Types of insulin and their action. Extended insulin - features of the treatment of diabetes mellitus
Diabetes mellitus is characterized by the body’s inability to break down glucose, as a result of which it settles in the blood, causing various disorders in the functionality of tissues and internal organs. In type 1 diabetes, this occurs due to insufficient insulin production by the pancreas. And to replenish this hormone in the body, doctors prescribe insulin to their patients long acting. What is it and how do these drugs work? This and much more will be discussed now.
Why are insulin injections required?
Long-acting insulin helps control fasting blood glucose levels. These drugs are prescribed only by a doctor, when the patient’s independent blood tests using a glucometer are noted throughout the week. significant violations this indicator in the morning hours.
In this case, short-, medium- or long-acting insulins can be prescribed. The most effective in this regard, undoubtedly, are long-acting drugs. They are used to treat types 1 and 2 diabetes mellitus. Administered intravenously 1–2 times a day.
It should be noted that long-acting insulin can be prescribed even in cases where a diabetic is already taking short-acting injections. This therapy allows you to give the body the support it needs and prevent the development of many complications.
Important! Long-acting insulin is prescribed when complete dysfunction pancreas (it stops producing the hormone) and rapid death of beta cells is observed.
Long-acting insulin begins to act 3-4 hours after administration. At the same time, there is a decrease in blood sugar levels and a significant improvement in the patient’s condition. The maximum effect of its use is observed after 8–10 hours. The achieved result can last from 12 to 24 hours and this depends on the dosage of insulin.
The minimum effect can be achieved with an insulin dose of 8010 units. They act for 14–16 hours. Insulin in the amount of 20 units. and is more able to keep blood sugar levels within normal range for about a day. It should be noted that if the drug is prescribed in dosages of more than 0.6 units. per 1 kg of weight, then 2-3 injections are given at once in different parts of the body - thigh, arm, stomach, etc.
It is important to use extended-release insulin correctly. It is not used to stabilize blood glucose after meals because it does not act as quickly as, for example, short-acting insulin. Moreover, insulin injections must be given strictly on schedule. If you skip the time of injection or extend/shorten the interval before them, this can lead to worsening general condition patient, since the glucose level will constantly “jump”, which increases the risk of complications.
Long-acting insulins
Long-acting subcutaneous injections allow diabetics to eliminate the need to take several times a day. medications, as they provide control over blood sugar levels throughout the day. This action is due to the fact that all long-acting products contain chemical catalysts that prolong their effectiveness.
In addition, these drugs have another function - they slow down the process of absorption of sugars in the body, thereby ensuring an improvement in the general condition of the patient. The first effect after the injection is observed after 4–6 hours, and it can last for 24–36 hours, depending on the severity of diabetes.
Name of long-acting insulin-containing drugs:
- Determinate;
- Glargine;
- Ultratard;
- Huminsulin;
- Ultralong;
- Lantus.
These drugs should only be prescribed by the attending physician, since it is very important to calculate correct dosage medicine, which will avoid the occurrence side effects after giving the injection. The drug is injected subcutaneously into the area of the buttocks, thighs and forearms.
These medications must be stored at a temperature of minus 2 degrees (can be in the refrigerator). This will avoid oxidation of the drug and the appearance of a granular mixture in it. Before use, the bottle must be shaken so that its contents become homogeneous.
Improper storage of the drug leads to a decrease in its effectiveness and shelf life
New long-acting insulins differ in duration of effect and composition. They are conventionally divided into two groups:
- identical human hormones;
- animal origin.
The former are obtained from the pancreas of a large cattle and is well tolerated by 90% of diabetics. And they differ from insulins of animal origin only in the amount of amino acids. Such drugs are more expensive, but have many advantages:
- to get maximum therapeutic effect requires administration of smaller doses;
- lipodystrophy after their administration is observed much less frequently;
- These drugs do not cause allergic reactions and can be easily used to control blood sugar levels in allergy sufferers.
Quite often, inexperienced diabetics independently replace short-acting medications with long-acting ones. But this is absolutely forbidden. After all, each of these medications performs its own functions. Therefore, in order to normalize blood sugar and improve your well-being, in no case should you adjust the treatment yourself. Only a doctor should do this.
Short review
The drugs whose names will be described below should never be used without a doctor’s prescription! Using them incorrectly can lead to serious consequences.
Basaglar
The drug is administered subcutaneously, no more than 1 time per day. It is recommended to give injections at the same time before bedtime. The use of Basaglar is often accompanied by side effects, the most common of which are:
- allergy;
- swelling lower limbs and faces.
Tresiba
This is one of the most the best drugs, which is an analogue of human insulin. It is well tolerated by 90% of patients. Only in some diabetics its use provokes the occurrence of allergic reaction and lipodystrophy (with long-term use).
Tresiba is an ultra-long-acting insulin that can keep blood sugar under control for up to 42 hours. This drug is administered once a day at the same time. Its dosage is calculated individually.
Such a long duration of this drug is due to the fact that the components included in its composition help to increase the process of processing insulin by the body's cells and reduce the rate of production of this element by the liver, which makes it possible to achieve a significant decrease in blood sugar levels.
But this tool has its drawbacks. Only adults can use it, that is, it is contraindicated for children. In addition, its use for the treatment of diabetes is impossible in women during pregnancy and lactation, as this can negatively affect the health of the unborn baby.
Lantus
It is also an analogue of human insulin. It is administered subcutaneously, 1 time per day at the same time. It begins to act 1 hour after administration and remains effective for 24 hours. It has an analogue - Glargine.
The peculiarity of Lantus is that it can be used in adolescents and children over the age of 6 years. In most cases it is well tolerated. Only in some diabetics does it provoke an allergic reaction, swelling of the lower extremities and lipodystrophy.
To prevent the development of lipodystrophy with long-term use of this drug, it is recommended to periodically change the injection site. It can be done on the shoulder, thigh, stomach, buttocks, etc.
Levemir
It is a soluble basal analogue of human insulin. It acts for 24 hours, which is caused by the pronounced self-association of insulin detemir molecules in the area of injection and the binding of drug molecules to albumin by the fatty acid chain.
Introduced this drug subcutaneously 1–2 times a day depending on the patient’s needs. It can also provoke the occurrence of lipodystrophy, and therefore the injection site must be constantly changed, even if the injection is placed in the same area.
Remember that long-acting insulins are strong drugs, which must be used strictly according to the scheme, without skipping the time of injection. The regimen for using such drugs is prescribed individually by the doctor, as well as their dosage.
Last updated: April 25, 2019
Insulin is one of the important hormones in the human body. Insulin is produced in the pancreas and has a multifaceted effect on metabolic processes in the tissues of the body. The main task of this bioactive compound is to reduce the concentration of sugars in the body.
When insulin production is impaired, a person develops a disease called diabetes mellitus. As a result of the development of this disease, carbohydrate metabolism processes are disrupted.
People suffering from diabetes are faced with the fact that the level of insulin in the body must be maintained artificially. The amount of insulin injected into the body depends on the magnitude of the difference between the insulin produced by the body and the amount of insulin that the body requires for normal functioning. Existing drugs Insulin is divided into several types depending on the speed of achieving the effect and the duration of action of the drug in the body. One type is long-acting insulin.
Extended-release insulin has a prolonged effect due to this property; this type of drug is called extended-release insulin. This type of artificial hormone acts as the main basic hormone that creates the required insulin level in the patient’s body.
Drugs of this type are able to accumulate insulin in the body throughout the day. During the day, it is enough to carry out 1-2 injections to normalize the level of the hormone in the blood. Gradually, with the use of long-acting insulin, normalization occurs. hormonal levels in organism. The effect is achieved on the second or third day; it should be noted that the maximum effect is achieved after 2–3 days, and the drug begins to act within a few hours.
The most common long-acting insulin preparations are the following:
- Insulin Monodar Long;
- Insulin Ultralong;
- Insulin Lantus.
Among long-acting drugs, the so-called faceless insulin preparations stand apart. This type of insulin, when introduced into the body, does not have a pronounced peak of action. The effect of these drugs on the body is smooth and milder. The most well-known drugs in this group are Levemir and Lantus.
All types of insulin are administered subcutaneously and the injection site of the insulin dose should be changed each time. Insulin preparations cannot be mixed or diluted.
Choosing long-acting insulin
Before choosing long-acting insulins, you should study information about what type of insulin there is. Additionally, you should study the information specified in the operating instructions and consult with an endocrinologist.
Today, two types of long-acting insulins are used to treat the disease:
- Insulins with a duration of action of up to 16 hours;
- Ultra-long-acting insulins that last more than 16 hours.
The group of first insulins includes:
- Gensulin N.
- Biosulin N.
- Isuman NM.
- Insuman Bazal.
- Protafan NM.
- Humulin NPH.
To the ultra insulin group long acting relate:
- Tresiba NEW.
- Levemir.
- Lantus.
Ultralong insulins are peakless. When calculating the dose for injection with a drug that has an ultra-long effect, this feature must be taken into account. The remaining selection rules are common to all types of insulin.
When calculating a one-time dose into the body, the indicator should be such that the glucose concentration remains at the same level within normal limits throughout the entire time between injections. During this time, permissible fluctuations should not exceed 1–1.5 mmol/l.
When implementing the right choice dose of insulin, the blood glucose concentration is stable.
Prohibited to use medical supplies containing insulin, the shelf life of which is expired. When storing medications, it is necessary to comply with the storage conditions and shelf life of the medications. The use of expired insulin in treatment can provoke in the patient’s body increased sweating, weakness, tremors, convulsions, and in some cases even coma.
Modern long-acting insulin preparations can be taken not only by injection, but also by oral administration of the drug during food consumption.
Oral administration of the drug is a promising development, which is designed to make the life of a person with diabetes mellitus easier.
Action of insulin, indications for use and method of administration
Sugar level
Subcutaneous administration of the drug allows the hormone to remain in fatty tissue for some time, which allows it to slow down its absorption into the bloodstream.
Indications for the use of long-acting insulin are:
- The patient has type 1 diabetes mellitus.
- The patient has type 2 diabetes mellitus.
- The presence of patient immunity to oral drugs intended to reduce the level of sugar in the blood plasma.
- Use as a component of complex therapy.
- Carrying out surgical interventions.
- Presence of gestational diabetes in pregnant women.
The amount of hormone used is determined by an endocrinologist on an individual basis and taking into account all individual characteristics the patient's body. The endocrinologist will be able to calculate the dose only after receiving the results. comprehensive survey patient and obtaining laboratory tests.
Shaking the insulin bottle before giving the injection is prohibited. Before administering the drug, you only need to roll the bottle of insulin in your palm, this will allow a homogeneous composition to form and at the same time allows you to warm up the medication before the injection.
When a patient switches from animal insulin to human insulin, the dose should be recalculated.
If a patient is transferred from one type of drug to another, it is also necessary to adjust the insulin dose received.
Characteristics of the most common types of long-acting insulin
The action of this drug is based on enhancing the utilization of glucose from blood plasma by fat cells and muscle tissue cells.
This process is activated by the attachment of the hormone to cell receptors. The second effect of the drug is to block the production of glucose by liver cells, which reduces the amount of glucose in the patient’s body.
The duration of action of this drug is more than 42 hours. The maximum concentration of insulin in the body is reached 24–36 hours after administration of the drug.
The drug Insulin-glargine is produced by the French company Sanori-Aventis. The composition of the medicine includes insulin glargine; m-cresol, zinc chloride, glycerol, sodium hydroxide, and water for injection are used as auxiliary compounds in the medicine.
This form of the drug is an analogue of human insulin.
When the drug is administered once a day, a stable concentration of the compound in the patient’s body is observed for 2 to 4 days after the administration procedure.
Having a long duration of action of the drug, it allows you to use it only once during the day. After the injection, the effect of the drug begins one hour after the injection.
The drug can only be used by subcutaneous injection. The drug is injected into the subcutaneous fatty tissue in the abdomen, shoulder or thigh.
Side effects of using this drug are the development of lipodystrophy and a delay in insulin absorption.
Contraindication for use is the presence hypersensitivity to insulin-glargine or any of the components of the drug. Additionally, this drug should not be used in children under 6 years of age.
The drug Humulin L is medical device, American company Eli-Lilly. The product is a sterile suspension of crystalline human insulin. The drug has a long-lasting effect.
In the video in this article, the doctor will continue to cover the topic of extended-release insulin.
Sugar level
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In a healthy body, insulin is secreted continuously (basal excretion) and begins to be produced when there is a need to reduce blood glucose levels (for example, after eating). If there is a lack of insulin in a person’s body, he needs insulin injection, that is, insulin therapy.
The role of long-acting insulin, which comes in pen form, is a reflection of the basal (continuous) secretion of the pancreas.
The main purpose of the drug is to maintain the required concentration of the drug in the blood for a sufficiently long period. That's why it is called basal insulin.
This hormone is usually divided into two types: long-acting drugs (NPH) and analogues.
New generation long-acting insulin
Human insulin NPH and its long-acting analogues are available for diabetics. The table below shows the main differences between these medications.
In September 2015, a new long-acting insulin, Abasaglar, was introduced, which is almost identical to the commonly used Lantus.
Long acting insulin names
| International name/active substance |
Commercial name of the drugs | Action type | Validity |
| Insulin glargine Glargine | Lantus Lantus | 24 hours | |
| Glargine | Abasaglar Abasaglar | Long-acting insulin - analogue | 24 hours |
| Insulin detemir Detemir | Levemir Levemir | Long-acting insulin - analogue | ≤ 24 h |
| Insulin glargine | Toujeo Toujeo | Extra long-acting basal insulin | > 35 hours |
| Degludec | Tresiba Tresiba | Very long-acting insulin - analogue | > 48 h |
| NPH | Humulnin N, Insulatard, Insuman Basal, Polhumin N | Insulin drug average duration actions | 18 - 20 h |
Quality Control Department food products and drugs (Food and Drug Administration, FDA, US FDA) - A government agency subordinate to the US Department of Health in 2016 approved another analogue of long-acting insulin - Toujeo. This product available on the domestic market and has proven its effectiveness in the treatment of diabetes.
NPH insulin (NPH Neutral protamine Hagedorn)
This is a form of synthetic insulin modeled after the design of human insulin, but enriched with protamine (fish protein) to slow its action. NPH has a cloudy appearance. Therefore, before administration, it should be carefully rotated to mix well.
NPH is the cheapest form of long-acting insulin. Unfortunately, it carries more high risk hypoglycemia and weight gain, since it has a pronounced peak of activity (although its action is gradual and not as rapid as bolus insulin).
Patients with type 1 diabetes are usually prescribed two doses of NPH insulin per day. And patients with type 2 diabetes can inject once a day. It all depends on your blood glucose level and your doctor’s recommendations.
Long-acting insulin analogues
Insulin, chemical components which is so altered that it slows down the absorption and action of the drug, is considered a synthetic analogue of human insulin.
Lantus, Abasaglar, Tujeo and Tresiba have common feature- longer duration of action and less pronounced peak of activity than NPH. In this regard, their intake reduces the risk of hypoglycemia and weight gain. However, the cost of analogues is higher.
Insulin drugs Abasaglar, Lantus and Tresiba are taken once a day. Some patients also use Levemir once a day. This does not apply to type 1 diabetics, for whom the drug is active for less than 24 hours.
Tresiba is the newest and this moment the most expensive form of insulin available on the market. However, it has an important advantage - the risk of hypoglycemia, especially at night, is the lowest.
How long does insulin last?
The role of long-acting insulin is to represent the basal secretion of insulin through the pancreas. Thus, a uniform level of this hormone in the blood is ensured throughout its activity. This allows our body's cells to use glucose dissolved in the blood within 24 hours.
How to inject insulin
All long-acting insulins are injected under the skin into areas where there is a fat layer. The lateral part of the thigh is best suited for these purposes. This site allows for slow, even absorption of the drug. Depending on the prescription by the endocrinologist, you need to do one or two injections per day.
Advantages and disadvantages of long-acting insulin
The type of insulin you choose depends on a number of factors, including your medical history, risk of hypoglycemia, and how much control you have over your daily insulin doses.
Injection frequency
If you want to keep your insulin injections to a minimum, then use analogues of Abasaglar, Lantus, Toujeo or Tresiba. One injection (in the morning or evening, but always at the same time of day) can provide a single insulin level around the clock.
Two injections per day may be required to maintain optimal blood levels of the hormone when choosing NPH. This, however, allows dosages to be adjusted depending on time of day and activity—higher during the day and lower at bedtime.
Risk of hypoglycemia with basal insulin use
Long-acting insulin analogues have been shown to be less likely to cause hypoglycemia (especially severe hypoglycemia at night) compared to NPH. With their use, target values for glycated hemoglobin HbA1c are likely to be achieved.
There is also evidence that the use of long-acting insulin analogues, compared with isoflan NPH, causes a decrease in body weight (and therefore a decrease in drug resistance and overall drug requirements).
Long-acting insulin for type I diabetes
If you suffer from type 1 diabetes, your pancreas is unable to produce enough insulin. Therefore, medications should be taken after each meal. long-term exposure, simulating the primary secretion of insulin by beta cells. If you miss an injection, you are at risk of developing diabetic ketoacidosis.
When choosing between Abasaglar, Lantus, Levemir and Tresiba, you need to know some features of insulins.
- Lantus and Abasaglar have a slightly flatter profile than Levemir and are active for 24 hours for most patients.
- Levemir may need to be taken twice daily.
- Using Levemir, doses can be calculated based on time of day, thereby reducing the risk of nocturnal hypoglycemia and improving daytime control.
- Toujeo and Tresibia are more effective in reducing the above symptoms compared to Lantus.
- You should also consider the side effects of medications, such as rashes. These reactions are relatively rare, but they can happen.
- If you need to switch from long-acting insulin analogues to NPH, keep in mind that your post-meal dosage will likely need to be reduced.
Long-acting insulin for type II diabetes
Treatment for type II diabetes usually begins with administration proper diet And oral medications(Metformin, Siofor, Diabeton, etc..). However, there are situations when doctors are forced to use insulin therapy.
The most common ones are listed below:
- Insufficient effect of oral drugs, failure to achieve normal glycemia and glycated hemoglobin
- Contraindications for taking oral medications
- Diagnosis of diabetes with high glycemic indicators, increased clinical symptoms
- Myocardial infarction, coronary angiography, stroke, acute infection, surgical procedures
- Pregnancy
Long acting insulin profile
The initial dose of medication is usually 0.2 units/kg body weight. This calculator is valid for people without insulin resistance, with normal function liver and kidneys. The dosage of insulin intake is prescribed exclusively by your attending physician (!)
In addition to the duration of action (the longest is degludec, the shortest is human genetically engineered insulin-isophane), these drugs also differ in appearance. When using NPH insulin, the peak effect is distributed over time and occurs between 4 and 14 hours after injection. Active analogue Long-acting insulin detemir reaches its peak between 6 and 8 hours after injection, but it lasts less and is less pronounced.
Insulin glargine is therefore called basal insulin. Its concentration in the blood is very low, so the risk of hypoglycemia is much lower.
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Long-acting insulin
The intensive insulin therapy model should replace physiological excretion insulin, both basal and after meals. In people with type 1 diabetes, the only option for replacing basal insulin release is with long-acting insulin.
Basal insulin is around 40-60% daily requirement body. In an ideal situation, the dose of basal insulin should cover the requirement between meals, and the introduction of short-acting insulin will correct postprandial glycemia.
Diabetes mellitus requires maintenance insulin therapy. Short insulin and long insulin are used to treat the disease. From observing everyone medical prescriptions The quality of life of a diabetic largely depends.
Effective long-acting insulin is needed when fasting blood glucose levels need to be leveled. The most common long-acting insulins today are Lantus, which should be administered to the patient once every 12 or 24 hours.
The attending physician determines the need for insulin treatment and prescribes specific medications, and the patient ultimately depends on strict adherence to recommendations positive prognosis in the treatment of the disease.
Long insulin has amazing property, it is able to imitate the natural hormone that is produced by pancreatic cells. At the same time, it is gentle on such cells and stimulates their restoration, which makes it possible to refuse insulin replacement therapy in the future.
Extended-release insulin injections should be given to patients who have increased level sugar during the day, but you should ensure that the patient eats food no later than 5 hours before bedtime. Also, long-term insulin is prescribed for the symptom of “dawning”, in the case when liver cells begin to neutralize insulin at night before the patient wakes up.
If short insulin needs to be injected during the day to reduce the level of glucose supplied with food, then long insulin guarantees an insulin level, serves as an excellent prevention, and also helps restore the beta cells of the pancreas. Extended-release insulin injections deserve attention because they help normalize the patient’s condition and ensure that type 2 diabetes does not develop into type 1 disease.
Correct calculation of the dose of long-acting insulin at night
To maintain a normal lifestyle, the patient needs to learn how to correctly calculate the dosage of Lantus, Protafan or Levemir at night so that the fasting glucose level is kept at 4.6 ± 0.6 mmol/l.
To do this, you should measure your sugar levels at night and in the morning on an empty stomach for a week. Then you should calculate the sugar value in the morning minus yesterday’s value at night and calculate the increase, this will give an indicator of the minimum required dosage.
For example, if the minimum increase in sugar is 4.0 mmol/l, then 1 unit of extended-release insulin can reduce this indicator by 2.2 mmol/l in a person weighing 64 kg. If your weight is 80 kg, then we use the following formula: 2.2 mmol/l * 64 kg / 80 kg = 1.76 mmol/l. The insulin dose for a person weighing 80 kg should be 1.13 units, this number is rounded to the nearest quarter and we get 1.25 units.
It should be noted that Lantus cannot be diluted, so it needs to be injected with 1 unit or 1.5 units, but Levemir can be diluted and injected with the required amount. IN next days You need to monitor what your fasting sugar is like and increase or decrease the dosage. It is selected correctly and correctly if during the week the fasting sugar is no more than 0.6 mmol/l, but if the value is higher, then try increasing the dosage by 0.25 units every three days.
Source: http://diabetanety.com/diabet/prodlennyj-insulin
Long-acting insulin: when it is prescribed and how it is used
There are no absolute cures for diabetes in the world. But the use of long-acting drugs can reduce the number of necessary injections and significantly improve the quality of life.
Attention!
What is the importance of long-acting insulin in the human body? Medium- and long-acting medications are administered by a diabetic 1-2 times a day (morning and evening) and are basic. The peak effectiveness of long-acting insulin occurs after 8-10 hours, but the decrease in sugar is noticeable after 3-4 hours.
How to choose a dose of insulin sufficient for a person: small volumes (no more than 10 units) are effective for about 12 hours, large quantity drug - up to 24 hours. If long-term insulin is prescribed in a dosage exceeding 0.6 units per 1 kg of body weight, then the injection is made in several stages in different places (shoulder, thigh, abdomen).
What does this treatment provide?
Long-acting insulin is necessary to maintain fasting glucose levels. Only a specialist, based on the patient’s self-monitoring, can determine whether the patient needs injections of a short-acting drug before each meal and a medium- and long-acting one.
Important. Long-acting insulin is a complete replacement for the basal hormone secreted by the pancreas. It also slows down the death of beta cells.
Incorrect use
Long-term medications are not used to stabilize glucose after meals. They won't be able to do it quickly. This is explained by a fairly slow approach to peak effectiveness, which differs from short-term remedies.
Unscheduled injections can have a significant impact on a person’s health:
Action at night and in the morning
People diagnosed with diabetes almost always have elevated sugar levels in the morning. This means that the body does not have enough long-acting insulin at night. But before demanding to prescribe an extended hormone, the doctor needs to check when the person last ate. If you eat food five or less hours before bedtime, then long-acting background medications will not help stabilize your sugar.
The phenomenon of “dawn” is also poorly explained by experts. Shortly before waking up, the liver rapidly neutralizes hormones, which leads to hyperglycemia. And even if you adjust the dose, this phenomenon still makes itself felt.
The effect of this phenomenon on the body determines the injection regimen: the injection is given eight hours or less before the approximate moment of awakening. After 9-10 hours, extended-release insulin acts much weaker.
A long-acting drug cannot maintain sugar levels in the morning. If this happens, it means that the doctor prescribed an excessive amount of the hormone. Excess of the drug is fraught with hypoglycemia. In a dream, by the way, it can manifest itself in the form of restlessness and nightmares.
To avoid this condition, you can do the following check: four hours after the injection, you need to wake up and measure your glucose level. If the indicator is less than 3.5 mmol/l, then it is advisable to inject extended-release insulin in two stages - immediately before bedtime and another 4 hours later.
Using this regimen allows you to reduce the dose to 10-15%, control the “dawn” phenomenon and wake up with ideal blood sugar.
Common long-acting drugs
Among the long-acting hormones, the following names appear most often (according to the radar):
- ultra tape;
- humulin;
- insumanbasal;
- glargine;
- detemir.
The last two samples are characterized as having the most even effect on glucose. This long-acting insulin is injected only once a day and does not provoke the development of hypoglycemia at night. It is considered promising in the field of insulin therapy.
The long-lasting effect of insulin Lantus (glargine form) can be explained by the very slow absorption when administered subcutaneously. However, to maintain this effect, you need to choose a new injection site each time.
A dose of Lantus insulin is prescribed for long-term stabilization of glucose in the body (up to 24 hours). The product is available in cartridges and syringe pens with a volume of 3 ml and bottles with 10 ml of the drug. Duration of action is from 24 to 29 hours. True, the influence throughout the day largely depends on physiological characteristics person.
In the first type of diabetes, long-acting insulin Lantus is prescribed as the main one; in the second type, it can be combined with a number of other sugar-lowering drugs.
When switching from short and medium samples to long-acting insulin, the dosage and injection schedule are adjusted in the first days. By the way, in last years A certain trend is emerging in which patients are trying to switch to ultra-long-duration drugs to reduce the number of injections and improve the quality of life.
Ultra long effect
The long-acting insulins described above are the most effective. They are also distinguished by absolute transparency: they do not need to be shaken or rolled in your hands to ensure uniform distribution of sediment. Along with Lantus, Levemir is the most stable drug, its characteristics are similar for diabetics with both types of the disease.
Attention!
It is worth noting that long forms still have a slight peak in their activity. In turn, these drugs do not have it. And this feature must be taken into account in the process of dose adjustment.
The basal drug is calculated based on its ability to maintain constant, stable level blood sugar. Allowable fluctuations are no more than 1.5 mmol/l. However, this should not happen within 24 hours after the injection. As a rule, the extended-release drug is injected into the thigh or buttock. Here the fat layer slows down the absorption of the hormone into the blood.
Often, inexperienced diabetics try to replace short-acting insulin with long-acting insulin, which cannot be done. After all, each type of hormone is necessary to perform a strictly defined function. Therefore, the patient’s task is to strictly adhere to the prescribed insulin therapy.
Only if long-acting insulin is used correctly is it possible to achieve permanent normal indicator on .
Source: http://diabet-expert.ru/insulin/insulin-dlitelnogo-dejstviya.html
Extended-acting insulin and its name
Diabetes mellitus is characterized by the body's inability to break down glucose, as a result of which it settles in the blood, causing various disturbances in the functionality of tissues and internal organs. This occurs due to insufficient production of insulin by the pancreas.
And to replenish this hormone in the body, doctors prescribe long-acting insulin to their patients. What is it and how do these drugs work? This and much more will be discussed now.
Why are insulin injections required?
Long-acting insulin helps control fasting blood glucose levels. These drugs are prescribed only by a doctor when the patient’s independent blood tests using a glucometer over the course of a week indicate significant violations of this indicator in the morning.
In this case, short-, medium- or long-acting insulins can be prescribed. The most effective in this regard, undoubtedly, are long-acting drugs. They are used to treat types 1 and 2 diabetes mellitus. Administered intravenously 1–2 times a day.
It should be noted that long-acting insulin can be prescribed even in cases where a diabetic is already taking short-acting injections. This therapy allows you to give the body the support it needs and prevent the development of many complications.
Important! Long-acting insulin is prescribed when there is complete dysfunction of the pancreas (it stops producing the hormone) and rapid death of beta cells is observed.
Long-acting insulin begins to act 3-4 hours after administration. At the same time, there is a decrease in blood sugar levels and a significant improvement in the patient’s condition. The maximum effect of its use is observed after 8–10 hours. The achieved result can last from 12 to 24 hours and this depends on the dosage of insulin.
The minimum effect can be achieved with an insulin dose of 8010 units. They act for 14–16 hours. Insulin in the amount of 20 units. and is more able to keep blood sugar levels within normal range for about a day. It should be noted that if the drug is prescribed in dosages of more than 0.6 units. per 1 kg of weight, then 2-3 injections are given at once in different parts of the body - thigh, arm, stomach, etc.
It is important to use extended-release insulin correctly. It is not used to stabilize blood glucose after meals because it does not act as quickly as, for example, short-acting insulin. Moreover, insulin injections must be given strictly on schedule.
If you skip the time of giving an injection or extend/shorten the interval before them, this can lead to a deterioration in the patient’s general condition, since the glucose level will constantly “jump”, which increases the risk of complications.
Long-acting insulins
Long-acting subcutaneous injections allow diabetics to eliminate the need to take medications several times a day, as they provide control over blood sugar levels throughout the day. This action is due to the fact that all types of long-acting insulin contain chemical catalysts that prolong their effectiveness.
In addition, these drugs have another function - they slow down the process of absorption of sugars in the body, thereby ensuring an improvement in the general condition of the patient. The first effect after the injection is observed after 4–6 hours, and it can last for 24–36 hours, depending on the severity of diabetes.
Name of long-acting insulin-containing drugs:
- Determinate;
- Glargine;
- Ultratard;
- Huminsulin;
- Ultralong;
- Lantus.
These drugs should be prescribed only by the attending physician, since it is very important to use a drug that will avoid side effects after the injection. The drug is injected subcutaneously into the area of the buttocks, thighs and forearms.
These medications must be stored at a temperature of minus 2 degrees (can be in the refrigerator). This will avoid oxidation of the drug and the appearance of a granular mixture in it. Before use, the bottle must be shaken so that its contents become homogeneous.
New long-acting insulins differ in duration of effect and composition. They are conventionally divided into two groups:
- identical to human hormones;
- animal origin.
The former are extracted from the pancreas of cattle and are well tolerated by 90% of diabetics. And they differ from insulins of animal origin only in the amount of amino acids. Such drugs are more expensive, but have a lot of advantages:
- to obtain the maximum therapeutic effect, smaller doses are required;
- lipodystrophy after their administration is observed much less frequently;
- These drugs do not cause allergic reactions and can be easily used to control blood sugar levels in allergy sufferers.
Quite often, inexperienced diabetics independently replace short-acting medications with long-acting ones. But this is absolutely forbidden. After all, each of these medications performs its own functions. Therefore, in order to normalize blood sugar and improve your well-being, in no case should you adjust the treatment yourself. Only a doctor should do this.
Short review
The drugs whose names will be described below should never be used without a doctor’s prescription! Using them incorrectly can lead to serious consequences.
Basaglar
The drug is administered subcutaneously, no more than 1 time per day. It is recommended to give injections at the same time before bedtime. The use of Basaglar is quite often accompanied by the appearance of side effects, among which the most common are:
- allergy;
- swelling of the lower extremities and face.
Tresiba
This is one of the best drugs, which is an analogue of human insulin. It is well tolerated by 90% of patients. Only in some diabetics does its use provoke an allergic reaction and lipodystrophy (with long-term use).
Tresiba is an ultra-long-acting insulin that can keep blood sugar under control for up to 42 hours. This drug is administered once a day at the same time. Its dosage is calculated individually.
Such a long duration of this drug is due to the fact that the components included in its composition help to increase the process of processing insulin by the body's cells and reduce the rate of production of this element by the liver, which makes it possible to achieve a significant decrease in blood sugar levels.
But this tool has its drawbacks. Only adults can use it, that is, it is contraindicated for children. In addition, its use for the treatment of diabetes is impossible in women during lactation, as this can negatively affect the health of the unborn baby.
Lantus
It is also an analogue of human insulin. It is administered subcutaneously, 1 time per day at the same time. It begins to act 1 hour after administration and remains effective for 24 hours. It has an analogue - Glargine.
The peculiarity of Lantus is that it can be used over the age of 6 years. In most cases it is well tolerated. Only in some diabetics does it provoke an allergic reaction, swelling of the lower extremities and lipodystrophy.
To prevent the development of lipodystrophy with long-term use of this drug, it is recommended to periodically change the injection site. It can be done on the shoulder, thigh, stomach, buttocks, etc.
Levemir
It is a soluble basal analogue of human insulin. It acts for 24 hours, which is caused by the pronounced self-association of insulin detemir molecules in the area of injection and the binding of drug molecules to albumin by the fatty acid chain.
Attention!
This drug is administered subcutaneously 1–2 times a day, depending on the patient’s needs. It can also provoke the occurrence of lipodystrophy, and therefore the injection site must be constantly changed, even if the injection is placed in the same area.
Remember that long-acting insulins are strong drugs that must be used strictly according to the schedule, without skipping the injection time. The regimen for using such drugs is prescribed individually by the doctor, as well as their dosage.
Diabetes mellitus type 2 is also called non-insulin dependent diabetes. This serious illness, characterized...
When prescribing the drug, the doctor must study the patient’s notes, reflecting the level of glucose in the blood over the past three weeks, or preferably one to two months.
For normal functioning, long-acting insulin is prescribed as basal insulin; for patients diagnosed with “,” long-acting insulin is prescribed as monotherapy for patients diagnosed with “.”
Basal insulin is insulin produced in the body constantly 24 hours a day, regardless of the time or frequency of meals. However, in patients with type 2 diabetes, the pancreas is not able to produce the hormone even in minimal doses. Long-acting insulin injections are given once in the morning, before meals, sometimes twice. The medication begins to act fully after three hours and retains its effect for up to 24 hours.
When treating type 1 diabetes, basal insulin is necessarily supplemented with injections of short or ultra-short insulin.
Long-acting insulin, the names of which are given below, is necessary in the following cases:
- stabilization in the morning before meals;
- maintaining the required level of the hormone at night;
- reducing the effect of such a phenomenon as “morning dawn”;
- prevention and preservation of beta cells in type 1 diabetes;
- stabilizing the body’s condition and preventing it from further developing the disease into type 2 diabetes.
The dose of long-acting insulin is determined only by the doctor, after a detailed examination of the patient and a series of experimental injections. To prevent hypoglycemia in initial doses, the concentration of the hormone is increased. Then the concentration gradually decreases until blood glucose levels normalize.
It is important to use long-acting insulin correctly. It will not help in quality emergency assistance stabilize blood sugar after meals, like short-term or ultra-short insulin. Its action is not so fast. Extended-release insulin injections require strict compliance mode and schedule. Deviations from the appointed time will most likely provoke serious consequences for the health of the patient, since the blood glucose level will not be stable.
Using long-acting insulins, the patient provides his body with the most accurate imitation of the human hormone. Conventionally, long-acting insulin, the names of which will be discussed below, is divided into two groups: a duration of action of 15 hours and a duration of action of up to 30 hours.
Having slowly reached the point of highest concentration, long-acting insulin begins the same gradual decline without causing acute reactions or surges in the patient’s blood. And here the most important thing is not to miss the moment when the effect of the injection becomes zero and administer the next dose of the drug. Long-acting insulin has its advantages and disadvantages like any other drug.
Advantages:
- simple introduction;
- the treatment regimen is quite simple and understandable to both the patient and his relatives;
- low indicator of the totality of skills and necessary information for treatment;
- no need for constant monitoring of blood glucose levels;
- independent control over the course of the disease and the therapy is possible.
Flaws:
- stable risk of hypoglycemia;
- stable hyperinsulinemia, which increases the risk of developing arterial hypertension;
- strict diet and injections;
- weight gain;
Drug names
The absence of activity peaks in long-acting insulin is due to the presence of the hormone glargine in its composition, which penetrates into the blood quite evenly. The Ph-balance of glargine is acidic and this factor excludes its interaction with drugs with a neutral Ph-balance, i.e. short and ultra-short insulin.
The most well-known names of long-acting insulins are shown in the table with detailed description:
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Buy on the official website| Drug name | Action | Characteristic |
|---|---|---|
| , Insuman, Bazal | Protamine significantly prolongs the effect of the drug. The effect lasts up to 12 hours, but depends on the dose. Sometimes this type of insulin works for up to 16 hours | Medium insulins, called NPH. They are an analogue of the human hormone with the addition of protamine |
| , | New generation drugs that have a progressive hormone effect. When used properly, they stabilize blood glucose levels throughout the day. Characterized by mild penetration into the blood and a mild decrease in concentration | Long insulins. These drugs have passed all laboratory tests, have been deeply studied and are widely used in prescribing treatment regimens for type 1 and type 2 diabetes mellitus |
| It has a long, stable effect without peaks for 42 hours. In the treatment of type 2 diabetes mellitus it has great superiority over other drugs. However, in the treatment of type 1 diabetes mellitus, its benefit is less noticeable. The drug perfectly stabilizes blood glucose levels in the morning, but increases the likelihood of developing hypoglycemia in the afternoon. | Extra long insulin. There is only one in this group so far. This newest analogue human insulin, but also the most expensive |
Popular drugs
Despite the wide selection of long-acting insulins, the names of which are given above in the table, the most popular are still Lantus and Levemir. Let's find out why.
Lantus
The drug that patients use more often than others. It does not need to be shaken before injection; the composition of the suspension is transparent and without sediment. Available in the form of a pen-syringe, cartridge, and systems with five cartridges. Having such a choice allows the patient to choose which option is acceptable to him.