1. Insulin Preparations

2. What is insulin?
 Isa hormone secreted by the
pancreatic beta cells that facilitates
the uptake of glucose into skeletal
muscle and adipose tissue by
increasing the number of glucose
transporters ( GLUT 1 and GLUT 4)
that facilitate glucose diffusion into
these targeted cells.

3. What is insulin
 A protein that contains 51 amino acids
 When the supply of, or response to, insulin is
adequate, the disease is known as Type
1(IDDM or juvenile-onset) and Type 2
(NIDDM or adult onset) Diabetes
respectively.

4. Insulin Injections
 Are
divided into 4 major categories
namely
 Rapid acting
 Short acting
 Intermediate Acting
 Long Acting

5. Rapid Acting Insulin
 Insulin Aspart (Novolog)
 Same with the regular Human insulin except that
proline was replaced by Aspartic acid in position
B28
 Onset :15 min; duration: 2-4 hours

6. Rapid Acting Insulin
 Insulin Lispro (Humalog)
 B28 Lys and B29 Proline Human insulin analog
where in the usual B28 Proline and B29 Lysine
is reversed
 Onset:15 mins;duration:2-4 hours

7. Rapid Acting Insulin
 Insulin glulisine
 is another insulin analogue, with asparagine
at position B3 replaced by lysine, and lysine
at B29 replaced by glutamic acid
 Same with other rapid acting insulins

8. Short Acting Insulins
 Regular Insulin (Humulin or Novolin)
 The only insulin that is approved to be
administered via IV route
 Comes from Pork(porcine), beef(bovine) or
Human pancreas or genetically engineered
using rDNA technology from certain
microorganisms(E.coli)
 Onset:30-60 min;duration:6 to 8 hours

9. Intermediate Acting Insulin
 Isophane Insulin Suspension or Neutral
Protamine Hagedorn (NPH) (Humulin N and
Novolin N)
 A sterile suspension of Zinc Insulin crystals
and Protamine sulfate—a protein from the
sperm of a fish (Onchorynchus Fam.
Salmonidae)
 Onset:1 to 2 hours; duration:10 to 16 hours

10. Intermediate Acting Insulin
 Insulin Zinc Suspension (Lente)
 A sterile suspension of insulin modified by the
addition of Zinc chloride
 It has an advantage of fewer allergic reactions
than NPH
 Onset:1 to 2 hours:duration:10 to 16 hours

11. Long Acting Insulins
 Glargine (Lantus)
 Differs from Human insulin that asparagine
at position A21 is replaced by GLycine and
an additional 30B-a-L-ARGinine-30B-b-L-
arginINE
 A clear solution that is the only true 24-hour
insulin available

12. Long Acting Insulins
 Glargine (Lantus)
 Onset:2 hours;duration:24 hours

13. Long Acting Insulins
 Extended Insulin Zinc suspension(Ultra
Lente)
 A sterile suspension of insulin modified by
the addition of Zinc chloride
 Onset:4 to 8 hours:duration:36 hours

14. Long Acting Insulins
 Insulin detemir is another long-acting
insulin analogue that may have some benefit
over isophane insulin.
 It is a neutral soluble human insulin
analogue in which the terminal amino acid at
B30 has been replaced by myristic acid, a
14-carbon fatty acid chain.
 Duration: up to 24 hours

15. Insulin Combinations
 Pre-mixed
 Novolin 70/30-contains 70 % NPH and 30 %
Regular Insulin
 Humulin 50/50-contains 50 % NPH and 50%
Regular insulin

16. Insulin Combinations
 Mixtures of insulin are being prepared prior
to administration if the pre-mixed
combinations of insulin are not suitable for
the patient or not available
 A combination of either a rapid or short
acting insulin and an intermediate or long
acting insulin is being used (except Insulin
Glargine which should not be used in
combination with any other types of insulin)

17. Insulin Combinations
 Guidelines in mixing insulin prior to
administration
 If not specified in a doctor’s order, use insulin of
same concentration
 Use proper syringe to measure insulin in units or
mL
 Do not contaminate the contents of one vial with
the contents of another vial

18. Insulin Combinations
 Always draw the short acting or regular insulin,
which is clear, first, then follow it with the
intermediate or long acting insulin (cloudy)
 Never mix a short acting insulin with a Lente or
Ultralente
 Never mix a phosphate-buffered insulin(isophane)
with a lente or Ultralente

19. Insulin administration
 Almost always being administered via SC
route usually in the arm, thigh or abdomen
 Administered by using an insulin syringe or a
tuberculin syringe
 Can also be administered by a portable pen
injector, which contains a cartridge that
holds the insulin or a continuous
subcutaneous Insulin infusion (CSII)
device, commonly know as an insulin pump

20. Portable Pen Injector

21. Continuous Subcutaneous
Insulin Infusion (CSII) Device