Short-acting insulin: how to inject human drugs. "Human insulins

Russian name

Soluble insulin [human genetically engineered]

Latin name of the substance Insulin soluble [human genetically engineered]

Insulinum solubile ( genus. Insulini solubilis)

Pharmacological group of the substance Insulin soluble [human genetically engineered]

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 the concentration of glucose 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 (reduced 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 fever; for upcoming surgeries, 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. The most common route of administration is subcutaneous. For diabetic ketoacidosis, diabetic coma, during surgery - intravenously and intramuscularly.

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 IU, in children - 8 IU, then in the 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 (urticaria, angioedema - fever, shortness of breath, decreased blood pressure);

hypoglycemia (pallor of the 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 disorders and vision), 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 or a hypertonic dextrose solution is administered subcutaneously, intramuscularly or intravenously. 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, pheny. toin, 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. If foreign bodies appear, cloudiness or precipitation of the substance appears 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 of infectious diseases, thyroid dysfunction, 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 can impair the ability of patients to actively participate in road traffic, as well as to maintain 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 whether treatment adjustments are necessary.

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 constantly changing the injection site. 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).

Patients receiving more than 100 units of insulin per day require hospitalization when changing the drug.

State register of medicines. Official publication: in 2 volumes - M.: Medical Council, 2009. - Volume 2, part 1 - 568 pp.; Part 2 - 560 s.

Interactions with other active ingredients

Trade names

Name	The value of the Vyshkowski Index ®

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 fever; for upcoming surgeries, 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. The most common route of administration is subcutaneous. For diabetic ketoacidosis, diabetic coma, during surgery - IV and IM.

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 IU, in children - 8 IU, then in the 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 (urticaria, angioedema - fever, shortness of breath, decreased blood pressure);

hypoglycemia (pallor of the 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 disorders and vision), 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 or a hypertonic dextrose solution is administered subcutaneously, intramuscularly or intravenously. 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. If foreign bodies appear, cloudiness or precipitation of the substance appears 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 of infectious diseases, thyroid dysfunction, 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 can impair the ability of patients to actively participate in road traffic, as well as to maintain 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 constantly changing the injection site. 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).

Insulin is the main medicine for treating patients with type 1 diabetes. 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 a sufficient amount of insulin, which helps maintain physiological blood sugar levels. 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 the 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 for medical purposes? Currently, this medicine is most often obtained using genetic engineering and biotechnology, but sometimes it is extracted from raw materials of animal origin.

Preparations obtained from raw materials of animal origin

Extracting this hormone from the pancreas of pigs and cattle is 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 the hormone is a protein substance, it consists of a certain set of 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 take the treatment of diabetics to a new level. Hormones obtained by this method lowered blood sugar, however, 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 the human hormone, which is why it is still used in practice

Such medications 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 of E. coli or yeast.

With a physicochemical change, the molecules of pork insulin under the influence of special enzymes become identical to human insulin. The amino acid composition of 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 the production of insulin itself, its purification plays an important role. To ensure 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 the active forms of 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.

The production of modern products is a complex technological process that involves automation and minimal human intervention.

Additional components

The production of insulin without excipients in the modern world is almost impossible to imagine, because they can improve its chemical properties, extend its action time and achieve a high degree of purity.

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

• prolongators (substances that are used to ensure a longer effect of the medicine);
• 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 special substances - prolongators - to the injection solution. 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 a negative effect on insulin activity or 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 only works 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 the stability of its chemical properties depend on the level of acidity. 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. An important property 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 task of insulin is not only to maintain normal blood sugar levels, but also not to 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.

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 of 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, trauma, frostbite), prolonged infectious process (tuberculosis, pyelonephritis).

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

Side effects: Hypoglycemia, postglycemic hyperglycemia (Somogyi phenomenon), edema, visual impairment, 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 soreness 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 insulin absorption, the occurrence of pain sensations when atmospheric pressure changes.

Interaction: The effect is enhanced by oral antidiabetic drugs, alcohol, androgens, anabolic steroids, disopyramide, guanethidine, MAO inhibitors, salicylates (in large doses), etc. 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 of varying 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) in proportion to the 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 activity, fatty infiltration of the liver, and organic kidney damage. 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 switched to monopeak and monocomponent highly purified insulins and temporarily prescribed glucocorticoids and antihistamines. Allergization requires hospitalization of the patient, identification of the component of the drug that is the allergen, administration of adequate treatment and replacement of insulin.

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

Other drugs containing active ingredients Human insulin

The ideal hormonal level is the basis for the full development of the human body. One of the key hormones of 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 of 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 diverse. 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 doses of insulin into their blood. The other extreme is an excess of the hormone, hypoglycemia. This disease leads to increased blood pressure and decreased vascular elasticity. 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, is 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, and transforming nutrients into muscle mass. At normal levels of the substance 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 of 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 of serious diseases.

Elevated

Long-term excess of normal insulin levels threatens 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 of hunger, nausea, fainting, coma. The following indicators influence the increase in hormone levels:

• intense physical activity;
• 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 of the adrenal glands.

Reduced

A decrease in insulin concentration occurs due to stress, intense physical activity, nervous exhaustion, and daily consumption of large amounts of 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 tests.

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 the following types are obtained artificially:

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 cost.
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 administration. 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, symptomatic therapy and replacement of the drug are required. Contraindications for use are:

• acute hepatitis, liver cirrhosis, jaundice, pancreatitis;
• nephritis, urolithiasis;
• 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.

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