Ultralente insulin

Insulin suspensions. When the hormone is injected as a suspension of insulin-containing particles, its dissolution and release in subcutaneous tissue are retarded (rapid, intermediate, and slow insulins). Suitable particles can be obtained by precipitation of apolar, poorly water-soluble complexes consisting of anionic insulin and cationic partners, e.g the polycationic protein protamine or the compound aminoqui-nuride (Surfen). In the presence of zinc and acetate ions, insulin crystallizes crystal size determines the rate of dissolution. Intermediate insulin preparations (NPH or isophane, lente or zinc insulin) act for 18 to 26 h, slow preparations (protamine zinc insulin, ultralente or extended zinc insulin) for up to 36 h. 

Slow-acting insulin Ultralente Cloudy 0.2-0.25 Acetate 4-6 16-18 20-36... 

Regular insulin (human) is clear solution of zinc insulin. Its time of onset is 30-60 min with peak activity at 2-3 hand duration of 3-6 h. The widely used insulin NPH (neutral protamine Hagedom) is a suspension of zinc insulin co-crystallized with protamine and has a slower onset (2-4 h) with longer time to peak (4-lOh) and duration of action (10-16h). Insulin lente is a suspension of mixed amorphous and crystalline zinc insulin, with onset time of 3-4 h and a duration of 12-18 h. Insulin ultralente, which is a suspension of crystalline insulin with a high zinc content, is the slowest onset (6-10 h) and longest duration (18-20h) of these preparations. Peak plasma concentrations occur after about 10 h with insulin ultralente (36). 

Extended Insulin Zinc Suspension 4-8 >36 Ultralente Insulin, Ultralente lletin 1, Ultralente Purified Beef. 

Ultralente Insulin is an almost colorless suspension of a mixture of characteristic crystals, the maximum dimension of which is predominandy 10—40 p.m. It contains, for each 100 USP units of insulin, 0.20—0.25 mg of 2inc (of which 40—65% is in the supernatant Hquid), and not more than 0.70 mg of nitrogen. It also contains on a wt/vol basis 0.15—0.17% sodium acetate, 0.65—0.75% sodium chloride, and 0.09—0.11% methylparaben. The purified form is available as Ultralente Purified Beef Insulin. 

Human Extended Insulin Zinc Suspension. Ultralente Humulin U is a long-acting form of human insulin produced by recombinant DNA techniques. It is adrninistered subcutaneously and should not be given intravenously. The time course of this preparation is similar for onset of activity but shorter for maximum activity and duration of action compared with ultralente preparations of animal origin. Insulins of the lente series can be mixed in any proportion to obtain the desired dose and modified activity. 

Combination preparations contain insulin mixtures in solution and in suspension (e.g., ultralente) the plasma concentration-time curve represents the sum of the two components. 

Extended insulin zinc suspension (ultralente) 4 to 8 10 to 30 20 to 36 Regular, semilente... 

Semilente, ultralente, and lente insulins may be mixed in any ratio. These mixtures are stable 1 month at room temperature or 3 months under refrigeration. 

Protamine zinc and extended insulin zinc suspension (Ultralente) are often referred to as long-acting insulin preparations. These insulins have more protamine and zinc in the mixture than is found in isophane insuhn suspension. Insuhn zinc suspension, extended Ultralente Insulin), is quite similar to the protamine zinc insulin suspension except that it does not contain protamine. Both of these long-acting insuhns have an approximate duration of action of 36 hours. 

Brand Name(s) Rong-Acting Insulin Glargine (Rantus Ultralente), Insulin Detemir (Revemir)... 

Long-acting insulin, slow onset of action (e.g., ultralente insulin)... 

Insulin zinc suspension extended (Ultralente HUMINSULIN-U) 40 lU/ml SC... 

Lepore, M., S. Pampanelli, C. FanelU, F. Forcellati, L. Bartocci, A. Di Vincenzo, C. Cordoni, E. Costa, P. Brunetti, and G.B. Bolli, Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes, 2000. 49(12) 2142-8. 

Semilente insulin is a suspension of amorphous insulin zinc. The onset is 1-3 hours after subcutaneous administration, reaches maximum effect in 5-10 hours and the effect lasts 10-16 hours. Isophane insulin (NPH Neutral solution. Protamine, Hagedorn s laboratoiy insulin) is an intermediate-acting preparation prepared with protamine. The maximum effect is reached in 4-12 hours and lasts 8-26 hours. Patients using these preparations who present for cardiac surgery are at increased risk for anaphylactic reactions to protamine. Ultralente insulin is a long-acting preparation formed with zinc rather than protamine. Zinc retards the release of insulin and these preparations have a duration of up to 36 hours. Protamine zinc insulin, which contains both protamine and zinc, has a duration of 28-36 hours. 

Humulin (R, L, N, U, 50/50, and 70/30). Human insulin manufactured by Eli Lilly and Company has the trademark Humulin and is available in six formulations—Regular (R), NPH (N), Lente (L), Ultralente (U), 50% human insulin isophane suspension (NPH)/50% human insulin injection (buffered regular) (50/50), and 70% human insulin isophane suspension (NPH)/30% human insulin injection (buffered regular) (70/30). 

Semilente) Lispro Insulin 0.25 Solution (Humalog) Aspart Insulin 0.5-1.5 6-8 Ultralente, NPH... 

Ultralente) Insulin Glargine Solution (Lantus) 1 none 24 none... 

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