Insulin (medication): indications, rapid, danger

Insulin, a hormone naturally secreted by our body, is also a leading treatment for diabetes. There are about thirty insulin-based drugs on the pharmaceutical market, which are not equivalent according to their duration and speed of action.

What are the indications for insulin?

L’insulin constitutes one of essential treatments for diabetes. It is indicated in particular in the insulin-dependent forms of the disease: diabetes type 1 (children, teenagers, adults), Type 2 diabetes in advanced condition or some gestational diabetes in pregnant women. Insulin is a hormone natural secreted continuously by the pancreas and which makes it possible to regulate, among other things, the blood glucose level, that is to say the blood sugar. When blood sugar rises, such as after a meal (carb ingestion), this consequently leads to a insulin secretion. This regulation is done autonomously, with a basal level of insulin at all times and occasional variations after meals. By the action of insulin, the glucose is transformed into energy or stored in order to constitute energy reserves. In people with diabetes, insulin is insufficiently (if at all) secreted and blood sugar is not regulated as it should. Injectable insulin-based drugs can overcome this dysfunction.

Rapid insulins, such as medications Actrapid®, Insuman Infusat® or Umuline Rapide® are short-acting insulins. Their effects are observed about 35 to 60 minutes after the injectiontheir action peak takes place 2 to 4 hours later and their duration of action is average of 5 to 8 hours. The rapid insulin injection should be done about 20 minutes before meals. The doses are to be adapted to the quantity of carbohydrates ingested during meals and is specific to each person. It must be assessed with the prescriber based on various parameters, including dietary habits and the severity of diabetes.

The structure of rapid insulin analogues (Apidra®, Fiasp®, Humalog®, Insulin aspart Sanofi®, Lyumjev®, Novorapid®) is not quite identical to that of human insulin, which gives these drugs slightly different properties (reproducibility, delay and duration of action). Their duration of action is very short, of the order of 3 to 5 hours. They act after approximately 15 to 35 minutes and their peak of action is observed 1 to 3 hours after the injection.

Intermediate-acting insulins, also called isophanes or NPH, are opaque solutions for injection (unlike rapid-acting insulins which are colorless and clear). Their formulation allows slower absorption in the organism. They act in about 2 hours, their peak action occurs after 4 to 6 hours and their duration of action is 12 to 24 hours. It’s about drugs Insulatard® and Umulin NPH®.

premixed insulins (Humalog mix®, Novomix®, Mixtard®, Umuline profil®) come, like intermediate-acting insulins, in the form of murky solutions. They correspond to a mixture in variable proportions of rapid-acting insulin (or rapid-acting insulin analogue) with an insulin of intermediate duration of action. They are generally little prescribed in children and adolescents because due to a fixed mixture of 2 different insulins, it is not possible to act on one or the other independently. This is therefore not not compatible with the varying needs of children and adolescents. On the other hand, in physiologically stable adults, premixed insulins can make it possible to limit the number of injections per day.

When to take long-acting insulin analogues?

Long-acting insulin analogues are intended for cover basic insulin needs for the day, apart from the necessary boluses related to meals (which will be provided if necessary by insulins or rapid and intermediate analogues). The onset of action of long-acting insulin analogues is 2 to 4 hours, with a duration of action of 18 to 42 hours. Depending on the analogue used, it will be necessary to carry out 1 to 2 injections per day. For instance Abasaglar®, Lantus® and Toujéo® (insulin glargine) are to be administered once a day, every day at a fixed time (duration of action approximately 24 hours). Tresiba® (insulin degludec) is also injected once a day. Due to its much longer duration of action (approximately 42 hours), this drug allows more flexibility as to the injection schedule and a difference of a few hours from one day to another will have little consequence. . Levemir® (insulin detemir) is injected 1 to 2 times a day depending on the case, its duration of action being approximately 18 hours. Its frequency of administration depends everyone’s needs.

What are the dangers and side effects of insulin?

The most common and disabling side effect of insulin is I’hypoglycemiawhich occurs for example when the doses of insulin injected are too high or are not adapted to the patient’s glycaemia, or even theafter skipping a meal (example: fasting). This potentially serious event may result in discomfort, a loss of consciousnessa coma or even death. Also, in the event of poor adjustment of doses during glucose intake or poorly controlled diabetes, it is possible, conversely, that a hyperglycemia Declares itself. In the most severe cases of hyperglycemia, diabetic ketoacidosis (presence of ketone bodies in the blood or urine) can occur and sometimes even be fatal. This is why it is very important to master your treatment and your illness well, which implies a therapeutic education, regular follow-up and increased monitoring blood glucose throughout treatment.

Occasional variations in sugar (glucose) intake absolutely require an adjustment.

Also, a stable and balanced diet as well as lifestyle measures are essential in order to stabilize your blood sugar on a daily basis. Of the occasional variations in sugar (glucose) intake absolutely require an adjustment insulin doses accordingly to avoid hyperglycaemia. It is also necessary to know how to recognize the signs of hyper or hypoglycaemia in order to react as quickly as possible. Driving a car or machinery can be dangerous if hypoglycaemia occurs. It is not recommended to change the brand or type of insulin during treatment; if this must take place, a transitional phase with an adjustment of the doses is often necessary, in support with the doctor. The doses of insulin to be injected may vary over time, in the event, for example, of changes in lifestyle, in diet, in the event of practicing or stopping a sport, during the occurrence of another illness or in the event of taking other medications. Some medications can raise or lower blood sugar or insulin requirements, while others may mask the symptoms of hypoglycaemia. Other side effects of insulin are local allergies and cutaneous lipodystrophy or amyloidosis at injection sites. To avoid these adverse cutaneous effects, it is strongly recommended to alternate the injection sites and to master the injection techniques relating to the insulin used. Finally, in very rare cases, a generalized allergy can occur after insulin injections.

What are the contraindications of insulin?

There are few contraindications to insulin, except in cases allergy to any of the components of the medicine or hypoglycemia. However, insulin should not be injected intravenously due to the risk of hypoglycaemia it may cause, nor is it recommended to be administered into a muscle due to variable absorption and random. Do not inject insulin outside of what is recommended by the doctor (concerning the type of insulin, the frequency and the doses to be administered). Also, insulin should not be used. outside the manufacturer’s recommendations (methods of injection, storage and handling of the drug).

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