A evolução da insulinoterapia no diabetes melito tipo 1

Abstract

RESuMOA descoberta da insulina foi o grande marco da história do diabetes melito e a grande conquista para o seu tratamento. A primeira insulina disponibilizada foi a regular. na seqüência, Hagedorn acrescentou a protamina à insulina, criando, assim, a insulina nPH. na década de 1950 foi sintetizada uma insulina desprovida de protamina, denominada insulina lenta. com o advento da biologia molecular, sintetizou-se, via dnA recombinante, a insulina humana sintética. Mais recentemente, foram disponibilizados vários tipos de análo-gos de insulina que permitiram o melhor controle metabólico dos pacientes. o tratamento do diabetes melito tipo 1, além do processo educacional, incluindo a prática regular de atividades físicas e orientações dietéticas, resumese na substituição plena de insulina de longa e curta durações de ação, de maneira individualizada, de acordo com a experiência do médico-assistente. no diabetes melito tipo 1, a preferência é pelas insulinas de menor variabilidade, por meio do esquema basal/bólus ou pelas bombas de infusão contí-nua de insulina subcutânea com o objetivo de mimetizar a liberação fisiológica de insulina pelas células-β. ABStRAct insulin therapy for type 1 Diabetes Mellitus: past and present. the discovery of insulin can be considered the milestone of diabetes mellitus history and a great achievement for its treatment. the first insulin available was the regular. Afterwards, Hagedorn added the protamine to the insulin, thus, creating the nPH insulin. in the 1950s an insulin free of protamine was synthesized: the lente insulin. With the advent of molecular biology, synthetic human insulin was synthesized using recombinant dnA technology. Most recently several types of insulin analogues were available, providing the patients with better metabolic control. type 1 diabetes mellitus treatment includes plain substitution and individualization for short-acting plus long-acting insulin according to the physician's assistance, besides regular practice of physical activities and diet orientations. in type 1 diabetes mellitus the insulin of low variability is the best choice since basal/bolus insulin therapy or continuous subcutaneous insulin infusion pump can mimetize the physiological release of insulin by β cells.

Pharmacological Treatments for Type 2 Diabetes

“…With this type of insulin, the monomers are presented in an associated hexamer form, which reduces the rate of absorption. Generally, regular insulin is indicated for the treatment of diabetic ketoacidosis, and it is also associated with human insulin intermediate-acting or basal analogs before meals [86]. This insulin must be given 30-45 minutes before meals to reduce the postprandial glycemia peak, and the activity lasts between 2 and 4 hours.…”

“…Insulin lispro is an analogue of human insulin developed using genetic engineering to reverse the amino acids proline and lysine in positions 28 and 29 of the beta chain, resulting in a sequence of Lys (B28) Pro (B29). This insulin in pharmaceutical preparations with phenol and zinc forms stable hexamers [86]. It has a lower tendency to self-aggregate at the site of subcutaneous injection, it is absorbed faster than regular human insulin, and it mimics the physiological insulin profile in response to a meal.…”

“…During the use of these analogs, an additional dose is required in the afternoon to compensate for hyperglycemia that may result from an afternoon snack. There is evidence that compared with regular insulin, lispro insulin reduces the postprandial hyperglycemic peaks as well as the risk of hypoglycemia, especially at night [86].…”

“…In vials or cartridges, the drug is present in the form of hexamers that rapidly dissociate into monomers and dimers in the subcutaneous tissue, ensuring rapid absorption. The pharmacokinetic profile includes the onset of action within 5 -15 minutes and a duration of action of 1-2 hours [86].…”

Multi Insulin Sensitization with Tolerante to New Therapeutic Option: Degludec

“…Compared to animal insulin, human insulin has a different pharmacodynamics and pharmacokinetics. Human insulin tends to be more rapidly absorbed and to have a shorter period of action, but with a peak action that occur totally unpredictable way [3].…”