Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle

Insulin has been available since early 1920,s. It was initially extracted from beef and pork pancreases.

Before they used insulin as a diabetes medication, people with type 1 diabetes often had to go without food and eat a low-carbohydrate, starvation-level diet.

In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin globally.

The first genetically engineered, synthetic “human” insulin was produced in 1978 using E. coli bacteria to produce the insulin. Eli Lilly went on in 1982 to sell the first commercially available biosynthetic human insulin under the brand name Humulin.

And now, insulin analogs are replacing human insulin.

What are Insulin Analogs?

The Discovery of Insulin

An analog refers to something that is “analogous” or similar to something else.

Therefore, “insulin” analogs are analogs that have been designed to mimic the body’s natural pattern of insulin release. These synthetic-made insulins are called analogs of human insulin.

However, they have minor structural or amino acid changes that give them special desirable characteristics when injected under the skin. Once absorbed, they act on cells like human insulin, but are absorbed from fatty tissue more predictably.

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food.

In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals.

People with type 2 diabetes make insulin, but their bodies don’t respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy.

Insulin now comes in many forms, from regular human insulin identical to what the body produces on its own, to ultra-rapid and ultra-long acting insulins. Thanks to decades of research, people with diabetes can choose from a variety of formulas and ways to take their insulin based on their personal needs and lifestyles. From Humalog to Novolog and insulin pens to pumps, insulin has come a long way. It may not be a cure for diabetes, but it’s literally a life saver.

Each type of insulin has an onset, a peak, and a duration time.

The onset is how soon the insulin starts to lower your blood glucose after you take it.

The peak is the time the insulin is working the hardest to lower your blood glucose.

The duration is how long the insulin lasts-the length of time it keeps lowering your blood glucose.

Your onset, peak, and duration times may be different.

You’ll work with your health care team to come up with an insulin plan and the type of insulin that’s best for you and your diabetes.

Making that choice will depend on many things, including:

1.How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.)
2.Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin.
3.Your willingness to give yourself multiple injections per day
4.How often you check your blood sugar
5.Your age
6.Your goals for managing your blood sugar

Insulin Strength

BD Microfine + U100 insulin syringe 1ml 0.33 (29g) 13mm pack 100

All insulins come dissolved or suspended in liquids. The standard and most commonly used strength today is U-100, which means it has 100 units of insulin per milliliter of fluid, though U-500 insulin is available for patients who are extremely insulin resistant.

U-40, which has 40 units of insulin per milliliter of fluid, has generally been phased out around the world, but it is possible that it could still be found in some places (and U-40 insulin is still used in veterinary care).

Types of Insulin

Photo Jigsaw Puzzle of Molecular structure of insulin hormone

There are five types of insulin. They vary by onset (how soon they start to work), peak (how long they take to kick into full effect) and duration (how long they stay in your body).

You may have to take more than one type of insulin, and these needs may change over time (and can vary depending on your type of diabetes).

Type of Insulin Rapid-acting	Brand Name         _ NovoLog	Generic Name   __Insulin aspart	Onset   15 minutes	Peak   30 to 90 minutes	Duration 3 to 5 hours
	__ Apidra	__ Insulin glulisine	15 minutes	30 to 90 minutes	3 to 5 hours
	__ Humalog	__ Insulin lispro	15 minutes	30 to 90 minutes	3 to 5 hours

 

                                                                              

Type of Insulin   Short-acting	Brand Name    __ Humulin R	Generic Name   __ Regular (R)	Onset   30 to 60 minutes	Peak   2 to 4 hours	Duration 5 to 8 hours
	__ Novolin R

 

                                                        

Type of Insulin   Intermediate-acting	Brand Name __ Humulin N	Generic Name   __ NPH (N)	Onset       1 to 3 hours	Peak     8 hours	Duration   12 to 16 hours
	__ Novolin N

 

                                                                                           

Type of Insulin Long-acting	Brand Name      __ Levemir	Generic Name      __ Insulin detemir	Onset       1 hour	Peak Peakless	Duration   20 to 26 hours
	__ Lantus	__ Insulin glargine

 

                                                                                                     

Type of Insulin      Pre-mixed NPH (intermediate-acting) and regular (short-acting)	Brand Name   __ Humulin 70/30 __ Novolin 70/30	Generic Name          __ 70% NPH and 30% regular	Onset 30 to 60 minutes	Peak   Varies	Duration 10 to 16 hours
	__ Humulin 50/50	__ 50% NPH and 50% regular	30 to 60 minutes	Varies	10 to 16 hours

 

 

                                                                                                            

Type of Insulin    Pre-mixed insulin lispro protamine suspension (intermediate-acting) and insulin lispro (rapid-acting	Brand Name    __ Humalog Mix 75/25	Generic Name __ 75% insulin lispro protamine and 25% insulin lispro	Onset   10 to 15 minutes	Peak    Varies	Duration  10 to 16 hours
	__ Humalog Mix 50/50	__ 50% insulin lispro protamine and 50% insulin lispro	10 to 15 minutes	Varies	10 to 16 hours

 

                                                                                                                   

Type of Insulin    Pre-mixed insulin aspart protamine suspension (intermediate-acting) and insulin aspart (rapid-acting)	Brand Name    __ NovoLog Mix 70/30	Generic Name __ 70% insulin aspart protamine and 30% insulin aspart	Onset     5 to 15 minutes	Peak    Varies	Duration 10 to 16 hours

 

Insulin cannot be taken as a pill because it would be broken down during digestion just like the protein in food. It must be injected into the fat under your skin for it to get into your blood.

In some rare cases insulin can lead to an allergic reaction at the injection site. Talk to your doctor if you believe you may be experiencing a reaction.

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How To Give Yourself an Insulin Shot for Diabetes

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There are different devices used to inject insulin, including syringes, insulin pens,and insulin pumps . Your doctor will help you decide which is best for you. Syringes remain a common method of insulin delivery. They’re the least expensive option and most insurance companies cover them.

Insulin is measured in “units.” A new bottle of U-100 insulin, the most commonly used strength of insulin holds 1,000 units.

New insulin cartridges or prefilled pens have 300 units each, so boxes of five cartridges or prefilled pens have a total of 1,500 units.

Unopened insulin should be refrigerated. Once opened, insulin may be kept at room temperature for 30 days. After 30 days it should be thrown away.

Before starting to use an insulin pump,diabetics should be instructed on how best to operate a pump by their healthcare professional.

As well as pump operation,diabetics need instruction in how to insert and care for their infusion set, and how to deal with any problems.

Daily insulin requirements vary from person to person. The aim of insulin pump treatment is to mimic the pancreas by using short acting insulin to give a background (basal) rate which is pre-programmed in and delivered in small pulses.

In addition you can press buttons to deliver a bolus to cover carbohydrate eaten or give a correction dose.

1.Follow these steps when using an insulin syringe

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1.Select a clean, dry work area, and gather the following insulin supplies:

Bottle of insulin

Sterile insulin syringe (needle attached) with wrapper removed

Alcotip 70% Isopropyl Alcohol Pre-Injection Swabs (100pk)

Two alcohol wipes (or cotton balls and a bottle of rubbing alcohol)

One container for used equipment (such as a hard plastic or metal container with a screw-on or tightly secured lid or a commercial “sharps” container)

Wash hands with soap and warm water and dry them with a clean towel.

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2. Follow these steps when injecting a mixed dose of insulin

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3.Follow these steps when using an insulin Flexipen

Novopen 4 Blue Reuseable Insulin Pen for use with Novo Nordisk 3ml Penfill cartridges

1.Preparing your FlexPen

Wash your hands. Check the label to make sure that you are using the right type of insulin. This is especially important if you take more than one type of insulin.

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4.Insulin Pumps

Pumping Insulin: Everything You Need to Succeed on an Insulin Pump

When you decide to start on the pump, you’ll need some training. Most people who are new to the pump start with at least a three- or four-hour session with a Certified Pump Trainer.

Pumps are not hard to operate, but you need to know what you’re doing and what to do if the pump malfunctions. You don’t throw away your syringe or insulin pen when you go on the pump. You keep them handy as a backup.

Insulin pumps are small computerized devices that deliver insulin in two ways:

In a steady measured and continuous dose (the “basal” insulin)

As a surge bolus dose, at your direction, around mealtime.

Doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place.

The insulin pump is not an artificial pancreas (because you still have to monitor your blood glucose level), but pumps can help some people achieve better control, and many people prefer this continuous system of insulin delivery over injections.

Pumps can be programmed to releases small doses of insulin continuously (basal), or a bolus dose close to mealtime to control the rise in blood glucose after a meal. This delivery system most closely mimics the body’s normal release of insulin.

How Do Insulin Pumps Work?

Insulin pumps deliver rapid-acting or short-acting insulin 24 hours a day through a catheter placed under the skin. Your insulin doses are separated into:

Basal rates

Bolus doses to cover carbohydrate in meals

Correction or supplemental doses

Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night.

When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it.

You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your right target range.

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Insulin Injection Sites

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Insulin should be injected into the fatty tissue just below your skin. If you inject the insulin deeper into muscle, your body will absorb it too quickly. This can lead to dangerously low blood glucose levels.(Hypoglycaemia)

People who take insulin daily need to rotate their injection sites. This is important because using the same spot over time can cause lipodystrophy. In this condition, fat either breaks down or builds up under the skin. Lipodystrophy causes lumps or indentations that interfere with or cause erratic insulin absorption.

You can rotate to different areas within the same site, keeping injection sites about an inch apart. Generally, you can inject anywhere that there is enough fat under the skin. Absorption rates may vary depending on the injection site.

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 Is it possible for a person to become immune to insulin after taking it for a long time?

This was a concern in the past when cows and pigs were a major source of commercial insulin. There were always very tiny amounts of impurities in the animal insulin. Most people’s bodies reacted by making some antibodies to build immunity to the impurities.

Genetic engineering has allowed large-scale production of insulin that has the same molecular structure as human insulin, so we don’t need to rely on pigs and cows any more. We don’t see much negative reaction to these newer insulin preparations, and little if any buildup of antibodies. So, there’s no likelihood that a person will become immune to the effects of insulin.

Don’t confuse immunity to insulin with insulin resistance. These are two totally different things. When people need much more insulin than most other adults who need insulin (40 to 50 units a day), it’s not because they’re immune to the insulin. It’s because their bodies aren’t able to use the insulin properly.

What’s the difference between Novolog and Humalog insulin?

Humalog is the brand name for Eli Lilly’s fast-acting analog insulin. It’s generic name is lispro. Novo Nordisk also developed a very fast-acting insulin analog sold under the brand name NovoLog. Its generic name is aspart. Another drug company, Sanofi-Aventis, has developed a very fast-acting insulin analog sold as Apidra. Its generic name is glulisine.

These three types of insulin analog are nearly the same in action. They start to work in five to 15 minutes, have their peak effect in about 45 to 90 minutes, and last about three hours.

Is it OK to switch brands of insulin?

Your doctor might prescribe different brands of insulin to use at different times of the day. Three companies make insulin: Eli Lilly, Novo Nordisk, and Aventis. You can use insulin from these manufacturers as long as you don’t mix them in the same syringe. Even with insulin from the same manufacturer, its not recommended mixing them together.

It’s important to know the kinds of insulin you’re taking and what you and your doctor expect the insulin to do.

 

Remembering Your Insulin Injections

Medisana GlucoDock Blood Glucose Module for iPod, iPhone and iPad

It is not unusual for people who inject daily to forget whether they took one of their injections. Forgetting whether or not you took a scheduled injection can affect your glucose levels and your overall health. To help you remember,here are some tips:

1. Don’t get distracted during injections

You might be in the middle of a conversation or finishing work, but when it’s time to inject, politely excuse yourself and take care of it right away. Putting off any kind of task – even for one minute – can increase the likelihood of forgetting it altogether.

2. Lump daily habits together

If your injection falls around the same time as other daily habits, get into the routine of doing them altogether. For example, an injection at night before you go to bed can be done along with brushing your teeth .

3. Keep insulin injection supplies in an obvious location

Having your insulin supplies in the location where you will need to inject can help serve as a reminder. In fact, having multiple insulin kits (one at home,one in your car and one at work) can make keeping up with insulin injections easier.

4.You can record your insulin injections in a blood glucose diary.

You can choose to merely note that you injected, or if you change your dose from time to time, you can record the time of your insulin injections; the dosage amount; the insulin type; and notes about your injection that might be important.

5.Use a GlucoDock Blood Sugar Meter

This device keeps track of insulin and food
– Additionally, trace amounts of different types of insulin and food

Diary, statistics, and monthly reports
– At hand everywhere – study each individual result in your diary, analyze your values over a longer period with the help of a curve diagram, or examine a monthly list of all data.

The 30-day chart – receive all results fast in an overview
– This illustration helps you to recognize all optimal values and exceptions within the last 30 days. If necessary, all details of each individual category can be traced.

What happens if you forget your insulin injection?

In this case, you’ll need to be aware that the injection was taken later and so the insulin will also be active in your body later than it would usually be. In some cases this could increase the chance of hypoglycaemia so speak to your health team if you have any doubts.

If it has been longer than 2 hours since your injection should have been taken and you are not sure what to do, speak to your health team who will be able to advise you. It is important not to delay getting advice as your blood glucose levels may begin rising to dangerous levels.

If your blood glucose levels are high when you notice you have missed a dose, you may need to take short acting or rapid acting insulin to lower your blood glucose levels. If you are at all unsure of what dose to take, seek advice from your healthcare team.

For information on the side effects of insulin refer to side-effects-of-diabetes-medication

 

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