Insulin is a hormone produced by the pancreas, responsible for regulating the glycemic index in our body.
This hormone makes it easier for the glucose that circulates in our blood to penetrate the cells, using it as an energy source.
How is insulin released in a non-diabetic person?
Insulin release in non-diabetics follows two different physiological patterns: basal secretion and prandial secretion.
Basal secretion occurs when insulin is released in the body of a non-diabetic person through a slow and continuous secretion and maintaining the balance in glucose levels between 70 and 100 mg/ml fasting.
This basal secretion represents approximately 50% of the total insulin production secreted by a non-diabetic person during a day.
Basal insulins are those that try to simulate that basal pattern, covering the continuous insulin requirements that are between meals.
Its action is mainly aimed at inhibiting the production of glucose by the liver. With this, they maintain values considered normal for blood glucose during the night, fasting, and even between meals.
Prandial secretion, unlike basal secretion, is rapid and occurs in response to food intake.
What characterizes insulin?
Insulin is characterized by the onset of action or the time that elapses from its administration until it reaches the blood and acts by lowering blood glucose levels.
Also, the different types of insulin are characterized by the peak of maximum action, that is, by the moment the insulin reaches its full potency. The faster an insulin is, its maximum activity elevation will be accentuated.
Finally, the duration of its action and the time that elapses while the insulin continues to lower the glucose concentration in the blood are taken into account.
Depending on this duration, insulins can be classified as ultrafast, fast, intermediate, or prolonged, the latter two being basal insulins.
Basal insulins and their characteristics
As mentioned before, basal insulins are considered slow, while prandial insulins are classified as fast.
The following graph reflects the peaks and duration of action of each of the basal insulins, in addition to the prandial insulins.
Maximum activity peak
Intermediate or NPH insulins have their maximum action peak between 4 and 8 hours after administration. In contrast, long-acting insulins, as all of them have a sustained action over time, hardly have prominent peaks or variations in their activity.
Long-acting insulins achieve a duration between 12 to 18 hours, while intermediate-acting or NPH insulins achieve a maximum of 12 hours.
Intermediate-acting basal insulins
Neutral Protamine Hagedorn (NPH) is an intermediate-acting human insulin. In recent years, their prescription has been decreasing, being replaced by long-acting insulins such as Glargine and Degludec due to their administration’s advantages compared to NPH.
NPH is still prescribed as basal insulin in patients with diabetes who are at low risk of hypoglycemia.
NPH insulin presentations
- Vials : Insulatard®, Humulin NPH®
- Feathers: Insulatard Flexpen®, Humulin NPH Kwikpen®
Its onset of action begins two hours after its administration, while the peak of maximum activity occurs between four and six hours later.
The duration of its effect is approximately 12 hours. Therefore, it is necessary to administer one or two doses together with oral antidiabetics.
Long-acting basal insulins
The endocrinologist recommends this type of basal insulin for diabetes at high risk of hypoglycemia, especially at night.
In addition, this type of long-acting insulin is recommended in those patients in whom the administration of a single daily dose is the best option based on their personal, healthcare, or social situation.
Presentations insulin Detemir
- Levemir Innolet®, Levemir Flexpen®
Although it is framed within the long-acting basal insulins, its duration does not reach 24 hours of action.
Its efficacy is very similar to NPH, and as with this insulin, two doses are needed in most people to achieve reasonable glycemic control.
One of the main advantages of Detemir, as with the rest of the long-acting insulins, is that they have less variability in their absorption.
This means that it reproduces the basal secretion of insulin in a physiologically similar way.
Insulin Glargine Presentations
- Vials: Lantus®
- Feathers: Lantus Solostar®
As we saw in the previous graph, insulin glargine has a smoother action profile and without appreciable peaks, achieving a duration of effect of between 20 and 24 hours.
It is administered once a day and has efficacy in reducing glycated hemoglobin HbA1c similar to that of NPH insulin, but it is administered between 1 and 2 times a day.
An advantage of this Glargine insulin compared to NPH is that the number of hypoglycaemias, including nocturnal ones, is lower although infrequent in both cases.
Presentations insulin Glargine Biosimilar U-100, Abasaglar Kwikpen®
Insulin began to be marketed in 2015, with efficacy and safety similar to insulin glargine. All the characteristics of insulin glargine apply to this other one.
- Flights: Abasaglar Kwikpen®
Presentations insulin glargine high concentration U-300 Toujeo Solostar®
- Flights: Toujeo Solostar®
This type of insulin began to be marketed in 2016.
Having a concentration three times higher than Lantus® (glargine U-100), the injection volume is reduced by a third, an aspect that can be assessed in people with type 2 diabetes who have insulin resistance and need high doses of basal insulin.
It provides broad time flexibility in its administration since it can be done from three hours before to three hours after your usual daily time.
In Spain, since the end of 2020, in addition to being administered to adults, it received commercial authorization for its use in children between 6 and 17 years of age.
Degludec insulin presentations
- Flights : Tresiba Flextouch 100®
- Flights : Tresiba Flextouch 200®
This type of insulin, thanks to the modifications that have been introduced, this type of insulin allows it to maintain a prolonged action that exceeds 40 hours.
Although it is recommended to administer once a day and at the same time, it presents excellent flexibility in its administration.
Its dispensing from the Community Pharmacy requires an inspection visa.