Long Acting Insulin

The clinical      management of diabetes mellitus
Ian W. P.H. Wilding, in Clinical Biochemistry: Metabolic and Clinical Aspects (Third Edition), 2014

Long-acting insulin analogues
Longer-acting insulin analogues (insulin g and insulin d) are produced by genetic engineering. The onset of action is within two hours and they have a longer duration of action of up to 24 h. These insulins provide a steady basal insulin profile with minimal peak action and are injected subcutaneously once daily.

In insulin laced by glycine at position 21 of the α chain of the insulin molecule and the carboxyl terminal of the β chain is changed with the addition of arginine. This insulin is slowly released into the circulation because of its acidic pH, which causes it to precipitate when injected subcutaneously. In insulin t position B30 is lost with acylation at B29 that results in a fatty acid side chain acid) becoming linked with lysine. With these alterations, insulin  hexamers with slower dissociation and a longer duration of action.

Therapeutic Areas I: Central Nervous System, Pain, Metabolic Syndrome, Urology, Gastrointestinal and Cardiovascular
L. B. Metzger, in Comprehensive Medicinal Chemistry II, 2007 Long-acting insulins  and insulin
Long-acting insulins are used to provide a basal level of insulin. insulin reaches a peak gradually (14–18 h after injection), with a duration of action of up to 24 h. Similar to n,  is a suspension of large, zinc-containing crystals that have been precipitated in an acetate buffer.

s two modifications of the human insulin molecule that change both the onset and duration of action. Two arginine residues are added to the carboxyl terminal end of the insulin B-chain, and glycine is substituted for asparagine at the end of the A-chain (position A21). The latter modification prevents d dimerization. Overall, these changes result in a stable molecule that is soluble at an acidic pH but insoluble at the neutral pH of subcutaneous tissues. When insulin  injected subcutaneously, the acidic solution is neutralized. of insulin  form in the subcutaneous tissue and are slowly absorbed over a period of up to 24 h, resulting in a nearly constant level of insulin throughout the day. Insulin ay be given at any time of day and has been shown to cause less nocturnal hypoglycemia when used at bedtime than NPH insulin. Insulin  cannot be mixed prior to injection with any other insulin or solution because this will alter its pH and affect its absorption profile.

Recent advancements in oral delivery of insulin: from challenges to solutions
… Anil Ku in Nanostructures for Oral Medicine, 2017

7.1.2 Long-acting insulin analogs
Long-acting insulin analogs were originally designed for the need of diabetics to maintain a healthy blood glucose levels throughout the night.

: Insulin is also known as Lantus. It is a long-acting basal insulin analog. It is given once daily to control the blood sugar level. It consists of microcrystals that slowly release insulin, giving a long duration of action of 18 to 26 h, with a “” profile (according to the insulin package insert et al., 2014 it resembles basal insulin secretion of nondiabetic pancreatic beta cells. Sometimes, in type 2 diabetes and in combination with a short-acting sulfonylurea (drugs that stimulate the pancreas to make more insulin), it can offer moderate control of serum glucose levels. In the absence of endogenous insulin—type 1 diabetes, depleted type 2 (in some cases) or latent autoimmune diabetes of adults in late stage—insulin needs the support of fast-acting insulin taken with food to reduce the effect of  derived long-acting human insulin analog for maintaining the basal level of insulin. The trade  It is an insulin analogue in which a  bound to the lysine amino acid at position B29. It is quickly absorbed after which it binds to albumin in the blood through its fatty acid at position B29. It then slowly dissociates from this complex

: Starts to act about 2 h after taking, and can last 20 to 24 Starts to act about 2 h after taking, and lasts between 14 and 24 h

The peaks of insulin analogs are shown in Fig. 15.6.

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Figure 15.6. Peak Time for Insulin Analogs

Special topics
Sujoy Ghosh MD(General Medicine) DM(Endocrinology) MRCP(UK) MRCPS(Glasgow), Andrew Collier BSc MD FRCP(Glasgow & Edinburgh), in Churchill’s Pocketbook of Diabetes (Second Edition), 2012

Insulin-treated patients
Minor surgery
Patients treated with long-acting insulin   should be switched to intermediate-acting forms before elective surgery. Close perioperative blood glucose monitoring is crucial to avoid extremes of glycaemia. IV insulin–glucose–potassium should be commenced before surgery. Blood glucose levels should be monitored hourly during and immediately after surgery. The infusion should be stopped and usual insulin treatment resumed once oral intake is established. There should be a 1-h overlap between stopping IV insulin and reinstituting subcutaneous insulin.

Major surgery
Insulin-treated patients undergoing major elective surgery should preferably be admitted 2–3 days before surgery, if  control is suboptimal (HbA1c > 8%). If admission is not feasible, a diabetes specialist nurse should work with the patient to optimize self-monitoring of blood glucose (SMBG) values in the days. SMBG should be performed at least before each meal and also at bedtime, with target  values of 80–120 mg/ and bedtime values of 100–140 mg/

The preoperative evaluation should include a thorough physical examination (with particular focus on autonomic neuropathy and cardiac status), measurement of serum electrolytes and creatinine and urine ketones. The presence of autonomic neuropathy mandates increased surveillance for hypotension, respiratory arrest  instability during surgery. Gross metabolic and electro acidosis) should also be corrected before surgery.

Several reports have emphasized the advantages of the insulin infusion regimen over subcutaneous

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