Protamine - Insulin zinc suspension

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. 

Grade USP, in various solutions or suspensions that include insulin injection isophane insulin suspension protamine zinc insulin suspension NF, as glo-bin zinc insulin injection. 

Protamine Zinc Insulin Suspension 4-8 >36 Protamine zinc, lletin 1 and II. 

This crystalline salmiridine-insulin can be removed if desired, as by filtration but it is not necessary to do that, as the suspension of crystalline salmiridine-insulin may be preserved as thus prepared, and dispensed and used (in the same manner as known preparations of protamine insulin and protamine-zinc-insulin are used) in the original suspending medium in which it is formed. 

Insulin is ordered by die generic name (insulin zinc suspension, extended) or the trade (brand) name (Humulin U) (see the Summary Drug Table Insulin Preparations). The nurse must never substitute one brand of insulin for anodier unless the substitution is approved by the health care provider because some patients may be sensitive to changes in brands of insulin. In addition, it is important never to substitute one type of insulin for anodier. For example, do not use insulin zinc suspension instead of die prescribed protamine zinc insulin. 

A patient is required to take 10 units of U-40 isophane insulin suspension and 18 units of U-100 protamine zinc insulin. What volume, in milliliters, of each type will provide the desired dosage ... 

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. 

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. 

Insulin glargine did not cause a peak in blood insulin concentration, compared with protamine zinc insulin and crystalline insulin zinc suspension (ultralente) the effect lasted 24 hours, almost comparable to continuous subcutaneous infusion of a short-acting insulin (15). 

Longer duration of action Insulin Zinc Suspension, crystalline, or Protamine Zinc Insulin (insulin in suspension with both zinc and protamine). 

Long-acting insulins include crystalline insulin-zinc suspensions and protamine-zinc-insulins. These generally have an onset after about 4 h and a duration of up to 36 h. 

Combination of basic proteins with neutral suspensions of insulin (protamine-zinc-insulin). 

Following a return to consciousness, carbohydrates by mouth may need to be given until the action of insulin has ceased which, for preparations with a relatively long duration of action such as globin-zinc-insulin, isophane-insulin, some insulin-zinc suspensions, and protamine-zinc-insulin, may be several hours. 

The importance of zinc ions for stabilizing insulin preparations has been known since the first reported crystallization of insulin in the presenoe of zino ions in 1934 (36). Suspensions of zinc insulin were used at that time. Presently, all pharmaceutical preparations are either solutions of zino insulin or suspensions of insoluble forms of zino insulin. A longer-acting and more stable form of insulin is protamine zinc insulin, which is prepared by precipitating insulin in the presence of zinc ions and protamine, a basic protein. This precipitate is known to contain two zinc ions per insulin hexamer. A somewhat shorter-acting and more useful preparation is neutral protamine Hagedorn (NPH) insulin, which includes m-cresol... 

More subtle effects of preservatives on injectable formulations are possible. Formulation of insulin is an illustrative case study. Insulin is usually formulated as a multiple-dose vial, since individual dosage varies among patients. Preservation of zinc insulin with phenol causes physical instability of the suspension, whereas methyl-paraben does not. However, the presence of phenol is required for obtaining protamine insulin crystals [9]. 

ISOPHANE INSULIN SUSPENSION (NPH insulin combined with protamine and zinc) ... 

Isophane insulin suspension Protamine zinc insuiin... 

Isophane insulin suspension This insulin, sometimes called neutral protamine Hagedom, NPH, is a suspension of crystalline zinc insulin combined at neutral pH with the positively charged polypeptide, protamine. Its duration of action is intermediate. 

The long-acting insulins in use today are mainly protamine insulin and zinc insulins. Protamine insulins are the salt-like compounds formed between the acid (insulin) polypeptide and the polypeptide protamine, which consists primarily of arginine. They are used in the form of neutral suspensions of protamine insulin crystals (isophane insulin). 

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