home Audience 2 “Human insulins. Insulin soluble

“Human insulins. Insulin soluble

Insulin is the main medicine for treating patients diabetes mellitus 1 type. Sometimes it is also used to stabilize the patient's condition and improve his well-being in the second type of disease. This substance by its nature is a hormone that can influence carbohydrate metabolism in small doses. Normally, the pancreas produces sufficient amounts of insulin, which helps maintain physiological level blood sugar. But in case of serious endocrine disorders The only chance to help the patient is often insulin injections. Unfortunately, it cannot be taken orally (in tablet form), since it is completely destroyed in digestive tract and loses its biological value.

Options for obtaining insulin for use in medical practice

Many diabetics have probably at least once wondered what insulin is made from, which is used in medical purposes? Currently, this medicine is most often obtained using methods genetic engineering and biotechnology, but is sometimes extracted from animal sources.

Preparations obtained from raw materials of animal origin

Obtaining this hormone from the pancreas of pigs and large cattle- an old technology that is rarely used today. This is due to the low quality of the resulting medicine, its tendency to cause allergic reactions and the insufficient degree of purification. The fact is that since a hormone is a protein substance, it consists of a certain set amino acids.

Insulin produced in the pig’s body differs in amino acid composition from human insulin by 1 amino acid, and bovine insulin by 3.

At the beginning and middle of the 20th century, when similar drugs did not exist, even such insulin became a breakthrough in medicine and made it possible to bring the treatment of diabetics to new level. Hormones obtained by this method lowered blood sugar, although they often caused side effects and allergies. Differences in the composition of amino acids and impurities in the drug affected the condition of patients, especially in more vulnerable categories of patients (children and the elderly). Another reason for the poor tolerability of such insulin is the presence of its inactive precursor in the drug (proinsulin), which was impossible to get rid of in this variation of the drug.

Nowadays, there are improved pork insulins that do not have these disadvantages. They are obtained from the pig's pancreas, but after that they are subject to additional processing and purification. They are multicomponent and contain excipients.

Modified pork insulin is practically no different from human hormone, which is why it is still used in practice

Such drugs are much better tolerated by patients and practically do not cause adverse reactions, they do not suppress the immune system and effectively lower blood sugar. Bovine insulin is not currently used in medicine, since due to its foreign structure it negatively affects the immune and other systems of the human body.

Genetically engineered insulin

Human insulin, which is used for diabetics, is commercially produced in two ways:

using enzymatic treatment of pork insulin;
using genetically modified strains coli or yeast.

With a physicochemical change in the pork insulin molecule under the influence special enzymes become identical to human insulin. Amino acid composition The resulting drug is no different from the composition of the natural hormone that is produced in the human body. During the production process, the medicine is highly purified, so it does not cause allergic reactions or other undesirable manifestations.

But most often, insulin is obtained using modified (genetically altered) microorganisms. Bacteria or yeast have been biotechnologically altered so that they can produce their own insulin.

In addition to receiving insulin itself, important role cleaning it plays. So that the drug does not cause any allergic or inflammatory reactions, at each stage it is necessary to monitor the purity of microorganism strains and all solutions, as well as the ingredients used.

There are 2 methods for producing insulin in this way. The first of them is based on the use of two different strains (species) of a single microorganism. Each of them synthesizes only one chain of the hormone DNA molecule (there are two in total, and they are spirally twisted together). Then these chains are connected, and in the resulting solution it is already possible to separate active forms insulin from those that do not carry any biological significance.

The second method of producing medicine using E. coli or yeast is based on the fact that the microbe first produces inactive insulin (that is, its precursor - proinsulin). Then, using enzymatic treatment, this form is activated and used in medicine.

Personnel who have access to certain production areas must always wear a sterile protective suit, thereby preventing contact of the drug with human biological fluids

All these processes are usually automated, the air and all surfaces in contact with ampoules and vials are sterile, and the equipment lines are hermetically sealed.

Biotechnology techniques enable scientists to think about alternative solutions to the problem of diabetes. For example, preclinical research is currently being conducted on the production of artificial pancreatic beta cells, which can be obtained using genetic engineering methods. Perhaps in the future they will be used to improve the functioning of this organ in a sick person.

Production of modern ones is complex technological process, which provides automation and minimal human intervention

Additional components

Production of insulin without excipients V modern world It’s almost impossible to imagine, because they make it possible to improve its chemical properties, extend its action time and achieve high degree cleanliness.

According to their properties, all additional ingredients can be divided into the following classes:

prolongators (substances that are used to provide more long acting medications);
disinfectant components;
stabilizers, thanks to which optimal acidity is maintained in the drug solution.

Prolonging additives

There are extended-acting insulins, the biological activity of which continues for 8 to 42 hours (depending on the drug group). This effect is achieved by adding injection solution special substances - prolongators. Most often, one of these compounds is used for this purpose:

proteins;
zinc chloride salts.

Proteins that prolong the effect of the drug undergo detailed purification and are low-allergenic (for example, protamine). Zinc salts also do not have negative influence neither on insulin activity nor on a person’s well-being.

Antimicrobial components

Disinfectants in insulin are necessary to ensure that microbial flora does not multiply in it during storage and use. These substances are preservatives and ensure the preservation of the biological activity of the drug. In addition, if the patient administers the hormone from one bottle only to himself, then the medicine may last him for several days. Due to high-quality antibacterial components, there will be no need to throw away unused drug due to the theoretical possibility of microbes multiplying in the solution.

The following substances can be used as disinfectant components in the production of insulin:

metacresol;
phenol;
parabens.

If the solution contains zinc ions, they also act as an additional preservative due to their antimicrobial properties

Certain disinfectant components are suitable for the production of each type of insulin. Their interaction with the hormone must be studied at the stage of preclinical trials, since the preservative should not disrupt the biological activity of insulin or otherwise negatively affect its properties.

The use of preservatives in most cases allows the hormone to be administered under the skin without pre-treating it with alcohol or other antiseptics (the manufacturer usually mentions this in the instructions). This simplifies the administration of the medicine and reduces the number of preparatory manipulations before the injection itself. But this recommendation works only if the solution is administered using an individual insulin syringe with a thin needle.

Stabilizers

Stabilizers are necessary to ensure that the pH of the solution is maintained at a given level. The safety of the drug, its activity and stability depend on the level of acidity chemical properties. When producing injectable hormones for diabetic patients, phosphates are usually used for this purpose.

For insulins with zinc, solution stabilizers are not always needed, since metal ions help maintain the necessary balance. If they are nevertheless used, then instead of phosphates, other chemical compounds are used, since the combination of these substances leads to precipitation and the unsuitability of the medicine. Important property The requirement for all stabilizers is safety and the absence of the ability to enter into any reactions with insulin.

The selection of injectable medications for diabetes for each individual patient should be carried out by a competent endocrinologist. The job of insulin is not only to retain normal level sugar in the blood, but also not harm other organs and systems. The drug must be chemically neutral, low-allergenic and preferably affordable. It is also quite convenient if the selected insulin can be mixed with other versions of it based on the duration of action.

The human pancreas, due to various reasons often cannot produce insulin. Then you need to use genetically engineered insulin, which replaces human insulin.

Human insulin is obtained either from the synthesis of Escherichia coli, or from porcine insulin by replacing one amino acid.

To imitate normal work human pancreas, produce insulin injections. The type of insulin is chosen based on the type of illness and the patient’s well-being. Insulin can be administered intravenously or intramuscularly. For lifelong and long-term therapy, subcutaneous injections are most often used.

Features of insulin

Insulin-dependent diabetes mellitus requires lifelong treatment. Human life depends on the presence of insulin. The disease is recognized as a non-infectious epidemic and is the third most widespread in the world.

Insulin was first created from the pancreas of a dog. A year later, the drug was introduced into widespread use. After 40 years, it became possible to synthesize the hormone chemically.

After some time, highly purified types of insulin were invented. Work is also underway to synthesize human insulin. Since 1983, this hormone began to be produced on a production scale.

Previously, diabetes was treated with drugs made from animals. Now such drugs are banned. Only genetic engineering products can be purchased in pharmacies; the creation of these drugs is based on the transplantation of a gene product into a microorganism cell.

For these purposes, yeast or a non-pathogenic type of E. coli bacteria is used. As a result, microorganisms begin to produce the hormone insulin for humans.

The modern drug insulin is different:

exposure time, there are short-acting, ultra-short-acting and long-acting insulins,
sequence of amino acids.

There are also combination drugs, which are called “mixes”. These products contain long-acting and short-acting insulin.

Receiving insulin may be indicated for diagnoses such as:

Lactic acid, diabetic and hypersmolar coma,
Insulin diabetes mellitus type 1,
For infections, surgical interventions, exacerbations of chronic ailments,
Diabetic nephropathy and/or liver dysfunction, pregnancy and childbirth,
Non-insulin-dependent diabetes mellitus type 2 with resistance to oral antidiabetic agents,
Dystrophic skin lesions,
Severe asthenia in various pathologies,
Long-term infectious process.

Duration of action of insulins

Sugar level

Insulins are classified according to their duration and mechanism of action:

ultra-short,
short,
average duration,
prolonged action.

Ultra-short insulins act immediately after injection. Maximum effect achieved in one and a half hours.

The duration of action reaches 4 hours. This type of insulin can be given either before meals or immediately after meals. Receiving this insulin does not require pauses between the injection and meals.

Ultra-short insulin does not require additional food consumption at the peak of action, which is more convenient compared to other types. These insulins include:

Apidra,
Humalog.

Short-acting insulins begin to act after half an hour. Peak action begins after 3 hours. The action lasts approximately 5 hours. This type of insulin is administered before meals; you need to maintain a pause between the injection and food. Eating is allowed after 15 minutes.

When using short-acting insulin, you should have a snack a few hours after the injection. The time of eating should coincide with the time of peak action of the hormone. Short insulins are:

Himulin Regular,
Actrapid,
Monodar (K50, K30, K15),
Insuman Rapid,
Khumodar and others.

Intermediate-acting insulins are drugs whose duration of action is 12-16 hours. For type 1 diabetes mellitus human insulin used as background or basal. Sometimes you need to give injections 2 or 3 times a day in the morning and evening time with a break of 12 hours.

This insulin begins to work after 1-3 hours, reaching its peak after 4-8 hours. Duration is 12-16 hours. Medium duration medications include:

Humodar br,
Protafan,
Humulin NPH,
Novomix.
Insuman Bazal.

Long-acting insulins are background or basal insulin. A person may need one or two injections per day. They are used in the treatment of type 2 diabetes mellitus.

The drugs have a cumulative effect. The effect of the dosage is maximally manifested after 2-3 days. Long-acting insulins work 4-6 hours after injection. Their peak action occurs after 11-14 hours, the action itself lasts about a day.

Among these drugs there are insulins that do not have a peak effect. Such products act gently and mostly imitate the effect natural hormone at healthy person.

These insulins include:

Side effects and dosage violations

In case of an overdose of insulin drugs, a person may experience:

All of the above are considered symptoms of hypoglycemia. If the condition has just begun to form and is at early stages, you can remove the symptoms yourself. For these purposes, take foods with sugar and large amounts of easily digestible carbohydrates.

Dextrose solution and glucagon can also be injected into the body. If the patient falls into a coma, a modified dextrose solution should be administered. It is used until the condition improves.

Some patients may develop allergies to insulin. Among the main symptoms:

Hyperglycemia occurs due to low dosages or the development of an infectious disease, as well as non-compliance with the diet. Sometimes a person develops lipodystrophy where the drug is injected.

When using the drug, the following may also occur on a temporary basis:

Swelling,
Drowsiness,
Loss of appetite.

Getting a hormone substitute instead of human insulin is an excellent treatment for diabetes. The substance helps reduce blood glucose levels, due to the fact that glucose is better absorbed by cells and the process of its transportation changes. These drugs replace human insulin, but they should only be taken as directed by a doctor because they may cause negative consequences for good health.

Important instructions for use

Women with diabetes should inform their doctor if they are planning or becoming pregnant. This category of women often requires changes in dosage and dietary intake during lactation.

Studying the toxicity of insulin preparations, scientists did not find a mutagenic effect.

It is worth noting that the need for the hormone may decrease if a person has renal failure. A person can only be switched to a different type of insulin or to a drug with a different brand name under close medical supervision.

The dosage must be adjusted if the activity of insulin, its type or species is changed. The need for insulin may be reduced in the following diseases:

Insufficient adrenal function thyroid gland or pituitary gland
Liver and kidney failure.

Under emotional stress or certain diseases the need for insulin increases. Dosage changes are also required when physical activity increases.

Symptoms of hypoglycemia, if human insulin is administered, may be less pronounced or different from those that were when insulin of animal origin was administered.

When normalizing blood sugar levels, for example, as a result intensive treatment insulin, all or some of the symptoms of hypoglycemia may disappear, about which people should be informed.

Precursors of hypoglycemia may change or be mild with long-term treatment diabetes or when using beta-blockers.

A local allergic reaction can be caused by reasons that are not related to the action of the medication, for example, skin irritation chemicals or incorrect injection.

In some cases of the formation of a permanent allergic reaction, immediate therapy is necessary. Desensitization or insulin changes may also be required.

With hypoglycemia, a person's concentration and speed of psychomotor reaction may decrease. This can be dangerous in cases where these functions are vital. An example would be driving a car or using various mechanisms.

This is extremely important for people who have mild symptoms, which are a harbinger of hypoglycemia. In these cases, the attending physician needs to assess the patient's need for driving. The video in this article will tell you about the types of insulin.

Sugar level

Latest discussions.

After obtaining highly purified insulins, the question arose about the immunogenicity of generic insulins. In the process of applying methods to determine the amount of insulin in the blood, antibodies to insulin were discovered. Studies have found that patients using combined bovine/porcine insulin had large quantity antibodies than when using only porcine insulin.

These antibodies can be insulin-binding, which can cause insulin resistance and, when insulin is spontaneously released, unmotivated hypoglycemia. The time had come to replace bovine insulin with pork, but patients in some countries refused to use pork insulin for religious reasons.

This problem became the basis for the development of “human insulins”. Since 1963, the era of “human insulins” began after Mirsky and his colleagues extracted insulin from the pancreas of a human corpse, and since 1974, after the discovery of chemical synthesis from amino acids, the possibility of complete chemical synthesis of the human insulin molecule became possible.
In 1979-1981 Biosynthetic DNA technology and a semi-synthetic route for the production of insulin were developed by enzymatic replacement of an amino acid in the molecule (Marcussen). Semi-synthetic human insulin was produced from pork; its correct name is enzymatically modified pork insulin. Currently rarely used.

The sequence of amino acids in the molecule of pork and human insulin is identical, with the exception of the final amino acid of the B-chain: in pork insulin - alanine, in human insulin - threonine. The semi-synthetic method is the catalytic cleavage of alanine and replacement with threonine. IN last decade The semi-synthetic method of producing insulin has been practically replaced by the biosynthetic method. Biosynthetic (genetic engineering) method for the production of human insulin is the process of changing the encoded hereditary information of living microorganisms for the synthesis of foreign proteins.
Biosynthetic human insulin is produced using recombinant DNA technology.

There are two main methods.
1. Separate synthesis using genetically modified bacteria.
2. From proinsulin synthesized by a genetically modified bacterium.

Phenol or metacresol is used as a preservative to preserve the antimicrobial state of insulins for short insulins and isophanes, and paraben (methyl parahydroxybenzoate) for Lente type insulins. Depending on the nature of diabetes, insulin therapy is indicated for approximately 30-35% of patients. These are patients with type 1 diabetes, who make up 10-15% of all patients with diabetes, as well as patients with type 2 diabetes of the insulin-requiring subtype, who make up 15-25% of all patients with type 2 diabetes.
Insulin therapy today remains the only pathogenetic method that saves life and ability to work in patients with type 1 diabetes.

Therefore, insulin therapy remains lifelong, which naturally creates certain difficulties for the patient due to the need to maintain the condition carbohydrate metabolism, close to that of a healthy person. There is no alternative to subcutaneous replacement therapy insulin, although it is only an imitation of the physiological action of insulin. IN normal conditions insulin enters the system immediately portal vein, then to the liver, where it is half inactivated, the remaining part appears on the periphery. All this happens so quickly that glycemic levels can be maintained within fairly narrow limits even after eating. A different path is observed for insulin injected subcutaneously: it enters the bloodstream with a delay and especially the liver, after which the concentration of insulin in the blood long time remains non-physiologically elevated. But modern strategy and tactics of insulin therapy make it possible to make the lifestyle of patients with type I diabetes very close to normal. This can only be accomplished by educating patients with diabetes.

The need for educational programs in diabetes has long been recognized. Back in 1925, one of the pioneers of insulin therapy, E. Joslin, taught patients what he considered the main thing for the success of treatment: daily three-time determination of glycosuria and changing the dose of insulin based on the data obtained. Necessity inpatient treatment rarely arose. But with the advent of long-acting insulin preparations, the development of insulin therapy took a different path. The patients were forbidden to independently change the dose of insulin; they administered long-acting insulin only once a day, and for many years they had to forget about normal nutrition, come to terms with increased risk hypoglycemia and the need for frequent hospitalizations.

By the early 80s, diabetologists had access to highly purified insulin preparations, human insulin, improved means for administering insulin (disposable insulin syringes and pen syringes), and methods for express analysis of glycemia and glycosuria using test strips. Contrary to expectations, their use in itself did not lead to a decrease in the number late complications diabetes and persistent improvement in carbohydrate metabolism compensation. According to the unanimous conclusion of experts, it was required new approach, which would allow effective management of this complex chronic disease by involving the patient himself in the active management of diabetes and its treatment. Currently, the term “therapeutic education” is officially recognized by the World Health Organization, and it is an essential part of the treatment of diabetes of any type. For patients with type 1 diabetes, this first of all means that the patient must become a competent insulin therapist.

Goals of insulin therapy in patients with type 1 diabetes:
1) normalize glucose metabolism (ideally - normalize the fasting blood glucose level, prevent its excessive increase, hyperglycemia, glycosuria and hypoglycemia after eating; satisfactorily - achieve elimination clinical symptoms diabetes, ketosis, excessive hyperglycemia, severe, frequent or undiagnosed hypoglycemia);
2) optimize the diet and maintain normal weight the patient's body;
3) normalize fat metabolism (in terms of total cholesterol, L ADL, L PVP, triglycerides, in blood serum);
4) improve the quality of life and achieve a normal and free lifestyle for the patient;
5) prevent the development or minimize vascular and neurological complications of diabetes.

Human insulin
Latin name: Insulinum humanum
Pharmacological groups: Insulins
Nosological classification (ICD-10): E10 Insulin-dependent diabetes mellitus. E10-E14 Diabetes mellitus. E11 Non-insulin-dependent diabetes mellitus. Z100 CLASS XXII Surgical Practice
pharmachologic effect

Active ingredient (INN) Human insulin (Insulin human)
Application of human insulin: Ketoacidosis, diabetic, lactic and hyperosmolar coma, insulin-dependent diabetes mellitus (type I), incl. in intercurrent conditions (infections, injuries, surgical interventions, exacerbation chronic diseases), diabetic nephropathy and/or liver dysfunction, pregnancy and childbirth, non-insulin-dependent diabetes mellitus (type II) with resistance to oral antidiabetic agents, degenerative skin lesions ( trophic ulcers, carbuncles, furunculosis), severe asthenia of the patient with severe pathology (infections, burn disease, injury, frostbite), long-term infectious process(tuberculosis, pyelonephritis).

Contraindications for human insulin: Hypersensitivity, hypoglycemia, liver and/or kidney diseases (cumulation possible), breast-feeding(there is a high risk of insulin excretion in breast milk).

Side effects: Hypoglycemia, postglycemic hyperglycemia (Somogyi phenomenon), edema, visual disturbances, insulin resistance ( daily requirement exceeds 200 units), allergic reactions: skin rashes with itching, sometimes accompanied by dyspnea and hypotension, anaphylactic shock; local reactions: redness, swelling and tenderness of the skin and subcutaneous tissue(go away on their own within a few days - weeks), post-injection lipodystrophy (increased fat formation at the injection site - hypertrophic form, or fat atrophy - atrophic form), accompanied by impaired absorption of insulin, the occurrence pain when atmospheric pressure changes.

Interaction: The effect is enhanced by oral antidiabetic drugs, alcohol, androgens, anabolic steroid, disopyramide, guanethidine, MAO inhibitors, salicylates (in large doses) and other NSAIDs, beta-blockers (mask the symptoms of hypoglycemia - tachycardia, increased blood pressure, etc.), reduce - ACTH, glucocorticoids, amphetamines, baclofen, estrogens, oral contraceptives, thyroid hormones, thiazide and other diuretics, triamterene, sympathomimetics, glucagon, phenytoin. The concentration in the blood increases (accelerates absorption) nicotine-containing drugs and tobacco smoking.

Overdose:Symptoms: hypoglycemia varying degrees severity, up to hypoglycemic coma.
Treatment: for mild hypoglycemia, glucose is given orally; for severe hypoglycemia, glucose is given intravenously (up to 50 ml of a 40% solution) with the simultaneous administration of glucagon or adrenaline.

Directions for use and dosage: PC. For a patient whose hyperglycemia and glucosuria are not eliminated by diet for 2–3 days, at the rate of 0.5–1 U/kg, and then the dose is adjusted in accordance with the glycemic and glucosuric profile; for pregnant women in the first 20 weeks, the insulin dose is 0.6 U/kg. The frequency of administration can be different (usually 3–5 times are used when selecting a dose), while the total dose is divided into several parts (depending on the number of meals) proportionally energy value: breakfast - 25 parts, second breakfast - 15 parts, lunch - 30 parts, afternoon snack - 10 parts, dinner - 20 parts. Injections are made 15 minutes before meals. In the future, double administration is possible (the most convenient for patients).

Precautionary measures: The development of hypoglycemia is facilitated by overdose, poor diet, physical exercise, fatty liver infiltration, organic lesions kidney To prevent post-injection lipodystrophy, it is recommended to change injection sites; treatment consists of administering insulin (6–10 units), mixed with 0.5–1.5 ml of 0.25–0.5% novocaine solution, into the transition zone of lipodystrophy, closer to healthy tissue, to a depth of 1/2–3/4 of the thickness of the fat layer. If resistance develops, the patient should be transferred to monopeak and monocomponent highly purified insulins, temporarily prescribed glucocorticoids and antihistamines. Allergization requires hospitalization of the patient, identification of the component of the drug that is an allergen, prescription adequate treatment and insulin replacement.

Special instructions: Reducing the number of daily injections is achieved by combining insulins of different durations of action.

Other drugs with active substance Human insulin

Soluble insulin [human semi-synthetic]

Latin name

Insulin soluble

Pharmacological group

Insulins

Typical clinical and pharmacological article 1

Pharmaceutical action. Short-acting insulin preparation. Interacting with a specific receptor on the outer cell membrane, it forms an insulin receptor complex. By increasing the synthesis of cAMP (in fat cells and liver cells) or directly penetrating the cell (muscles), the insulin receptor complex stimulates intracellular processes, incl. synthesis of a number of key enzymes (hexokinase, pyruvate kinase, glycogen synthetase, etc.). The decrease in glucose content in the blood is due to an increase in its intracellular transport, increased absorption and assimilation by tissues, stimulation of lipogenesis, glycogenogenesis, protein synthesis, a decrease in the rate of glucose production by the liver (decreased glycogen breakdown), etc. After subcutaneous injection, the effect occurs within 20-30 min, reaches a maximum after 1-3 hours and lasts, depending on the dose, 5-8 hours. The duration of action of the drug depends on the dose, method, place of administration and has significant individual characteristics.

Pharmacokinetics. The completeness of absorption depends on the route of administration (s.c., i.m.), injection site (abdomen, thigh, buttocks), dose, concentration of insulin in the drug, etc. It is unevenly distributed in tissues. Does not penetrate the placental barrier and into breast milk. Destroyed by insulinase, mainly in the liver and kidneys. T 1/2 - from several to 10 minutes. Excreted by the kidneys (30-80%).

Indications. Diabetes mellitus type 1, diabetes mellitus type 2: stage of resistance to oral hypoglycemic drugs, partial resistance to oral hypoglycemic drugs ( combination therapy); diabetic ketoacidosis, ketoacidotic and hyperosmolar coma; diabetes mellitus that occurs during pregnancy (if diet therapy is ineffective); for intermittent use in patients with diabetes mellitus against the background of infections accompanied by high temperature; for upcoming surgical operations, injuries, childbirth, metabolic disorders, before switching to treatment with long-acting insulin preparations.

Contraindications. Hypersensitivity, hypoglycemia.

Dosing. The dose and route of administration of the drug is determined individually in each specific case based on the glucose level in the blood before meals and 1-2 hours after meals, as well as depending on the degree of glucosuria and the characteristics of the course of the disease.

The drug is administered subcutaneously, intramuscularly, intravenously, 15-30 minutes before meals. Most common way administration - s.c. In diabetic ketoacidosis, diabetic coma, during surgical intervention- i.v. and i.m.

With monotherapy, the frequency of administration is usually 3 times a day (if necessary, up to 5-6 times a day), the injection site is changed each time to avoid the development of lipodystrophy (atrophy or hypertrophy of subcutaneous fat tissue).

The average daily dose is 30-40 units, in children - 8 units, then on average daily dose- 0.5-1 IU/kg or 30-40 IU 1-3 times a day, if necessary - 5-6 times a day. With a daily dose exceeding 0.6 U/kg, insulin must be administered in the form of 2 or more injections into different areas of the body.

Can be combined with long-acting insulins.

The insulin solution is drawn from the vial by piercing the rubber stopper with a sterile syringe needle, wiped with ethanol after removing the aluminum cap.

Side effect. Allergic reactions(hives, angioedema- fever, shortness of breath, decreased blood pressure);

hypoglycemia (pallor skin, increased sweating, perspiration, palpitations, tremor, hunger, agitation, anxiety, paresthesia in the mouth, headache, drowsiness, insomnia, fear, depressed mood, irritability, unusual behavior, uncertainty of movements, speech and vision disorders), hypoglycemic coma;

hyperglycemia and diabetic acidosis (at low doses, skipping an injection, non-compliance with the diet, against the background of fever and infections): drowsiness, thirst, loss of appetite, facial flushing);

impairment of consciousness (up to the development of a precomatous and comatose state);

transient visual disturbances (usually at the beginning of therapy);

immunological cross-reactions with human insulin; an increase in the titer of anti-insulin antibodies with a subsequent increase in glycemia;

hyperemia, itching and lipodystrophy (atrophy or hypertrophy of subcutaneous fat) at the injection site.

At the beginning of treatment - swelling and refractive error (they are temporary and disappear with continued treatment).

Overdose. Symptoms: hypoglycemia (weakness, “cold” sweat, pale skin, palpitations, trembling, nervousness, hunger, paresthesia in the hands, legs, lips, tongue, headache), hypoglycemic coma, convulsions.

Treatment: the patient can eliminate mild hypoglycemia on his own by ingesting sugar or foods rich in easily digestible carbohydrates.

Glucagon is administered subcutaneously, intramuscularly or intravenously hypertonic solution dextrose. When a hypoglycemic coma develops, 20-40 ml (up to 100 ml) of a 40% dextrose solution is injected intravenously until the patient comes out of the comatose state.

Interaction. Pharmaceutically incompatible with solutions of other drugs.

The hypoglycemic effect is enhanced by sulfonamides (including oral hypoglycemic drugs, sulfonamides), MAO inhibitors (including furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (including salicylates), anabolic steroids (including stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, fenfluramine, Li + drugs, pyridoxine, quinidine, quinine, chloroquinine, ethanol.

The hypoglycemic effect is weakened by glucagon, somatropin, corticosteroids, oral contraceptives, estrogens, thiazide and loop diuretics, BMCC, thyroid hormones, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclic antidepressants, clonidine, calcium antagonists, diazoxide, morphine, marijuana, nicotine, fenito in, epinephrine, H1-histamine receptor blockers.

Beta-blockers, reserpine, octreotide, pentamidine can both enhance and weaken the hypoglycemic effect of insulin.

Special instructions. Before taking insulin from the vial, you must check the transparency of the solution. When foreign bodies If the substance becomes cloudy or precipitates on the glass of the bottle, the drug cannot be used.

The temperature of the administered insulin should be at room temperature. The insulin dose must be adjusted in cases infectious diseases, with dysfunction of the thyroid gland, Addison's disease, hypopituitarism, chronic renal failure and diabetes mellitus in people over 65 years of age.

The causes of hypoglycemia can be: insulin overdose, drug replacement, skipping meals, vomiting, diarrhea, physical stress; diseases that reduce the need for insulin (advanced kidney and liver diseases, as well as hypofunction of the adrenal cortex, pituitary gland or thyroid gland), change of injection site (for example, skin on the abdomen, shoulder, thigh), as well as interaction with other drugs. It is possible to reduce the concentration of glucose in the blood when transferring a patient from animal insulin to human insulin.

Transferring a patient to human insulin should always be medically justified and carried out only under the supervision of a physician. The tendency to develop hypoglycemia may impair the ability of patients to actively participate in traffic, as well as maintenance of machines and mechanisms.

Patients with diabetes can relieve self-perceived mild hypoglycemia by eating sugar or eating foods high in carbohydrates (it is recommended to always have at least 20 g of sugar with you). It is necessary to inform the attending physician about hypoglycemia in order to decide on the need for treatment correction.

When treated with short-acting insulin, in isolated cases there may be a decrease or increase in the volume of adipose tissue (lipodystrophy) in the injection area. These phenomena can be largely avoided by permanent shift injection sites. During pregnancy, it is necessary to take into account a decrease (I trimester) or increase (II-III trimesters) in the need for insulin. During and immediately after childbirth, the need for insulin may decrease dramatically. During lactation, daily monitoring is necessary for several months (until insulin needs stabilize).