Insuhn aspart

Aspart insulin and biphasic insuhn aspart (30% soluble rapid-acting insulin and 70% protamine-bound aspart insulin) have been reviewed (4). 

The new, short-acting insulins can be bound to protamine, allowing the preparation of mixed formulations. In an open, randomized, single-dose, three-way, crossover trial biphasic insuhn aspart 30 (30% aspart plus 70% protaminated aspart, BIAsp 30), biphasic insulin lispro 25 (25% hspro plus 75% protaminated lispro. Mix 25), and biphasic human insulin 30 (30% regular plus 70% isophane insuhn, BHI 30) were compared in 45 patients (15). Biphasic insulin aspart improved postprandial control better. There were 23 episodes of hypoglycemia with BIAsp 30, 19 with Mix 25, and 11 with BHI 30 two episodes with BIAsp 30, five with Mix 25, and two with BHI 30 required third-party intervention. 

When 30% insuhn aspart plus 70% protamine aspart was compared with the same mixture of regular plus isophane insuhns, both injected twice-daily for 12 weeks, in 294 patients with type 1 and type 2 diabetes, control was better with the aspart mixture (16). There were fewer episodes of major hypoglycemia (20 versus 42) but the same number of minor episodes (362) with aspart. 

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

A 45-year-old man with type 2 diabetes treated with glib-enclamide and metformin received combined chemotherapy for non-Hodgkin s lymphoma and was given premixed insuhn. He developed local wheal-and-flare reactions immediately after the injections. Skin prick tests were positive for various types of insuhn but weakly positive for hspro and negative for insuhn aspart. He tolerated aspart insuhn without any allergic reactions. 

A few patients treated with insuhn aspart developed antibodies, which cross-reacted with antibodies against human insuhn and fell after 3 months (19). In lipodystrophy with lipoatrophic diabetes high insuhn resistance is often found, for which leptin deficiency is one contributory factor. 

Allergic reactions have been described with insuhn aspart. 

When insulin lispro and insuhn 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 (22). However, in another study, the pharmacokinetic and pharmacodynamic profiles of insulin aspart compared with human insulin in 24 healthy Japanese were the same as those in non-Japanese subjects (23). 

Bode B, Weinstein R, Bell D, McGill J, Nadeau D, Raskin P, Davidson J, Henry R, Huang WC, Reinhardt RR. Comparison of insuhn aspart with buffered regular insulin and insulin hspro in continuous subcutaneous insulin infusion a randomized study in type 1 diabetes. Diabetes Care 2002 25(3) 439-44. 

Setter SM, Corhett CF, Camphell RK, et al. Insuhn aspart a new rapid-acting insulin analog. Arm Pharmacother 2000 34 1423-1431. 

Human insulin is derived from a biosynthetic proems using strains of Escherichia coli (recombinant DNA, rDNA). Human insulin )pears to cause fewer allergic reactions than does insulin obtained from animal sources. Insuhn analog, insulin lispro, and insuhn aspart are newer fomis of human insulin made by using recombinant DNA technology and are structurally similar to human insulin. 

Insulin aspart is a rapid-acting synthetic insulin in which prohne is replaced by aspartate at position 28 in the B chain. Insulin aspart has been reviewed (1). Its adverse effects do not differ from those of soluble human insuhn and it has a similar effect on the blood glucose concentration (2). 

In an open comparison of insulin aspart and regular human insuhn 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. 

Mudahar SR, Lindberg FA, loyce M, Beerdsen P, Strange P, Lin A, Henry RR. Insulin aspart (B28 asp-insuhn) a fast-acting analogue of human insulin absorption kinetics and action profile compared with regular human insuhn in healthy nondiabetic subjects. Diabetes Care 1999 22(9) 1501-6. 

Takata H, Kumon Y, Osaki F, Kumagai C, Arii K, Ikeda Y, Suehrro T, Hashimoto K. The human msuhn analogue aspart is not the almighty solution for insuhn allergy. Diabetes Care 2003 26(l) 253-4. 

Hedman CA, Lindstrom T, Arnqvist HJ. Direct comparison of insuhn lispro and aspart shows smah differences in plasma insuhn profiles after subcutaneous iujectiou iu type 1 diabetes. Diabetes Care 2001 24(6) 1120-1. 

Kaku K, Matsuda M, Urae A, Irie S. Pharmacokiuehes aud pharmacodynamics of insulin aspart, a rapid-acting analogue of human insuhn, in healthy Japanese volunteers. Diabetes Res Clin Pract 2000 49(2-3) 119-26. 

Plank J, Wutte A, Brunner G, Siebenhofer A, Semlitsch B, Sommer R, Hirschberger S, Pieber TR. A direct comparison of insulin aspart and insuhn hspro in patients with type 1 diabetes. Diabetes Care 2002 25(ll) 2053-7. 

IV injection is short, and changes in TV insulin rates whl reach steady state in approximately 45 minutes. Intravenous pharmacokinetics of other soluble insulins (lispro, aspart, glulisine, and even glargine) appear similar to TV regular insulin, but they have no advantages over IV regular insuhn and are more expensive. 

Fig. 1. Trends in the use of insuhn in Denmark in the new millennium, all insuhns (defined daily doses, DDD) (A), fast-acting insuhns (left human insuhn, middle lispro, right aspart) (B), basal insuhns (left glargine, middle detemir, right human insuhn) (C). (From The Danish Medicines Agency at www.dkma.dk.) The numbers reflect the use of insuhn in 44,467 patients in 2001, increasing to 56,501 in 2005. Total use of analogues is increasing.

In a second smdy detemir plus aspart was compared with NPH and hnman fast-acting insuhn [47]. Nocturnal hypoglycaemia weight gain and... 

Figure 5.5 Primary structures of (a) human insulin (mol wtmonoisotopic = 5803.6 Da), (b) Humalog LisPro (mol wt, onoisotopic = 5803.6 Da), (c) Novolog Aspart (mol wt ono otopic = 5821.6Da), (d) Glulisine Apidra (mol whnonoisotopic = 5818.6Da), (e) Lantus Glargine (mol wtmonoisotopic = 6058.8Da), and (f) Detemir (mol wtmonoisoiopic = 5913.8Da). Disulfide bonds are indicated in case of human insuhn (a) only but are present in all synthetic derivatives.

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