Short/rapid-acting insulins

Insulin aspart Rapid-acting, short-acting the proline at site 28 of the B chain is replaced by aspartate (B28Asp)... 

Insulin glulisine Rapid-acting, short-acting the asparagine at B3 is replaced by lysine and the lysine at B29 is replaced by glutamic acid (B3Lys,B29Glu)... 

Prandial insulin releasers (meglitinides) Repaglinide, nateglinide Stimulate insulin secretion (rapid and short-acting < 6 h) Oral... 

Currently, the most advanced form of insulin therapy is the insulin pump, also referred to as continuous subcutaneous insulin infusion (CSII). Using the short- or rapid-acting insulins only, these pumps are programmed to provide a slow release of small amounts of insulin as the basal portion of therapy, and then larger bolus doses are injected by the patient to account for the consumption of food. 

Patients with insulin-using type 2 diabetes - In patients with insulin-using type 2 diabetes, initiate pramlintide at a dose of 60 meg and increase to a dose of 120 meg as tolerated. Patients should initiate pramlintide at 60 meg subcutaneously, immediately prior to major meals. Patients should reduce preprandial, rapid-acting, or short-acting insulin dosages, including fixed-mix insulins (eg, 70/30) by 50%. 

Commercially available insuhns differ in their onset of action, maximal activity, and duration of action (Table 67.3). They can be classified as rapid acting (0-5 hours), short acting (0-8 hours), intermediate acting (2 to 16 hours), and long acting (4 to 36 hours). Human insulin (e.g. Humulin, Novolin) produced by rDNA technology is now widely available and has largely supplanted in-... 

Ultra-short-acting insulin, very rapid onset, short duration (e.g., lispro insulin)... 

Short-acting neutral buffered insulin by pump is sometimes ineffective. Treatment with non-buffered insulin can make things worse, but short-acting acidified insulin can improve HbAic. This type of insulin is well tolerated for over 3 years. The acid insulin may contain more monomers than neutral insulin, which may act less rapidly, as it contains more polymers (249). 

The preparations marketed can be divided into three types (1) the short-acting or rapid-acting insulins, (2) the intermediate-acting insulins and... 

Verspohl et al., 1982 Ammon et al., 1991). Conversely, glucose-mediated insulin secretion was augmented when freshly released insulin was rapidly removed from a perfusion system by increasing the flow rate and/or addition of insulin antibody (Ammon et al., 1991). This led to the concept of a short-loop feedback, where freshly released insulin acts on B-cells (Ammon et al., 1991). 

CLASSIFICATION OF INSULINS Short- and Rapid-Acting Insulins... 

Traditionally, the short-acting insulins were solutions o/regular, crystalline zinc insuhn (insulin injection) dissolved in a buffer at neutral pH. These preparations have a rapid onset of action but short duration (Table 60-2). More recently, modified recombinant insulins have been introduced with even more rapid onset and shorter duration of action they therefore are termed rapid-acting" insulins. 

Mechanism of Action. The drug is a very rapid-acting insnlin which may be injected conveniently just prior to a meal. It exhibits an onset of action within a short span of 15 minutes besides having a relatively much shorter peak ranging between 0.5 to 1.5 hour, and having duration of action varying between 6 to 8 hours in comparison to the regular insulin injection . 

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