Insulin is a hormone produced by the pancreas, which helps regulate blood glucose levels. This hormone is vital for the transport and storage of glucose in cells and helps to use glucose as a source of energy for the body. Insulin acts as a key to allow glucose access to cells. If glucose can’t get into cells, it builds up in the blood.

The pancreas produces insulin in two different ways: A slow and continuous one that helps keep glucose levels always stable between 70-100 mg / dl known as basal secretion. The other, fast and in greater quantity, secreted generally when the blood glucose has high values ​​after meals; this is known as pulsatile secretion.

In the past, patients with diabetes were treated with bovine (cow) and swine (pig) insulin.

Until a few years ago, mainly human insulin was used with a chemical structure identical to that produced by the human pancreas. Human insulin is produced using semisynthetic methods, modifying it enzymatically. For nearly 50 years the only insulin available was from cows and pigs, until NovoNordisk discovered how to make synthetic human insulin using the key ingredient in a loaf of bread, yeast. Human insulin is obtained by genetic engineering to add the gene for insulin production to its DNA, in simpler terms, it has been genetically modified to produce insulin with a chemical structure indistinguishable to that produced by the pancreas beta cells.

Currently, insulin analogues, (i.e., chemical compounds that have similar properties to original human insulin), obtained by genetic engineering are mainly used, incorporating human genes for insulin production in yeast cells (insulin aspart) or bacteria, such as Escherichia coli (this happens with lispro and glulisine insulins). In this way, yeast or bacteria cells are tricked into producing insulin instead of their own proteins.

There are many different types of insulin, such as:

To know how a type of insulin works, it is important to understand a drugs action profile. All insulin types have an onset of effect, which is the period from the injection of it until it begins to work. A maximum effect or peak of action, which is the period where there is more insulin effect, this must coincide with the maximum concentration of carbohydrates in the body, and an end of effect, which is the residual active insulin after the end of the peak of action.

Here is comparison table between the different insulin types:

             There is also a fast-acting inhaled insulin, whose onset of action is 10 to 15 minutes after inhalation and has a peak at 30 minutes. This insulin lasts approximately 3 hours. It is usually inhaled just before a meal and often used with long-acting injectable insulins.

On the other hand, in the market there are ultra-long-acting insulins whose effect starts at 6 hours, does not reach a peak and lasts 36 hours or more. It is used to provide insulin continuously for long periods of time.

How and when insulin is given is different for each person. This can change over time given the diabetes’s progression. Some may take just one type, others several different types of insulin throughout the day, depending on their lifestyle, eating habits, and blood sugar levels. The diabetes self-management education and support service (DSMES) is a useful tool in patient care.

Classification of insulin types according to diet-regimen:

Bolus insulin: It can be short-acting or rapid-acting. It is administered before or at the time of eating to control blood sugar levels.

Basal insulin: Intermediate-acting or long-acting. It is given to keep blood sugar levels stable between meals and throughout the night.

Basal-bolus regimen: Rapid-acting insulin given at mealtime, and long-acting insulin given once or twice a day.

There are various forms of delivering insulin. The common are being syringes and pens, which deliver insulin through a needle. Pens are typically more convenient, and children typically find them more comfortable than syringes.

An insulin pump is a small device that releases insulin through a small plastic tube (catheter). The device continuously pumps insulin day and night. It can also release insulin faster (bolus) before meals.

There are two types of insulin pumps; traditional and patch pumps:

Traditional pumps include an insulin reservoir (cartridge) and a catheter. The catheter is inserted with a plastic needle just under the skin into the fatty tissue. This is held in place with an adhesive band. The catheter is connected by tubes to a pump that has a digital screen. This allows the user to program the device to deliver the necessary insulin. On the other hand, patch pumps are worn directly on the body with the reservoir and tubing inside a small box. A separate wireless device programs the release of insulin from the pump.

It is recommended that insulin be stored in a refrigerator at approximately 36°F to 46°F. Freezing insulin must also be avoided.

Insulin can cause adverse drug effects that lead to emergency visits. From 2007 to 2011, nearly 100,000 estimated emergency department visits occurred each year in the U.S. for insulin-related low blood sugar or errors when taking insulin. Some of the most prevalent adverse reactions were:

A call to the main physician should be made immediately if there are serious side effects. Calling 911 is a must if the symptoms are life-threatening. Serious insulin side effects and their symptoms can include the following:

Not only people with type 1 diabetes must inject insulin every day, often up to 4 or 5 times per day. Advanced type 2 diabetes patients may also need it too. Doctors and nurses are also educators who can teach the patient where and when to inject insulin and how to store it properly.

Photo by Mikhail Nilov at Pexels

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