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]

Model clinical and pharmacological article 1

Pharma action. Short-acting insulin preparation. Interacting with a specific receptor on the outer membrane of cells, it forms an insulin receptor complex. By increasing the synthesis of cAMP (in fat cells and liver cells) or directly penetrating into 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 (decrease in glycogen breakdown), etc. After s / c 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 the drug depends on the dose, method, site of administration and has significant individual characteristics.

Pharmacokinetics. The completeness of absorption depends on the method of administration (s / c, / m), the injection site (abdomen, thigh, buttocks), dose, insulin concentration in the preparation, etc. It is distributed unevenly 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 occurred during pregnancy (with the ineffectiveness of diet therapy); for intermittent use in diabetic patients on the background of infections accompanied by high fever; with upcoming surgeries, injuries, childbirth, metabolic disorders, before switching to treatment with prolonged insulin preparations.

Contraindications. Hypersensitivity, hypoglycemia.

Dosing. The dose and route of administration of the drug is determined individually in each case, based on the content of glucose 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 s / c. With diabetic ketoacidosis, diabetic coma, during the period of surgical intervention - 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).

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 . At a daily dose exceeding 0.6 U / kg, insulin must be administered in the form of 2 or more injections in different areas of the body. May be combined with long-acting insulins.

The insulin solution is taken 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, lowering blood pressure);

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

hyperglycemia and diabetic acidosis (at low doses, missed injections, non-compliance with the diet, against the background of fever and infections): drowsiness, thirst, decreased appetite, flushing of the face);

impaired consciousness (up to the development of a precomatous and coma 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, followed by an increase in glycemia;

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

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

Overdose. Symptoms: hypoglycemia (weakness, "cold" sweat, pallor of the skin, palpitations, trembling, nervousness, hunger, paresthesia in the hands, feet, 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.

Subcutaneously, intramuscularly or intravenously, glucagon or intravenous hypertonic dextrose solution is administered. With the development of hypoglycemic coma, 20-40 ml (up to 100 ml) of a 40% dextrose solution are injected intravenously until the patient comes out of a coma.

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 + preparations, pyridoxine, quinidine, quinine, chloroquine, ethanol.

The hypoglycemic effect is weakened by glucagon, somatropin, GCS, oral contraceptives, estrogens, thiazide and loop diuretics, BMCC, thyroid hormones, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclic antidepressants, clonidine, calcium antagonists, diazoxide, morphine, marijuana, nicotine, phenytoin, epinephrine, blockers of H 1 -histamine receptors.

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

Special instructions. Before taking insulin from the vial, check the transparency of the solution. If foreign bodies appear, cloudiness or precipitation of the substance on the glass of the vial, the drug cannot be used.

The temperature of the injected insulin should correspond to room temperature. The dose of insulin 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 diseases of the kidneys and liver, as well as hypofunction of the adrenal cortex, pituitary gland or thyroid gland), changing the injection site (for example, the 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 the patient is transferred from animal insulin to human insulin.

The transfer of 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 traffic, as well as to maintain machines and mechanisms.

Patients with diabetes can stop their own mild hypoglycemia by eating sugar or high-carbohydrate foods (it is recommended to always have at least 20 g of sugar with you). It is necessary to inform the attending physician about the transferred hypoglycemia in order to decide on the need to correct the treatment.

In the treatment of short-acting insulin in isolated cases, a decrease or increase in the volume of adipose tissue (lipodystrophy) in the injection area is possible. 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 an increase (II-III trimesters) in insulin requirements. During childbirth and immediately after them, the need for insulin can drop dramatically. During lactation, daily monitoring is necessary for several months (until the need for insulin stabilizes).

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

State register of medicines. Official publication: in 2 volumes - M .: Medical Council, 2009. - V.2, part 1 - 568 p.; part 2 - 560 p.

Interactions with other active substances

Trade names

Name	The value of the Wyshkovsky Index ®

Insulin soluble [human semi-synthetic]

Latin name

Insulin soluble

Pharmacological group

insulins

Model clinical and pharmacological article 1

Pharma action. Short-acting insulin preparation. Interacting with a specific receptor on the outer membrane of cells, it forms an insulin receptor complex. By increasing the synthesis of cAMP (in fat cells and liver cells) or directly penetrating into 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 blood glucose 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 (decrease in glycogen breakdown), etc. After s / c 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 the drug depends on the dose, method, site of administration and has significant individual characteristics.

Pharmacokinetics. The completeness of absorption depends on the method of administration (s / c, / m), the injection site (abdomen, thigh, buttocks), dose, insulin concentration in the preparation, etc. It is distributed unevenly 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 occurred during pregnancy (with the ineffectiveness of diet therapy); for intermittent use in diabetic patients on the background of infections accompanied by high fever; with upcoming surgeries, injuries, childbirth, metabolic disorders, before switching to treatment with prolonged insulin preparations.

Contraindications. Hypersensitivity, hypoglycemia.

Dosing. The dose and route of administration of the drug is determined individually in each case, based on the content of glucose 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 s / c, / m, / in, 15-30 minutes before meals. The most common route of administration is s / c. With diabetic ketoacidosis, diabetic coma, during the period of surgical intervention - in / in and / 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).

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 . At a daily dose exceeding 0.6 U / kg, insulin must be administered in the form of 2 or more injections in different areas of the body.

May be combined with long-acting insulins.

The insulin solution is taken 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, lowering blood pressure);

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

hyperglycemia and diabetic acidosis (at low doses, missed injections, non-compliance with the diet, against the background of fever and infections): drowsiness, thirst, decreased appetite, flushing of the face);

impaired consciousness (up to the development of a precomatous and coma 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, followed by an increase in glycemia;

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

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

Overdose. Symptoms: hypoglycemia (weakness, "cold" sweat, pallor of the skin, palpitations, trembling, nervousness, hunger, paresthesia in the hands, feet, 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.

Subcutaneously, intramuscularly or intravenously, glucagon or intravenous hypertonic dextrose solution is administered. With the development of hypoglycemic coma, 20-40 ml (up to 100 ml) of a 40% dextrose solution are injected intravenously until the patient comes out of a coma.

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 + preparations, pyridoxine, quinidine, quinine, chloroquine, ethanol.

The hypoglycemic effect is weakened by glucagon, somatropin, GCS, oral contraceptives, estrogens, thiazide and loop diuretics, BMCC, thyroid hormones, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclic antidepressants, clonidine, calcium antagonists, diazoxide, morphine, marijuana, nicotine, phenytoin, epinephrine, blockers of H 1 -histamine receptors.

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

Special instructions. Before taking insulin from the vial, check the transparency of the solution. If foreign bodies appear, cloudiness or precipitation of the substance on the glass of the vial, the drug cannot be used.

The temperature of the injected insulin should correspond to room temperature. The dose of insulin 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 diseases of the kidneys and liver, as well as hypofunction of the adrenal cortex, pituitary gland or thyroid gland), changing the injection site (for example, the 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 the patient is transferred from animal insulin to human insulin.

The transfer of 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 traffic, as well as to maintain machines and mechanisms.

Patients with diabetes can stop their own mild hypoglycemia by eating sugar or high-carbohydrate foods (it is recommended to always have at least 20 g of sugar with you). It is necessary to inform the attending physician about the transferred hypoglycemia in order to decide on the need to correct the treatment.

In the treatment of short-acting insulin in isolated cases, a decrease or increase in the volume of adipose tissue (lipodystrophy) in the injection area is possible. 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 an increase (II-III trimesters) in insulin requirements. During childbirth and immediately after them, the need for insulin can drop dramatically. During lactation, daily monitoring is necessary for several months (until the need for insulin stabilizes).

Insulin is the main drug for the treatment of people 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 is capable of influencing the metabolism of carbohydrates in small doses. Normally, the pancreas produces enough insulin to help maintain normal blood sugar levels. But with serious endocrine disorders, insulin injections often become the only chance to help the patient. Unfortunately, it is impossible to take it orally (in the form of tablets), 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 wondered at least once, what is insulin used for medical purposes made of? Currently, most often this medicine is obtained using genetic engineering and biotechnology methods, but sometimes it is extracted from raw materials of animal origin.

Preparations derived from raw materials of animal origin

Obtaining 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 drug, its tendency to cause allergic reactions and insufficient purification. The fact is that, since the hormone is a protein substance, it consists of a certain set of amino acids.

The insulin produced in the body of a pig 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 there were no similar drugs, even such insulin became a breakthrough in medicine and made it possible to bring 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 tolerance 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 porcine insulins that are devoid of these shortcomings. They are obtained from the pancreas of a pig, but after that they are subject to additional processing and purification. They are multicomponent and contain excipients in their composition.

Modified porcine insulin is practically no different from the human hormone, so 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 reduce blood sugar. Bovine insulin is not currently used in medicine, because 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 produced on an industrial scale in two ways:

• using enzymatic treatment of porcine insulin;
• using genetically modified strains of Escherichia coli or yeast.

With a physicochemical change, the porcine insulin molecules under the action 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 undergoes high purification, therefore it does not cause allergic reactions and other undesirable manifestations.

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

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

There are 2 methods for obtaining 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 strand 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 way to obtain a drug using E. coli or yeast is based on the fact that the microbe first produces inactive insulin (that is, its precursor, proinsulin). Then, with the help of enzymatic treatment, this form is activated and used in medicine.

Personnel who have access to certain production areas must always be dressed in a sterile protective suit, due to which contact of the drug with human biological fluids is excluded.

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

Biotechnology methods enable scientists to think about alternative solutions to the problem of diabetes. For example, preclinical studies are currently underway 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 is a complex technological process that provides for automation and minimal human intervention.

Additional components

The production of insulin without excipients in the modern world is almost impossible to imagine, because they improve its chemical properties, extend the duration of action 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 action of the drug);
• 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 lasts 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 the following compounds is used for this purpose:

• proteins;
• chloride salts of zinc.

Proteins that prolong the action of the drug are highly purified and are low allergenic (for example, protamine). Zinc salts also do not adversely affect either insulin activity or human well-being.

Antimicrobial Ingredients

Disinfectors in the composition of insulin are necessary so that the microbial flora does not multiply during storage and use. These substances are preservatives and ensure the safety of the biological activity of the drug. In addition, if a patient injects a hormone from one vial only to himself, then the medicine may last him for several days. Due to high-quality antibacterial components, he will not need to throw away an unused drug due to the theoretical possibility of reproduction in a solution of microbes.

The following substances can be used as disinfectants 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.

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

The use of preservatives in most cases allows you to enter the hormone under the skin without pre-treatment with alcohol or other antiseptics (the manufacturer usually mentions this in the instructions). This simplifies the administration of the drug 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 needed to keep the pH of the solution at a given level. The safety of the drug, its activity and the stability of chemical properties depend on the level of acidity. In the production of injectable hormone for diabetic patients, phosphates are usually used for this purpose.

Solution stabilizers are not always needed for insulins with zinc, since the metal ions help maintain the necessary balance. If they are still used, then other chemical compounds are used instead of phosphates, since the combination of these substances leads to precipitation and the unsuitability of the drug. An important property that is required of all stabilizers is safety and the inability to enter into any reactions with insulin.

The selection of injectable drugs for diabetes for each individual patient should be handled by a competent endocrinologist. The task of insulin is not only to maintain a normal level of sugar in the blood, but also not to harm other organs and systems. The drug should 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 for the duration of action.

human insulin
Latin name: Insulin 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) Insulin human (Insulin human)
Application of human insulin: Ketoacidosis, diabetic, lactic acid and hyperosmolar coma, insulin-dependent diabetes mellitus (type I), incl. with 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 drugs, dystrophic skin lesions (trophic ulcers, carbuncles, furunculosis), severe asthenization of the patient with a severe pathology (infections, burn disease, injuries, frostbite), a long infectious process (tuberculosis, pyelonephritis).

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

Side effects: Hypoglycemia, postglycemic hyperglycemia (Somoji 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 soreness of the skin and subcutaneous tissue (pass on their own within a few days or 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 of pain sensations when atmospheric pressure changes.

Interaction: The effect is enhanced by oral antidiabetic agents, alcohol, androgens, anabolic steroids, disopyramide, guanethidine, MAO inhibitors, salicylates (in high 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 is increased (accelerated absorption) by nicotine-containing drugs and smoking.

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

Dosage and administration: PC. A patient whose hyperglycemia and glucosuria are not eliminated by diet within 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 dose of insulin is 0.6 U / kg. The frequency of administration can be different (usually 3–5 times is 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 tea - 10 parts, dinner - 20 parts. Injections are made 15 minutes before meals. In the future, a double administration is possible (the most convenient for patients).

Precautionary measures: The development of hypoglycemia contributes to an overdose, diet violations, physical activity, fatty liver, organic kidney damage. For the prevention of post-injection lipodystrophy, it is recommended to change injection sites, the treatment consists in 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. With the development of resistance, the patient should be transferred to monopeak and monocomponent highly purified insulins, temporarily prescribe glucocorticoids and antihistamines. Allergization requires hospitalization of the patient, identification of the drug component that is an allergen, the appointment 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 with the active substance Human insulin (Insulin human)

The ideal hormonal level is the basis for the full development of the human body. One of the key hormones in 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, ignoring information about what insulin is and what its level should be.

The hormone insulin

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

Which organ produces insulin

The insulin-producing organ is the pancreas, where conglomerates of B cells are located, known to the scientific world as Lawrence's islets 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 proinsulin subtype is isolated from the hormone.

What is the insulin subtype is not fully known. The hormone itself, before taking the 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. The resource of B-cells is limited and 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? This is the most important regulator of metabolism. Without it, the glucose that enters 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 supply of energy that is used by the human body as needed.

Functions

The functions of insulin are diverse. It ensures the work of muscle cells, influencing the processes of protein and fat metabolism. The hormone plays the role of an informant of the brain, which, according to the receptors, determines the need for fast carbohydrates: if there is a lot of it, the brain concludes that the cells are starving and it is necessary to create reserves. The effect of insulin on the body:

1. Prevents essential amino acids from being broken down into simple sugars.
2. Improves protein synthesis - the basis of life.
3. It does not allow proteins in the muscles to break down, prevents muscle atrophy - anabolic effect.
4. Limits the accumulation of ketone bodies, an excessive amount of which is deadly to humans.
5. Promotes the transport of potassium and magnesium ions.

The role of insulin in the human body

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

Insulin dependent tissues

Insulin stimulates the production of protein in the muscles, without which muscle tissue is not able to develop. The formation of adipose tissue, which normally performs vital functions, is impossible without a hormone. Patients who develop diabetes face ketoacidosis, a form of metabolic disorder in which shock intracellular starvation occurs.

blood insulin level

The functions of insulin include maintaining the right amount of glucose in the blood, regulating the metabolism of fats and proteins, and transforming nutrients into muscle mass. At a normal level of a substance, the following happens:

• protein synthesis for building 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, potassium enter the cells.

Norm

The concentration of insulin is measured in mcU / ml (0.04082 mg of a crystalline substance is taken per unit). Healthy people have an indicator equal to 3-25 such units. For children, a decrease to 3-20 mcU / ml is allowed. In pregnant women, the norm is different - 6-27 mcU / ml, in older people over 60 years old, this figure is 6-35. A change in the norm indicates the presence of serious diseases.

elevated

Prolonged excess of normal insulin levels threatens with irreversible pathological changes. This condition occurs due to a drop in sugar levels. You can understand about the excess of insulin concentration by signs: trembling, sweating, heart palpitations, sudden bouts of hunger, nausea, fainting, coma. The following indicators affect the increase in hormone levels:

• intense physical activity;
• chronic stress;
• diseases of the liver and pancreas;
• obesity;
• violation of cell resistance to carbohydrates;
• polycystic ovaries;
• malfunction of the pituitary gland;
• cancer and benign tumors of the adrenal glands.

Reduced

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

What is insulin for diabetics made of?

The issue of raw materials for the manufacture 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. The pancreas of animals is used for production. In the preparation of pork raw materials, there is proinsulin, which cannot be separated, it becomes a source of allergic reactions.
2. Biosynthetic or porcine modified - 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 Escherichia coli.

Instructions for use of insulin

The functions of insulin are very important for the human body. If you are a diabetic, you have a doctor's referral and a prescription for free medicines 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 use of insulin.

Indications for use

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

Insulin administration

The doctor prescribes the medication after diagnosis and blood tests. For the treatment of diabetes mellitus, drugs of different duration of action are used: short and long-term. The choice depends on the severity of the course of the disease, the condition of the patient, the speed of the onset of action of the remedy:

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

Syringes are used to facilitate administration and dosage compliance. One division corresponds to a certain number of units. Rules for insulin therapy:

• store the drugs in the refrigerator, and the started ones at room temperature, warm the product before entering, because the cool one is weaker;
• it is better to inject a short-acting hormone under the skin of the abdomen - introduced into the thigh or above the buttock acts more slowly, even worse - into the shoulder;
• a long-acting drug is injected into the left or right thigh;
• do each injection in a different zone;
• with insulin injections, capture the entire area of ​​\u200b\u200bthe body part - this way you can avoid soreness and seals;
• retreat at least 2 cm from the place of the last injection;
• do not treat the skin with alcohol, it destroys insulin;
• if the liquid flows out, the needle was inserted incorrectly - you need to hold it at an angle of 45-60 degrees.

Side effects

With subcutaneous administration of drugs, lipodystrophy may develop at the injection site. Very rarely, but there are allergic reactions. If they occur, symptomatic therapy and replacement of the agent are required. Contraindications for admission are:

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

The price of insulin

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

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