude the fact that in some cases, with this method of injection, a complex of zinc-insulin and a short-acting drug may form under the skin, which leads to impaired absorption of the latter.

Therefore, it is better to administer short-acting insulin completely separately from zinc insulin, to make two separate injections into areas of the skin located at a distance of at least 1 cm from each other. This is not convenient, which cannot be said about the standard dose.

Combined insulins

Currently produced by the pharmaceutical industry combination drugs containing short-acting insulin together with protamine insulin in a strictly defined percentage. Such drugs include:

• mixtard,
• actrafan,
• insuman com.

The most effective combinations are those in which the ratio of short- and long-acting 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, have a regular motor activity. For example, they are often used by elderly patients with type 2 diabetes.

Combined insulins are not suitable for so-called “flexible” insulin therapy, when there is a need to constantly change the dosage of short-acting insulin.

For example, this should be done when changing the amount of carbohydrates in food, decreasing or increasing physical activity, etc. In this case, the dose of basal insulin (long-acting) remains practically unchanged.