Dosage forms of insulin

This is an automatically translated article.

Article by Doctor Huynh Xuan Loc - Faculty of Pharmacy, Vinmec Central Park International General Hospital.

Insulin-containing drugs are mainly made as injections. In the United States, there is a form of insulin inhaled through the nose, but it is not popular because it does not show a good treatment effect.

1. What is insulin and what role does it play?

Keeping blood sugar levels normal is the way to reduce your risk of diabetes-related complications. It can be acute complications such as life-threatening ketoacidosis or long-term effects that damage the eyes, kidneys, nerves, causing blindness, kidney failure, foot ulcers leading to amputation. limb or impotence in men.
Insulin is a hormone produced by the body that helps sugar (glucose) get into the cells. In type 1 diabetes, the body does not produce enough insulin, so sugar does not enter to feed cells, but accumulates in the blood causing harmful effects. In type 2 diabetes, the cells respond poorly to insulin and in the long term, the pancreas does not produce enough insulin, leading to a deficiency and causing hyperglycemia. When the body lacks insulin, it becomes difficult to control blood sugar in the normal range and the patient needs to be supplemented with this hormone with suitable insulin-containing drugs.

2. Dosage forms and types of insulin

Insulin-containing drugs are mainly made as injections. In the United States, there is a form of insulin inhaled through the nose, but it is not popular because it does not show a good treatment effect.
Insulin injectables are classified primarily in terms of duration of onset and duration of action. Includes:
Rapid-acting: Insulin lispro (Humalog) Insulin aspart (NovoLog) Insulin glulisine (Apidra) Short-acting: regular insulin (Humulin R) Intermediate-acting: Insulin NPH (Humulin N) Long-acting insulin lispro protamine Insulin glargine (Lantus) Insulin detemir (Levemir) Insulin degludec (Tresiba) There are also mixed insulins (such as Novomix, Mixtard, Ryzoderg ...) which are drugs that combine different types of insulin to achieve control goals. control blood sugar when put into the body.
The treating doctor is the person who will choose the right type of insulin for the patient based on the patient's health status and blood sugar control goals.

3. How to take insulin

The treating doctor will be the one to guide the patient about the type of insulin to use, when to take it and how often to use it. Patients can also consult a pharmacist for advice on how to take insulin based on the prescription and prescription of the doctor. Some people will need 1 or 2 injections a day, while others will need 3 or more injections and usually before each meal. Taking insulin injections several times a day helps to better control blood sugar levels.
To inject insulin, the patient needs to use a prefilled syringe or a set of needles and syringes to remove the medication from the vial. Using a pre-filled injection pen will be easier and safer for the patient. This type of injection pen has a knob at the top of the pen that allows the user to rotate the insulin dose selector to each unit. If the knob cannot be turned, the insulin in the pen has run out and needs to be replaced.

Whether using a needle and syringe or a pre-filled syringe, the patient needs to check the correct medication and ensure the correct insulin dose to each unit. It is also important to check that the pen or needle is working properly before each injection to make sure the correct dose of insulin is injected into the body.
How to inject insulin as follows:
Select an area to inject on the body which can be the lower abdomen, buttocks, front of thighs or back of hands. Patients also need to change the injection site to avoid lipodystrophy at the injection site; Gently pinch a skin fold in the area to be injected and quickly insert the needle under the skin; Press the entire injection and count to 10; Release the skin fold and pull out the needle; Discard used needles and syringes (if any) in suitable containers. It should be remembered that the patient should not use another person's injection pen, even when changing a new needle, to ensure hygiene and avoid infectious diseases. Different types of insulin pens may have their own instructions on how to use and store them, so patients need to carefully read the instructions for use of each drug or consult a pharmacist to ensure use. and store the injection pen properly.

4. Note when taking insulin

The most serious complication of taking insulin is hypoglycemia. Patients should be aware of symptoms of hypoglycemia such as sweating, shaking hands and feet, feeling nauseous, anxious or worse, difficulty walking, weakness, blurred vision. When you encounter these signs, you must quickly eat or drink sugar into the body through sweet candies, juices, soft drinks (do not choose sugar-free diets), honey or syrup ... If the symptoms If the symptoms do not improve or the patient faints or loses consciousness, it is necessary to take the patient to the emergency room immediately at the nearest medical facility.
To prevent insulin-induced hypoglycemia, the patient also needs to note the following points:
Always make sure the insulin dose is correct. Dosage of insulin is given in units, units or abbreviated as UI, IU. Always confirm with your treating doctor your insulin dose when feeling uncertain, especially with handwritten prescriptions. There has been a case of mistakenly seeing the word UI in the drug indication as "0", leading to 10 times the wrong dose of the drug, causing serious harm to the patient; Always change and reverse the injection site, avoid injecting the same place more than once to avoid irritation and injury to the injection site. Note that insulin is absorbed differently in different areas of the body, fastest in the abdomen, slowest in the buttocks or thighs, and averagely in the arms. Therefore, although the injection site is changed, it is advisable to keep one body area for one time of day to use the drug; For example, choose the abdomen during the day for meals because it is necessary to quickly control blood sugar after meals, and choose the thighs and buttocks in the evening so that insulin is absorbed slowly at night. Check and monitor blood sugar regularly. The doctor will instruct the patient how often to check blood sugar as well as each person's target blood sugar level;
Smoking and physical activity also affect insulin absorption. Smoking reduces blood flow in the body, reduces insulin absorption, while physical activities such as exercise, playing sports increase blood flow, increase insulin absorption and easily cause hypoglycemic effects. exceed. Therefore, it is best to avoid injecting insulin immediately before or immediately after physical activity and to inform the treating physician about these situations for appropriate management. Currently, Vinmec International General Hospital is providing a Diabetes Screening Package to help patients detect the disease early and improve treatment efficiency.

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References:
UptoDate, Patient education: Type 2 diabetes insulin treatment – ​​Beyond the basics UptoDate, Patient education: Low blood sugar in people with diabetes - The-basics UptoDate, General principles of insulin therapy in diabetes