473. INSULIN - Long-Term Effects of Insulin on Blood Vessels

INSULIN  -  Long-Term Effects of Insulin on Blood Vessels

        Insulin is the most common treatment for diabetes and is usually administered by injection.

        People with diabetes take insulin as long as the disease persists.

        Over time, there can be some side effects which affect blood vessels.

        Some patients develop a kind of insulin resistance, which can reduce the correct interaction of insulin inside blood vessels.

Other People Are Reading

How Insulin Works

        Patients with diabetes suffer from a lack of control of blood sugar levels, which has many dangerous effects if left untreated.
        All the carbohydrates we eat are converted to glucose, which acts as the "fuel" to give us energy daily.
        Insulin controls blood sugar levels by allowing the glucose to be processed so that it can get into the body's cells.
        Your liver converts glycogen to glucose and releases it into your bloodstream when you're extremely hungry or you're under stress.

Insulin Varieties

        Insulin is available in several varieties. Some are designed to start working quickly, and others last for several hours so that insulin users are able to keep close control of their blood sugar levels.
        It cannot be taken by pill, since stomach acid destroys its active ingredients;
        it must be injected. Today's insulin syringes are compact with thin needles and so are easy to carry with you and almost painless to use.

Insulin Dosage

        Insulin can be taken on a regular fixed time basis or on a flexible basis and, in some cases combined with other medications for control of blood sugar.
        Your doctor will work out the right regiment for you along with an eating plan which works well with the medication. Also, you and your doctor need to monitor your blood sugar carefully.
        At times it may be important to change the dosage, the timing or your diet.

 

 

Long-Term Effects

        Doctors have known for a long time that that insulin resistance and the high insulin levels in the blood are definite risk factors for vascular disease.
        What was not clear is whether arteries become diseased because they were over-exposed or because they could not respond to the insulin.
        Christian Rask-Madsen of the Joslin Diabetes Center in Boston remarks, "We think about insulin resistance in liver, muscle and fat, but insulin also works on vascular cells."

Research

        In the May 2010 issue of Cell Metabolism, a Cell Press publication indicates that the problem seems to be that vascular cells don't respond to the insulin, which can lead to arteriosclerosis.
        Many of the worst complications for diabetes patients, including

1.    strokes,

2.    heart disease and

3.    leg amputations,

are caused by atherosclerosis.
        So while traditional insulin treatment must continue the Report points to some promising new treatments to accommodate these findings.
DRUG CLASS AND MECHANISM:
        Insulin is a naturally-occurring hormone secreted by the pancreas.
        Insulin is required by the cells of the body in order for them to remove and use glucose from the blood.
        From glucose the cells produce the energy that they need to carry out their functions.
        Researchers first gave an active extract of the pancreas containing insulin to a young diabetic patient in 1922, and the FDA first approved insulin in 1939.
        Currently, insulin used for treatment is derived from beef and pork pancreas as well as recombinant (human) technology.
        The first recombinant human insulin was approved by the FDA in 1982.
        Patients with diabetes mellitus have a reduced ability to take up and use glucose from the blood, and, as a result, the glucose level in the blood rises.
        In type 1 diabetes, the pancreas cannot produce enough insulin. Therefore, insulin therapy is needed.
        In type 2 diabetes, patients produce insulin, but cells throughout the body do not respond normally to the insulin.
        Nevertheless, insulin also may be used in type 2 diabetes to overcome the resistance of the cells to insulin.
        By increasing the uptake of glucose by cells and reducing the concentration of glucose in the blood, insulin prevents or reduces the long-term complications of diabetes, including damage to the blood vessels, eyes, kidneys, and nerves.
        Insulin is administered by injection under the skin (subcutaneously).
        The subcutaneous tissue of the abdomen is preferred because absorption of the insulin is more consistent from this location than subcutaneous tissues in other locations.
GENERIC: No
PRESCRIPTION: Yes; No (regular and NPH insulin)
PREPARATIONS: Types of Insulin

·Regular (Humulin R, Novolin R) insulin has an onset of action (begins to reduce blood sugar) within 30 minutes of injection, reaches a peak effect at 1-3 hours, and has effects that last 6-8 hours.

·NPH insulin (Novolin N, Humulin N) is an insulin with an intermediate duration of action. It has an onset of action starting about 2 hours following injection. It has a peak effect 4-12 hours after injection, and a duration of action of 18-26 hours.

·Lente insulin also is an insulin with an intermediate duration of action. It has an onset of action 2-4 hours after injection, a peak activity 6-12 hours after injection, and a duration of action of 18 to 26 hours. Lente insulins have been discontinued.

·Ultralente insulin is a long-acting insulin with an onset of action 4-8 hours after injection, a peak effect 10-30 hours after injection, and a duration of action of more than 36 hours. Ultralente insulins have been discontinued.

·Novolog (Insulin aspart) is a human insulin with a slightly modified chemical composition. The chemical changes provide insulin as part with a faster onset of action (20 minutes) and a shorter duration of action (3-5 hours) than regular human insulin. It reaches peak activity 1-3 hours after injection.

·Humalog (Insulin Lispro) is an ultra rapid-acting insulin. It is a chemically-modified, natural insulin. It was approved by the FDA in June, 1996. As compared to regular insulin, insulin lispro has a more rapid onset of action, an earlier peak effect, and a shorter duration of action. It reaches peak activity 0.5-2.5 hours after injection. Therefore, insulin lispro should be injected 15 minutes before a meal as compared to regular insulin which is injected 30-60 minutes before a meal.

·Apidra (insulin glulisine recombinant) is also a chemically modified human insulin. It has an onset of action of 20-30 minutes, peaks at one hour and its duration of action is 5 hours.

·Lantus (insulin glargine recombinant) is a human insulin with a slightly modified chemical composition. The chemical changes provide Insulin glargine with a slower onset of action (70 minutes) and a longer duration of action (24 hours) than regular human insulin. Its activity does not peak.

·Levemir (insulin detemir recombinant) is modified human insulin with an onset of 3-4 hours a peak of 6-8 hours and duration of up to 24 hours.

Insulin comes in three different forms-vials, prefilled syringes, and cartridges. The cartridges are to be used in a pen-like device that simplifies injection. Regular human insulin (Novolin R, Humulin R) is available in vials, cartridges, and prefilled syringes.

NPH human insulin (Novolin N, Humulin N) is available in vials, cartridges and prefilled syringes. A mixture of 70% NPH human insulin and 30% regular human insulin (Novolin 70/30, Humulin 70/30) is available in vials, cartridges and pre-filled syringes.

·A mixture of 50% NPH human insulin and 50% regular human insulin (Humulin 50/50) is available in vials.

·Insulin lispro (Humalog) is available in vials and cartridges.

·Insulin aspart (Novolog) is available in vials and cartridges.

·Insulin glargine (Lantus) is available in vials and cartridges.

·Levemir (insulin detemir): Supplied in a vial, prefilled pen (FlexPen)

·Apidra (insulin glulisine): Supplied in a cartridge, vial, prefilled pen (Solostar)