Human insulin types

Skyler JS, Cefalu WT, Kourides IA, Landschulz WH, Balagtas CC, Cheng S-L, Gelfand RA (2001) Efficacy of inhaled human insulin type a diabetes mellitus a randomized proof-of-concept study. Lancet 357 331-335. 

METHODS OF ADMINISTERING INSULIN. Several methods can be used to administer insulin. The most common method is the use of a needle and syringe Use of microfine needles has reduced the discomfort associated with an injection. Another method is the jet injection system, which uses pressure to deliver a fine stream of insulin below the skin. Another method uses a disposable needle and special syringe The syringe uses a cartridge that is prefilled with a specific type of insulin (eg, regular human insulin, isophane [NPH] insulin, or a mixture of isophane and regular insulin). 

A similar approach is fruitful for investigating insulin mutants that may be under consideration as replacements for wild-type insulin in human therapy. For lispro insulin (in which positions P28 and K29 in human insulin are reversed), and for several other insulin mutants, PLIMSTEX clearly can distinguish the self-association properties and binding constants of lispro and r-human insulins [33]. 

Insulin, a pancreatic hormone, is a specific antidiabetic agent, especially for type I diabetes. Human insulin is a double-chain protein with molecular mass around 6000 that contains 51 amino acids (chain A—21 amino acids, chain B—30 amino acids), which are bound together by disulfide bridges. 

Highly purified (single component) and human Insulins Local insulin allergy, immunologic insulin resistance, injection-site lipodystrophy temporary insulin use (ie, surgery, acute stress type 2 diabetes, gestational diabetes) newly diagnosed diabetic patients. 

Insulin lispro Insulin lispro has a more rapid onset and shorter duration of action than regular human insulin. Therefore, in patients with type 1 diabetes, use in regimens that include a longer-acting insulin. However, in patients with type 2 diabetes, insulin lispro may be used without a longer-acting insulin when used in... 

Insulin Preparations. Since diabetes mellitus is a defect of one or more of insulin production, secretion, or action, the administration of insulin replacement as a treatment for diabetes in the 1920s was a landmark discovery. Historically, most commercial insulin came from either bovine or porcine sources. Beef insulin differs from human insulin by three amino acid substitutions pork insulin differs by only one residue. For many years, standard insulin preparations were 70% beef and 30% porcine. However, the biosynthesis of human insulin has now displaced the animal insulins, especially bovine insulin which was more antigenic. Mass production of human insulin by recombinant DNA methods is achieved by inserting the human proinsulin gene into either E. coli or yeast and treating the resulting proinsulin to yield the human insulin molecule. Insulin preparations may be divided into four major types ... 

Biopharmaceuticals based on natural proteins and peptides are often called by the same name as the biologic natural material despite differences in one or more amino-acid residues. For example, insulin, which regulates blood glucose and is used clinically to treat type 1 diabetes and some cases of type 2 diabetes, has several variants that are approved for human use. Insulin contains two polypeptides, A and B chains (Figure 1.2), that are linked together by two disulfide bridges to assume a biologically active conformation. Compared with human insulin, insulin extracted from beef tissue exhibits threonine alanine and isoleucine valine substitutions at posi-... 

Skyler, IS., W.T. Cefalu, I.A. Kourides, W.H. Landschulz, C.C. Balagtas, S.L. Cheng, and R.A. Gelfand, Efficacy of inhaled human insulin in type I diabetes mellitus a randomised proof-of-concept study. Lancet, 2001.357(9253) 331-5. 

Control of hyperglycemia tor type 1 and type 2 diabetes mellitus, tor a more rapid response GI 124617 insulin precursor PID gl24617 Lys(B28)Pro(B29)-human insulin PDB ID ILPH... 

A 45-year-old woman who had used insulin for 4 years had a biphasic hypersensitivity reaction to human insulin (or another component of the injection fluid) (135). Within 20 minutes after the injection a swelling developed and in a later phase papular lesions with lichenoid features and post-inflammatory hyperpigmentation emerged. Histologically, there was neutrophilic infiltration with erythrocyte extravasation and eosinophilic amorphous material, surrounded by neutrophilic infiltrate. Saline injection did not elicit an effect. IgE anti-insulin antibodies were not found. There was no Arthus reaction (type IV allergy). 

In patients who have never used other types of insulin, allergic reactions can be seen when human insulin is used and anti-insulin antibodies can be demonstrated... 

Tawata M, Ikeda M, Kodama Y, Aida K, Onaya T. A type 2 diabetic patient with liver dysfunction due to human insulin. Diabetes Res Clin Pract 2000 49(1) 17-21. 

Mandrup-Poulsen T, Molvig J, Pildal J, Rasmussen AK, Andersen L, Skov BG, Petersen J. Leukocytoclastic vasculitis induced by subcutaneous injection of human insulin in a patient with type 1 diabetes and essential thrombocyte-mia. Diabetes Care 2002 25(l) 242-3. 

In a double-blind, crossover study of insulin aspart or soluble human insulin before meals and protamine zinc insulin before bedtime, 90 of 104 patients with type 1 diabetes completed the trial (5). Insulin aspart improved postprandial control by reducing hyperglycemic and hypoglycemic variations, but night-time control was inferior. There were 547 hypoglycemic episodes in the aspart... 

In an open comparison of insulin aspart and regular human insulin for 6 months in 882 patients with type 1 diabetes and extended to 714 patients for another 6 months, postprandial glucose concentrations were lower with insulin aspart (7). HbAic was slightly but significantly lower (7.78 versus 7.93%). There were no differences in hypoglycemic periods or adverse events. 

When insulin lispro and insulin aspart were compared in a single-blind, randomized, crossover study in 14 patients with type 1 diabetes, insulin lispro had a faster onset of action but a shorter duration (11). However, in another study the pharmacokinetic and the pharmacodynamic profiles of insulin aspart compared with human insulin were the same in 24 healthy Japanese as in non-Japanese (12). Insulin aspart and insulin lispro were equally effective in another 24 patients with type 1 diabetes (13). 

In a double-blind, crossover study with insulin aspart and human insulin in type 1 diabetes, human insulin was given 30 minutes before a meal with placebo immediately before the meal, or placebo was given 30 minutes before the meal with aspart insulin or human insulin immediately before the meal (17). On average, insulin aspart was absorbed twice as fast as human insulin. Postprandial glucose control improved on aspart. There were no episodes of serious hypoglycemia. 

Home PD, Lindholm A, Riis AEuropean Insulin Aspart Study Group. Insulin aspart vs. human insulin in the management of long-term blood glucose control in type 1... 

Hermansen K, Colombo M, Storgaard H, O Stergaard A, Kolendorf K, Madsbad S. Improved postprandial glycemic control with biphasic insulin aspart relative to biphasic insulin lispro and biphasic human insulin in patients with type 2 diabetes. Diabetes Care 2002 25(5) 883-8. 

Boehm BO, Home PD, Behrend C, Kamp NM, Lindholm A. Premixed insulin aspart 30 vs. premixed human insulin 30/70 twice daily a randomized trial in Type 1 and Type 2 diabetic patients. Diabet Med 2002 19(5) 393-9. 

Murphy NP, Keane SM, Ong KK, Ford-Adams M, Edge JA, Acerini CL, Dunger DB. Randomized crossover trial of insulin glargine plus lispro or NPH insulin plus regular human insulin in adolescents with type 1 diabetes on intensive insulin regimens. Diabetes Care 2003 26(3) 799-804. 

Raskin P, Klaff L, Bergenstal R, Halle JP, Donley D, Mecca T. A 16-week comparison of the novel insulin analogue insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care 2000 23(11) 1666-71. 

A 54-year-old woman with type 2 diabetes had poor metabolic control, despite using 60-80 units of shortacting and long-acting human insulins for 10 years (34). Transfer to insulin lispro reduced the daily amount of insulin to 28 units. Insulin specific antibodies fell from 2.7 to 0.3% and cross-reactive antibodies, binding both human insulin and insulin lispro, fell from 44 to 16%. Specific insulin lispro antibodies rose from 0 to 0.3%. HbAic fell from 9.1% to 6.8% and body mass index from 30 to 27, probably because of the reduced dose of insulin. 

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