Time-Action Characteristics of Regular and NPH Insulin in Insulin-Treated Diabetics*

Roy, Bhaskar; Chou, Margaret C. Y.; Field, James B.

doi:10.1210/jcem-50-3-475

Cited by 50 publications

(15 citation statements)

References 14 publications

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“…Regular human insulin and the two fast-acting analogues have identical in vivo potency on a molar basis [5][6][7]9,10,12,13,15,16,20]. With regular human insulin it takes 2-4 h before 50% of the injected dose has disappeared from the injection site [2][3][4]. The fast-acting analogues peak in plasma concentration about 40 min after injection and the plasma profile is close to that of a normal subject observed during a meal [5][6][7]9,10,12,13,15,16,19,20].…”

Section: Fast-acting Analoguesmentioning

confidence: 65%

“…Until a few years ago there was only soluble fast-acting insulin and the intermediate and long-acting NPH insulin. The pharmacokinetics of these traditional insulin preparations do not match the profile of physiological insulin secretion, and in most patients it has been impossible to obtain HbA 1c values around or below 7.0 [1][2][3][4]. The Danish experience is that in outpatient clinics with a diabetes team, treating the patients with multiple injections, when the patients use home blood glucose monitoring for adjusting insulin doses the average HbA 1c is in the range 8-9%.…”

Section: Introductionmentioning

confidence: 99%

“…There are many major problems with insulin therapy: first, the large day-to-day variation in insulin absorption [2][3][4]. Furthermore, the absorption rate of the short-acting insulin results in a peak action 2-4 h after injection, and does not provide the early and rapid rise in plasma insulin required to prevent unphysiological post-prandial hyperglycaemia after a meal.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the absorption rate of the short-acting insulin results in a peak action 2-4 h after injection, and does not provide the early and rapid rise in plasma insulin required to prevent unphysiological post-prandial hyperglycaemia after a meal. The pharmacokinetics also increase the risk of hypoglycaemia 3-5 h after a meal, especially if snacks are omitted [2][3][4]. The intermediate-acting NPH insulin cannot deliver insulin at a constant and reproducible lowlevel rate that characterises normal insulin secretion, but produces a peak in insulin concentration 4-6 h after injection which increases the risk of nocturnal hypoglycaemia [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The pharmacokinetics also increase the risk of hypoglycaemia 3-5 h after a meal, especially if snacks are omitted [2][3][4]. The intermediate-acting NPH insulin cannot deliver insulin at a constant and reproducible lowlevel rate that characterises normal insulin secretion, but produces a peak in insulin concentration 4-6 h after injection which increases the risk of nocturnal hypoglycaemia [2][3][4]. The introduction of recombinant DNA (rDNA) technology offered new methods for creating insulin analogues with altered kinetics [5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Insulin analogues: have they changed insulin treatment and improved glycaemic control?

Madsbad

2002

Diabetes Metab. Res. Rev.

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To improve insulin therapy, new insulin analogues have been developed. Two fast-acting analogues with a more rapid onset of effect and a shorter duration of action combined with a low day-to-day variation in absorption rate are now available. Despite this favourable time-action profile most studies have not been able to show any improvement in overall glycaemic control with the fast-acting analogues. A reduced post-prandial increase in blood glucose has been found in all studies, whereas between 3 and 5 h after the meal and during the night an increased blood glucose level is the normal course. This is probably the main explanation for the absence of improvement in overall glycaemic control when compared with regular human insulin. A tendency to a reduction in hypoglycaemic events during treatment with fast-acting analogues has been observed in most studies. Recent studies have indicated that NPH insulin administered several times daily at mealtimes can improve glycaemic control without increasing the risk of hypoglycaemia. The fast-acting analogues are now also available as insulin mixed with NPH. Insulin glargine is a new long-acting insulin which is soluble and precipitates after injection, resulting in a long half-life with a residual activity of about 50% 24 h after injection. Insulin glargine is a peakless insulin and studies in both type 1 and type 2 diabetic patients indicate that glargine improves fasting blood glucose control and reduces the incidence of nocturnal hypoglycaemia. Surprisingly, the new fast-acting analogues have not achieved the expected commercial success, which emphasises the need for new strategies for basal insulin supplementation, exercise, diet and blood glucose monitoring.

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Section: Fast-acting Analoguesmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Insulin analogues: have they changed insulin treatment and improved glycaemic control?

Madsbad

2002

Diabetes Metab. Res. Rev.

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Insulin treatment in diabetic pregnancy

Mathiesen¹,

Vaz²

2008

Diabetes Metab. Res. Rev.

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Pregnancy in women with diabetes is associated with increased risk of obstetric complications and neonatal morbidity and mortality. The 1989 St Vincent declaration set out a series of targets for improving quality of life in people with diabetes. For women, the declaration stated as a 5-year goal that the outcome of pregnancy should approximate that of the nondiabetic pregnancy [1]. Since then, a number of large, population-based studies have investigated the impact of the declaration on pregnancy outcomes among women with both pregestational (types 1 and 2) and gestational diabetes. The most recent is the Confidential Enquiry into Maternal and Child Health (CEMACH) [2]. This large survey of the outcomes of pregnancy complicated by both type 1 and type 2 diabetes comprised an extensive descriptive survey of all women with pregestational diabetes who gave birth in England, Wales and Northern Ireland in the calendar year from 1 March 2002. The results, along with those from other countries [3][4][5], demonstrate that the objectives of the St Vincent declaration remain unfulfilled. Moreover, it is estimated that up to one in four women with pregestational diabetes have a poor pregnancy outcome [6]. Risks include fetal and neonatal loss, congenital malformations, preterm delivery, macrosomia, pre-eclampsia, Caesarean section and maternal mortality [3,4,[6][7][8][9][10].Many studies assessing the risk of adverse outcomes in diabetic pregnancy have focused on women with type 1 diabetes [3,4,7], but type 2 diabetes is also a growing concern. The number of new cases of type 2 diabetes is increasing and, due to the increasing prevalence of obesity, the disease is now being recognised in adolescents and young adults. Pregnancy outcomes in those with type 2 diabetes are as poor as or worse than those with type 1 diabetes [11,12]. In the CEMACH, type 2 diabetes represented 27.2% of all pregnancies complicated by diabetes. The results of the survey found that rates of perinatal mortality and prevalence of congenital abnormalities are similar between infants of women with type 1 and type 2 diabetes (Table 1) [10,13].Between 2 and 12% of pregnant women develop gestational diabetes [14], which can result in macrosomia, shoulder dystocia, birth injuries and neonatal hypoglycaemia as well as increased perinatal mortality [15]. For the mother, gestational diabetes is a very strong predictor for the development of permanent diabetes later in life. Fetal and neonatal lossAmong women with diabetes, pregnancy loss remains significantly higher than in the nondiabetic maternity population. A lack of information on the rate of early fetal loss in the general population precludes accurate quantification of the increased risk of this outcome among diabetic Insulin treatment in diabetic pregnancy R E V I E W A R T I C L E DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2008; 24(Suppl 2): S3-S20

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Diabetes in Pregnancy

Kalhan¹,

Hertz²

1985

Principles of Medical Therapy in Pregnancy

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Time-Action Characteristics of Regular and NPH Insulin in Insulin-Treated Diabetics*

Cited by 50 publications

References 14 publications

Insulin analogues: have they changed insulin treatment and improved glycaemic control?

Insulin analogues: have they changed insulin treatment and improved glycaemic control?

Insulin treatment in diabetic pregnancy

Diabetes in Pregnancy

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