Insulin is a hormone produced by the endocrine cells of the pancreas. Its main task is to maintain carbohydrate balance.

Insulin preparations are prescribed for diabetes mellitus. This condition is characterized by insufficient secretion of the hormone or a violation of its action in peripheral tissues. Medicines differ in chemical structure and duration of effect. Short forms are used to reduce sugar that enters the body with food.

Indications for appointment

Insulin is prescribed to normalize blood glucose levels in various types of diabetes. Indications for the use of the hormone are the following forms of the disease:

• Type 1 diabetes associated with autoimmune damage to endocrine cells and the development of absolute hormone deficiency;
• Type 2, which is characterized by a relative lack of insulin due to a defect in its synthesis or a decrease in the sensitivity of peripheral tissues to its action;
• gestational diabetes that occurs in pregnant women;
• pancreatic form of the disease, which is a consequence of acute or chronic pancreatitis;
• non-immune types of pathology - Wolfram syndrome, Rogers syndrome, MODY 5, neonatal diabetes and others.

In addition to the hypoglycemic effect, insulin preparations have an anabolic effect - they contribute to the growth of muscle mass and the renewal of bone tissue. This property is often used in bodybuilding. However, this indication is not registered in the official instructions for use, and the administration of the hormone to a healthy person threatens with a sharp drop in blood glucose - hypoglycemia. Such a condition may be accompanied by loss of consciousness up to the development of coma and death.

Types of insulin preparations

Depending on the method of production, genetically engineered drugs and human analogues are isolated. The pharmacological action of the latter is more physiological, since the chemical structure of these substances is identical to human insulin. All drugs differ in duration of action.

During the day, the hormone enters the blood at different rates. Its basal secretion allows you to maintain a stable concentration of sugar regardless of the meal. Stimulated release of insulin occurs during meals. In this case, the level of glucose that enters the body with foods containing carbohydrates decreases. In diabetes, these mechanisms are violated, which leads to negative consequences. Therefore, one of the principles of the treatment of the disease is to restore the correct rhythm of hormone release into the blood.

Physiological secretion of insulin

Short-acting insulins are used to mimic the stimulated hormone secretion associated with food intake. The background level is maintained by long-acting drugs.

Unlike fast-acting remedies, extended forms are used regardless of food.

The classification of insulins is presented in the table:

Characteristics of prandial forms

Prandial insulins are prescribed to correct glucose after meals. They are short and ultra-short and are applied 3 times a day before the main meals. They are also used to reduce high sugar levels and maintain background hormone secretion using insulin pumps.

Medicines differ in the time of onset of action and the duration of the effect.

The characteristics of short and ultrashort preparations are presented in the table:

Method of application and dose calculation

Insulin is released from pharmacies only by prescription. Before using the drug, you must familiarize yourself with the method of its use described in the instructions.

Medicines are produced in the form of solutions that are injected into the subcutaneous tissue. Before the injection of prandial insulin, the concentration of glucose is measured using a glucometer. If the sugar level is close to the norm set for the patient, then short forms are used 20–30 minutes before meals, and ultrashort forms immediately before meals. If the indicator exceeds the allowable values, the time between the injection and the meal is increased.

Insulin solution in cartridges

The dose of drugs is measured in units (ED). It is not fixed and is calculated separately before breakfast, lunch and dinner. When determining the dosage of the drug, the sugar level before meals and the amount of carbohydrates that the patient plans to consume are taken into account.

For convenience, such a concept as a bread unit (XE) is used. 1 XE contains 12-15 grams of carbohydrates. The characteristics of most products are presented in special tables.

It is believed that 1 unit of insulin reduces sugar levels by 2.2 mmol / l. There is also an approximate need for the drug for 1 XE during the day. Given these data, it is easy to calculate the dose of medication for each meal.

Estimated need for insulin per 1 XE:

Suppose a person with diabetes has a fasting blood glucose of 8.8 mmol/l in the morning (with an individual goal of 6.5 mmol/l) and plans to eat 4 XE for breakfast. The difference between the optimal indicator and the real one is 2.3 mmol / l (8.8 - 6.5). To reduce sugar to normal without food, 1 IU of insulin is required, and when using 4 XE, another 6 IU of the drug (1.5 IU * 4 XE). This means that before eating, the patient must enter 7 IU of the prandial agent (1 IU + 6 IU).

For patients receiving insulin, a low-carbohydrate diet is not required. The exception is people who are overweight or obese. They are recommended to eat 11-17 XE per day. With intense physical exertion, the amount of carbohydrates can increase up to 20-25 XE.

Injection technique

Fast-acting drugs are produced in vials, cartridges and ready-made syringe pens. The solution is administered using insulin syringes, syringe pens and special pumps.

Medicine that is not being used should be kept in the refrigerator. Means for daily use is stored at room temperature for 1 month. Before the introduction of insulin, its name, the patency of the needle are checked, the transparency of the solution and the expiration date are evaluated.

Prandial forms are injected into the subcutaneous tissue of the abdomen. In this zone, the solution is actively absorbed and begins to act quickly. The injection site within this area is changed every day.

This technique allows you to avoid lipodystrophy - a complication that occurs when the technique of the procedure is violated.

When using a syringe, it is necessary to check the concentration of the drug indicated on it and the vial. As a rule, it is 100 IU / ml. During the administration of the drug, a skin fold is formed, the injection is made at an angle of 45 degrees.

NovoRapid FlexPen for single use

There are several types of syringe pens:

• Prefilled (ready to use) - Apidra SoloStar, Humalog QuickPen, Novorapid FlexPen. After the end of the solution, the pen must be disposed of.
• Reusable, with a replaceable insulin cartridge - OptiPen Pro, OptiClick, HumaPen Ergo 2, HumaPen Luxura, Biomatic Pen.

Reusable pen for the introduction of an ultra-short analogue of Humalog - HumaPen Luxura

Before their use, a test is performed to assess the patency of the needle. To do this, collect 3 units of the drug and press the trigger piston. If a drop of solution appears on its tip, you can inject insulin. If the result is negative, the manipulation is repeated 2 more times, and then the needle is changed to a new one. With a fairly developed subcutaneous fat layer, the introduction of the agent is carried out at a right angle.

insulin pump

Insulin pumps are devices that allow you to maintain both basal and stimulated levels of hormone secretion. They install cartridges with ultra-short counterparts. The periodic intake of small concentrations of the solution into the subcutaneous tissue imitates the normal hormonal background during the day and night, and the additional administration of the prandial component reduces the sugar ingested with food.

Some devices are equipped with a system that measures blood glucose. All patients with insulin pumps are trained in how to set up and manage them.

Preparations for insulin therapy differ in time of action for short, medium, long and combined. Long insulin is designed to evenly maintain the basic level of this hormone, which is normally produced by the pancreas. It is used in type 1 and type 2 diabetes, as well as in conditions where blood sugar control is required.

Mechanism of action

Long-acting insulin is a long-acting agent necessary to maintain physiological glucose levels for a long time. It mimics the production of basal insulin by the pancreas and prevents the development of the process of gluconeogenesis.

Activation of prolonged hormone is noted approximately 4 hours after injection. The peak content is mild or absent, a stable concentration of the drug is observed within 8-20 hours. After about 28 hours after administration (depending on the type of drug), its activity is reduced to zero.

Long-acting insulin is not designed to stabilize the spikes in blood sugar that occur after a meal. It mimics the physiological level of hormone secretion.

Types of drugs

Currently, two groups of long-acting drugs are used - medium and ultra-long duration. Intermediate-acting insulins have a peak period, although not as pronounced as short-acting insulins. Ultra-long acting insulins - peakless. These features are taken into account when selecting the dose of basal hormone.

Indications

The use of long-acting insulin is recommended for the following indications:

• type 1 diabetes;
• type 2 diabetes;
• resistance to oral drugs to lower blood glucose concentrations;
• preparation for the operation;
• gestational diabetes.

Mode of application

Extended-release insulin is available as a suspension or injectable solution. When administered subcutaneously, the drug remains in the adipose tissue for some time, where it is slowly and gradually absorbed into the blood.

The amount of the hormone is determined by the doctor individually for each patient. Further, the patient can independently calculate the dose, based on his recommendations. When switching from animal insulin to human insulin, the dose must be re-selected. When replacing one type of drug with another, medical supervision and more frequent checks of blood sugar concentration are necessary. If during the transition the administered dose exceeded 100 units, the patient is sent to the hospital.

Long insulin preparations must not be mixed or diluted.

The injection is performed subcutaneously, each time in a different place. Insulin can be injected into the triceps muscle, near the navel, in the upper outer quadrant of the gluteal muscle, or in the upper anterolateral thigh. Insulin preparations must not be mixed or diluted. Do not shake the syringe before injection. You need to twist it between your palms so that the composition becomes more uniform and warms up a little. After the injection, the needle is left under the skin for a few seconds to fully inject the drug, and then removed.

Dose calculation

A healthy person with normal pancreatic function produces 24–26 units of insulin per day, or about 1 unit per hour. This determines the level of basal, or extended, insulin that needs to be injected. If an operation, hunger, psychophysical stress is expected during the day, the dose should be increased.

To calculate the dosage of basal insulin, a fasting test is performed. You should stop eating 4-5 hours before the study. It is recommended to start the selection of a dose of long-term insulin at night. For the calculation results to be more accurate, you need to have dinner early or skip the evening meal.

Every hour, sugar is measured with a glucometer. During the test period, there should be no rise or decrease in glucose by 1.5 mmol. If the sugar level has changed significantly, the basis-insulin needs to be corrected.

Overdose

An excessive amount of medication can lead to hypoglycemia. Without medical attention, it leads to serious complications. Convulsions, nervous disorders occur, hypoglycemic coma is not excluded, in difficult cases, the condition can lead to death.

With hypoglycemia, it is urgent to take fast carbohydrates, which will increase blood glucose levels. In the future, you will need a doctor's control, correction of nutrition and administered doses of insulin.

Contraindications

Extended insulin is not allowed for all patient groups. It can not be used for hypoglycemia and hypersensitivity to the components of the drug. It is contraindicated in pregnant women and children under 6 years of age.

The drug can be used on the recommendation of a specialist if the expected benefit outweighs the risk of possible complications. The dosage should always be calculated by the doctor.

Side effects

When using long-acting insulin, it should be borne in mind that overdose can cause hypoglycemia, precoma and coma. Allergic reactions, redness and itching at the injection site are not excluded.

Long-acting insulin is only for glucose control, it does not help with ketoacidosis. Short insulin is used to remove ketone bodies from the body.

In type 1 diabetes mellitus, long-acting insulin is combined with short-acting drugs and acts as a basic element of therapy. To keep the concentration of the drug the same, the injection site is changed each time. The transition from medium to long insulin should be carried out under the supervision of a doctor and subject to regular measurement of blood glucose levels. If the dose does not meet the needs, it will have to be adjusted with other drugs.

To avoid nocturnal and morning hypoglycemia, it is recommended to reduce the concentration of long insulin and increase the dose of short insulin. The calculation of the volume of drugs is carried out by the doctor.

Modern pharmacology offers patients with diabetes a huge selection of insulin preparations. And today we will talk about what types of insulin are.

Insulin: types

All available insulin preparations are divided into three types (depending on the time of action and the onset of the therapeutic effect):

• "short";
• "medium";
• "long".

"Short" insulins

It is short-acting insulin preparations that are most often prescribed to patients who have problems with blood sugar.

After the agent enters the human body, it begins to work within thirty minutes. This translates it into the category of highly effective drugs used in the treatment of diabetes. Quite often, this type of insulin is prescribed simultaneously with long-acting insulins.

To make a choice, you need to take into account the following factors:

• general condition of the patient;
• the place of administration of the drug;
• dosage.

The most popular are insulin preparations, which begin to act within the first 15 minutes after administration. These are the means "Apidra", "Humagol" and "Novorapid".

Peculiarities

Among the fast-acting human insulins, it is worth highlighting the preparations "Homorap" and "Insumad Rapid". There is practically no difference between them. The only difference is in the amount of residue of amino acids present in its composition.

"Fast" insulins of animal origin also include drugs "Insulrap SPP", "Iletin II Regular" and others. They are most often prescribed for type II diabetes. Means from this category contain proteins with a different structure, and therefore are not suitable for all patients. For example, "fast" insulins of animal origin should not be given to people whose bodies are unable to process animal lipids.

Reception, dosage, storage of "short" insulins

Take the drug immediately before meals. In this case, it is food that accelerates the absorption of insulin, the effect occurs almost immediately.

"Fast" insulins can be taken orally, after diluting them to a liquid state.

If subcutaneous administration of the drug is practiced, then the injection must be done approximately 30 minutes before the planned meal.

The dosage for each person with diabetes mellitus is selected individually. For adults, the dose will be 8-24 units per day, and for children - no more than 8 units.

Store drugs at a temperature of +2-+8 degrees. For this, a shelf in the refrigerator door is suitable.

"Average" insulins

Diabetics are forced to take maintenance drugs. But each type of diabetes needs a certain type of insulin. So a drug that has an average duration is used when glucose needs to be gradually broken down. It can also be used if there is currently no possibility of using "short" insulin.

Features of "average" insulins

The drugs have several features:

• they begin to act within 10 minutes after administration;
• it takes quite a long time for the drug to completely break down.

• among human insulins - means "Protafan", "Humulin", "Monotard" and "Homolong";
• among animal remedies - medicines "Berlinsulin", "Monotard HM" and "Iletin II".

"Long" insulins

It is the timely administered drug that allows diabetics to enjoy life without experiencing the discomfort caused by high. What distinguishes this type of insulin preparations from others and what types of long-acting insulin exist - we'll talk about this.

The main difference between insulin in this case is that the action of the drug sometimes lasts more than 24 hours.

In addition, all types of extended-release insulin contain chemical catalysts that ensure long-term operation of the drug. They also delay the absorption of sugars. The therapeutic effect occurs after about 4-6 hours, and the duration of action can be up to 36 hours.

Long-acting insulins: what types exist

The most commonly prescribed drugs are Determite and Glargine. Their main difference is a uniform decrease in blood sugar levels.

Insulins with a long period of action are also drugs "Ultratard", "Ultralente-iletin-1", "Huminsulin", "Ultralong", etc.

Medicines are prescribed by the attending physician, which further helps to avoid various troubles in the form of side effects.

Use and storage of the drug

This type of insulin can only be administered by injection. Only after entering the body in this way, it begins to work. The injection is placed in the forearm, buttock or thigh.

Before use, the bottle must be shaken so that the mixture inside it acquires a uniform consistency. After that, it is ready for use.

Store the drug under the same conditions as short-acting insulins. Such a temperature regime prevents the formation of flakes and granulation of the mixture, as well as the oxidation of the drug.

They inject insulin once, sometimes twice a day.

Origin of insulin

Differences in insulins - not only in the time of action, but also in the origin. Allocate animal drugs and insulins identical to human.

Pigs are used to obtain drugs from the first category, and the biological structure of insulins obtained from the organs of pigs is most suitable for humans. The difference in this case is quite insignificant - just one amino acid.

But the best preparations are, of course, human insulins, which are used most often. possible in two ways:

1. The first way is to replace one inappropriate amino acid. In this case, semi-synthetic insulin is obtained.
2. In the second method of producing the drug, Escherichia coli is involved, which is capable of synthesizing protein. It will already be a biosynthetic agent.

Preparations similar to human insulin have several advantages:

• to obtain the desired therapeutic effect requires the introduction of smaller doses;
• the development of lipodystrophy is relatively rare;
• Allergy to drugs is practically not observed.

Cleaning degree

Depending on the degree of purification, the preparations are divided into:

• traditional;
• monopeak;
• monocomponent.

Traditional insulins are among the very first insulin preparations. They contained in their composition a huge variety of protein impurities, which became the cause of frequent allergic reactions. Currently, the production of such drugs has been significantly reduced.

Monopeak insulin agents have a very small amount of impurities (within acceptable limits). But monocomponent insulins are almost perfectly pure, since the amount of unnecessary impurities is even less than the lower limit.

The main differences between "short" and "long" insulins

	"Long" insulin	"Short" insulin
Place of injection	The injection is placed in the thigh, because in this case the drug is absorbed very slowly	The injection is placed in the skin of the abdomen, since in this case insulin starts working almost immediately
Timing	It is administered at the same time (morning and evening). Simultaneously with the morning dose, an injection of "short" insulin is given.	Taking the drug 20 - 30 minutes before meals
Attachment to food	"Long" insulin is not associated with food intake	After the introduction of short insulin, food must be taken without fail. If this is not done, then there is a possibility of developing hypoglycemia.

As you can see, the types of insulin (the table clearly shows this) differ in the main indicators. And these features must be taken into account.

We reviewed all available types of insulin and their effect on the human body. We hope that the information was useful. Be healthy!

In diabetes, to keep glucose at the target level all night and ensure its normal concentration on an empty stomach during the day, long-acting insulin is used. Its goal is to bring the hormone content in the blood closer to its natural basal secretion. Long insulin is usually combined with a short one, which is injected before each meal.

Doses are strictly individual, they can be selected only experimentally. To prevent hypoglycemia, the initial amount of the hormone is made deliberately high, and then gradually reduced until blood glucose returns to normal.

Adequately selected dose of long-acting insulin significantly alleviates the complications of diabetes mellitus and allows the patient to remain active for many years.

Choice of extended insulin

The physiological release of insulin into the blood does not stop around the clock, regardless of the presence or absence of food. At night and during the day, when one portion of food has already been digested, and the other has not yet arrived, the background concentration of the hormone is maintained. It is necessary for the breakdown of sugar, which enters the blood from glycogen stores. To ensure an even stable background, long-term insulin is needed. Based on the foregoing, it is clear that a good drug should have a long lasting effect, do not have pronounced peaks and dips.

For these purposes are used:

A drug	Characteristic	Action
Human insulin supplemented with protamine	These are the so-called NPH, or medium insulins, the most common of them:, .	Thanks to protamine, the effect is significantly prolonged. The average duration of work is 12 hours. The time of action is directly proportional to the dose and can be up to 16 hours.
Long insulin analogues	These agents are well studied and widely used in all types of insulin-dependent diabetes. Representatives:,.	They belong to the most progressive group, they allow to provide the most physiological effect of the hormone. Reduce sugar day and almost do not have a peak.
Means of extra long action	So far, only one drug has been included in the group -. It is the newest and most expensive analogue of insulin.	Provides 42 hours of even, peak-free action. In type 2 diabetes, its undoubted superiority over other insulins has been proven. In type 1 disease, its benefits are not so obvious: Tresiba helps lower blood sugar early in the morning, while increasing the risk of hypoglycemia during the day.

The choice of prolonged insulin is the competence of the attending physician. It takes into account the discipline of the patient, the presence of residual secretion of his own hormone, the tendency to hypoglycemia, the severity of complications, the frequency of hyperglycemia on an empty stomach.

Which long-acting insulin to choose:

1. In most cases, preference is given to insulin analogues, as the most effective and well-researched.
2. Protamine products are usually used when an alternative is not available. NPH insulins can provide sufficient compensation for type 2 diabetes at the beginning of insulin therapy, when the need for the hormone is still low.
3. Tresiba can be used successfully in type 1 diabetics who are not prone to sudden drops in blood sugar and begin to experience symptoms of hypoglycemia at the very beginning. In type 2 diabetes, Tresiba is the undisputed leader in the insulin market, as it combines well with oral hypoglycemic agents, is distinguished by its constancy of action, and reduces the frequency of nocturnal hypoglycemia by 36%.

The daily volume of prolonged insulin is divided into morning and evening administration, their dose is usually different. The need for the drug depends on the severity of diabetes. Several methods have been developed for its calculation. All of them require multiple measurements of blood sugar. The selection of the dose takes some time, since the initially calculated amount of long insulin is adjusted taking into account the characteristics of the absorption and breakdown of the hormone in the body of a particular patient. Appointment of the starting dose "by eye" will lead to a longer and more serious decompensation of diabetes mellitus, aggravation of the complications of the disease.

The criterion for a properly selected dose is normal fasting glycemia, minimization of lungs and the absence of severe hypoglycemia. During the day, fluctuations in sugar before meals should be less than 1.5 mmol / l -.

Calculation of the evening dose

The first dose of extended insulin is selected, it should provide the target glucose level at night and in the morning after waking up. In diabetes mellitus, the “dawn phenomenon” is often observed. This is an increase in glycemia in the early morning hours, caused by an increase in the secretion of hormones that weaken the effect of insulin. In healthy people at this time, the release of insulin increases, so the glucose remains stable.

In diabetes, these fluctuations can be eliminated only by insulin preparations. Moreover, the usual increase in dose can reduce blood sugar to normal in the morning, but lead to too low glycemia in the early and middle of the night. As a result, the diabetic is tormented by nightmares, his heartbeat and sweating increase, and the nervous system suffers.

To solve the problem of hyperglycemia in the morning without increasing the dose of drugs, you can use an earlier dinner, ideally 5 hours before the introduction of long insulin. During this time, all the sugar from the food will have time to pass into the blood, the action of the short hormone will end, and the prolonged insulin will only have to neutralize the glycogen from the liver.

Calculation algorithm:

1. In order to correctly determine the amount of the drug for the evening injection, glycemic numbers for several days are needed. You need to have an early dinner, measure your sugar before going to bed, and then in the morning immediately after getting up. If the morning glycemia was higher, measurements continue for another 4 days. The list excludes the days on which dinner turned out to be late.
2. To reduce the risk of hypoglycemia, choose the smallest difference between the two measurements from all days.
3. The insulin sensitivity factor is calculated. This is the amount of reduction in glycemia after the introduction of one unit of the hormone. In a person weighing 63 kg, 1 unit of extended insulin will, on average, lower glucose by 4.4 mmol / l. The need for the drug increases in direct proportion to weight. FFI = 63 * 4.4 / actual weight. For example, with a weight of 85 kg FFI = 63*4.4/85 = 3.3.
4. Calculate the starting dose, it is equal to the smallest difference between the measurements at bedtime and in the morning, divided by the PFI. If the difference is 5, it takes 5 / 3.3 = 1.5 units to enter at bedtime.
5. For several days, sugar is measured after waking up and, based on these data, the starting amount of insulin is adjusted. It is better to change the dose every 3 days, each correction should not be more than one unit.

In type 2 diabetes, sugar in the morning may be lower than at bedtime. In this case, prolonged insulin is not injected in the evening. If glycemia is elevated after dinner, a quick hormone correction is done. Long insulin for these purposes cannot be used, it is administered at the same dose.

If dose adjustment fails

Hypoglycemia at night can be hidden, that is, the patient does not feel anything in a dream and is not aware of their presence. To detect hidden drops in blood sugar, measurements are taken several times a night: at 12, 3 and 6 hours. If at 3 am the glycemia is close to the lower limit of the norm, the next day it is measured at 1-00, 2-00, 3-00. If at least one indicator is underestimated, it's about overdosing

Some diabetics who require little insulin are faced with the fact that the effect of the hormone weakens in the morning, and it is not enough to eliminate the dawn phenomenon. Increasing the dose in this case leads to nocturnal hypoglycemia. Such an effect can be observed when using not only obsolete NPH insulins, but also Lantus, Tujeo and Levemir.

Ways to solve the problem: an additional injection of 1-2 units of extended insulin at 2-00 or a corrective injection of 0.5-1 units of a short preparation at 4-00.

If there is a financial opportunity, the need for extra long insulin can be discussed with the attending physician. Tresiba's action lasts all night, so blood sugar in the morning will be normal without additional injections. During the transition period, more frequent monitoring of glycemia is required to prevent its decrease during the day.

Most endocrinologists recommend switching to Tresiba only when indicated. Diabetics who are well compensated by proven agents are advised to refrain from new insulin until the manufacturer has done enough research and experience has been gained with the drug.

Selection of morning doses

Long insulin during the day is needed to reduce sugar when the food has already been digested. Carbohydrates from food are compensated with the help of a short hormone. So that its effect does not interfere with choosing the right amount of prolonged insulin, you will have to starve part of the day.

Algorithm for calculating the daily dose:

1. Choose a completely free day. Eat early the night before. Measure blood sugar after waking up, after an hour, and then three more times every 4 hours. All this time you can not eat, only water is allowed. After the last measurement, you can eat.
2. Choose the lowest sugar level of the day.
3. Calculate the difference between this level and the target level, which is 5 mmol/l.
4. Calculate daily insulin: divide the difference by the FFI.
5. After a week, repeat measurements on an empty stomach, if necessary, adjust the dose taking into account the data obtained.

If prolonged fasting is prohibited for a diabetic, measurements can be taken in several stages: first skip breakfast, the next day - lunch, the next day - dinner. From eating to measuring sugar, 5 hours should pass if the patient injects short analogues of insulin before meals, and about 7 hours if human insulin is used.

Calculation example

A patient with type 2 diabetes weighing 96 kg does not have enough hypoglycemic agents, so he was prescribed insulin therapy. To calculate the daily dose of long insulin, we measure:

The minimum value is 7.2. Difference from the target level: 7.2-5 = 2.2. PFI = 63 * 4.4 / 96 = 2.9. Required daily dose = 2.2 / 2.9 = 0.8 units, or 1 unit. subject to rounding.

Comparison of the rules for calculating the morning and evening dose

Index	Amount of extended insulin required
	for the day	overnight
The need for an introduction	If the daily glycemia is always more than 5.	If fasting glucose is higher than at bedtime.
Basis for calculation	The difference between the minimum and target value of daily fasting glucose.	The minimum difference in glycemia on an empty stomach and before sleep.
Determination of the sensitivity factor	Likewise in both cases.
Dose adjustment	Required if repeated measurements show deviations from the norm.

With type 2 diabetes, it is not at all necessary to have both short and extended insulin in therapy. It may turn out that the pancreas itself copes with providing a normal basal background, and an additional hormone is not needed. If the patient is on a strict low-carbohydrate diet, there may be no need for short insulin before meals. If a diabetic requires long-term insulin both day and night, the daily dose is usually lower.

At the debut of type 1 diabetes, the type and amount of the drug is usually selected in a hospital. The above calculation rules can be used to adjust the dose if the original dose no longer compensates well.

Disadvantages of NPH Insulin

Compared with Levemir and Lantus, NPH insulins have a number of significant disadvantages:

• show a pronounced peak of action after 6 hours, so they do not model well the background secretion, which is constant;
• unevenly destroyed, so the effect may differ on different days;
• more likely to cause allergies in diabetics. The risk of anaphylactic reactions is increased by antibiotics, radiopaque agents, NSAIDs;
• are a suspension, not a solution, so their effect depends on the thorough mixing of insulin and compliance with the rules for its administration.

Modern long insulins do not have these shortcomings, so their use in the treatment of diabetes is preferable.

Insulin for diabetics of the first type, and rarely the second, is a vital drug. It replaces the hormone insulin, which the pancreas must produce in a certain amount.

Quite often, patients are prescribed only short and ultra-short insulin, injections of which are made after meals. But it also happens that long-acting insulin is required, which has certain requirements for the time of injection.

Below we will consider the trade names of insulins with prolonged action, their pharmaceutical properties and cases when their injections are necessary, as well as reviews of diabetics on the use of long-acting insulin.

long-acting insulin

For type 1 diabetics, long-acting insulins are prescribed as basal insulin, and for type 2 diabetics as monotherapy. The concept of basal insulin means insulin, which must be produced in the body during the day, regardless of meals. But in type 1 diabetes, not all patients with pancreas can produce this hormone even in minimal doses.

In any case, type 1 treatment is supplemented with short or ultra-short injections of insulin. Long-acting insulin injections are made in the morning on an empty stomach, once a day, less often two. The drug begins to act after one to three hours, active from 12 to 24 hours.

Cases when you need to prescribe long-acting insulin:

• suppression of the dawn phenomenon;
• stabilization of blood sugar levels in the morning on an empty stomach;
• treatment of the second type of diabetes, to prevent its transition to the first type;
• in the first type of diabetes - the avoidance of ketoacidosis and the partial preservation of beta cells.

Long-acting insulins were previously limited in choice, patients were prescribed NPH-insulin with the name Protofan. It has a cloudy color, and the vial had to be shaken before injection. At the moment, the community of endocrinologists has reliably revealed the fact that Protofan has a negative effect on the immune system, stimulating it to produce antibodies to insulin.

All this leads to a reaction in which insulin antibodies enter, which makes it inactive. Also, bound insulin can suddenly become active when it is no longer needed. This reaction rather has a mild character and entails a small jump in sugar, in the range of 2-3 mmol / l.

This is not particularly felt by the patient, but, in general, the clinical picture becomes negative. More recently, other drugs have been developed that do not have such an effect on the patient's body. Analogues of Protafana:

1. Lantus;
2. Levemir.

They have a transparent color, do not require shaking before injection. Long-acting insulin analogues can be easily purchased at any pharmacy.

The average price of Lantus in the Russian Federation ranges from 3335 - 3650 rubles, and Protofan - 890-970 rubles. Reviews of diabetics indicate that Lantus has a uniform effect on blood sugar levels throughout the day.

Before prescribing long-acting insulin, the endocrinologist must require the patient to record blood sugar control, which were made from one to three weeks daily. This will show the full picture of spikes in blood glucose and the need or cancellation of this type of insulin.

If the doctor prescribes a medicine without taking into account the clinical picture of blood sugar levels, then it is better to contact another endocrinologist.

Mechanism of action of long-acting insulin

Sugar level

A long-acting drug is a combination of medium-acting and long-acting insulin preparations. Moreover, the first ones begin to act in the body after one to two hours, reaching their peak at 4 to 11 hours, the total duration is 9 to 12 hours.

Drugs of medium duration are absorbed more slowly, and have a pronounced prolonged effect. This is achieved thanks to a special prolongator - protamine or zinc. NPH-insulin includes in its composition protamine obtained from fish milk in a stoichiometric ratio.

On the pharmacological market for diabetics, such insulin preparations of medium duration are presented:

• Genetically engineered insulin, trade names Protafan HM, Humulin NPH, Biosulin, Gansulin.
• Human semi-synthetic insulin - Humador, Biogulin.
• Pork monocomponent insulin - Protafan MS;
• Composite insulin suspension - Monotard MS.

The long-acting drug begins its activity already 1.5 hours after the injection, the total duration is 20-28 hours. At the same time, such drugs distribute insulin evenly in the patient's body, which improves the clinical picture and does not provoke frequent changes in the volume of injections of short and ultrashort insulin.

Long-acting drugs include insulin glargine, which is similar to human insulin. It does not have a pronounced peak activity, as it is released into the blood at a fairly constant rate. Glargine has an acidic pH balance. This excludes its combined administration with short- and ultra-short-acting insulins, since these drugs have a neutral pH balance.

These insulin medications are often available as a suspension and are administered either subcutaneously or intramuscularly. Trade names:

1. Insulin glargine Lantus.
2. Insulin detemir Levemir.

There are such contraindications to injections of insulin glargine and detemir - diabetic coma, pre-coma.

Below is a detailed instruction on the use of insulin Lantus.

Instructions for using the medicine

Lantus Solostar 1 ml contains insulin glargine in an amount of 3.63 mg, which is equivalent to 100 IU of the human hormone insulin.

Also includes excipients: glycerol, zinc chloride, sodium hydroxide, water for injection.

It is a clear, colorless liquid for subcutaneous injection into the patient's adipose tissue. The drug has several forms of release:

• The OpticClick system, which includes 3 ml cartridges. There are five cartridges in one package.
• Syringe pens OptiSet, 3 ml. When the insulin is over, you just need to buy a new cartridge and install it in the syringe pen. One carton contains five syringe pens.
• Lantus Solotar, cartridges with a volume of 3 ml. They are hermetically inserted into the syringe pen for single use, the cartridges are not replaced. There are five syringe pens in one carton, without injection needles.

Lantus is a drug belonging to the pharmacotherapeutic group of antidiabetic drugs. The active ingredient in Lantus, insulin glargine, is a basal-acting human insulin analogue. Dissolves in the human bloodstream completely. comes quickly.

The drug has such an effect on the patient's body:

1. Reduces blood glucose levels.
2. Increases glucose uptake and utilization by skeletal muscle and adipose tissue.
3. Stimulates the biotransformation of glucose into glycogen in the liver.
4. Increases protein production in muscle tissue.
5. Increases lipid production.

It is recommended to make injections once a day, the dose is prescribed only by an endocrinologist, taking into account the severity of the course of the disease. For patients with the same blood sugar levels, doses may be different due to the different effects on the body of patients and their physiological predispositions.

Lantus is prescribed only for type 1 and type 2 diabetes, adults and children over six years of age. The effectiveness of the medicine has not been tested in children under the age of six.

Mostly manifested in the case of the appointment of the wrong dosage. The main ones are:

• Hypoglycemia.
• Neuroglycopenia.
• Adrenergic counter-regulation.

There may also be allergic reactions in the form of itching, burning and urticaria at the injection site. This local symptom usually lasts up to seven days and goes away on its own.

Special instructions: the medicine should not be mixed with other types of insulin, because Lantus has an acidic pH. Injections should be given at the same time of day, regardless of meals. The video in this article will tell you who is prescribed insulin.