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Bit frustrating how myth 2 is totally devoid of facts that would permit further reading. What's the scientific names for these different types of insulin and th

Bit frustrating how myth 2 is totally devoid of facts that would permit further reading. What's the scientific names for these different types of insulin and the actual physiological difference between their effects?

m348e912 7y ago
This was one of the comments posted below the article that may answer your question: Epistemologist2: As a physician myself, with Type I diabetes for the past 56 years, I have lived through quite a lot of change in the management of my diabetes. I am particularly concerned about the discussion in Myth #2. The inexpensive insulin, U-100 Regular Insulin, is readily available and it is just as potent, unit for unit, as the newer synthetic insulins. What is different is the rate of onset of action. Regular Insulin does not "turn on" as quickly as the others, but if taken in advance of a meal will do the job sufficiently well that you can maintain reasonable blood sugars. The over-riding intent with insulin therapy is to mimic natural insulin production/action in one's body. The expensive modified insulins become active much faster and consequently will more closely mimic natural insulin release, but it is critical to note that once injected, those insulins do not turn off as promptly as naturally produced insulin from the pancreas, and this can be a serious problem! In my case, I had had my diabetes for about twenty years and was adequately controlled using those "old" insulin products extracted from beef and pork pancreas after which we got the now inexpensive Human Insulin, chemically identical to that from the human pancreas, and it did not "turn on" any faster than the predecessor products. It was not until 1996, 33 years into my own diabetes, that we saw the introduction of a synthetic insulin with much faster onset of action. Bottom line is that the price of the fancy new insulins should not be such a barrier that it leads to one's death. The inexpensive older products work, just like you old "dumb" phone works to do its basic job. Newer is better, but not critical, and neither doctors nor patients should forget that using older techniques and products is a viable option. It is the doctor's failure to think outside the box to adequately educate the patient that causes death.
projektfu 7y ago
Broadly speaking, there’s insulin in solution (insulin-R or regular insulin) and crystalline insulin. Insulin-R is relatively short acting and is frequently used in acute therapy or intensive care. It used to be the only type, and can be used in a mode where it’s given before a meal and as needed. Insulin-N (NPH, neutral protamine Hagedorn insulin) and protamine zinc insulin (PZI) are the first generation crystalline insulins. They have longer lasting (baseline) effects as well as peaking effects that allow them to be given easily on schedule based on the sizes of meals. There’s a variety of modern insulins now, which are substituted with different amino acids to give them different effects. Insulin glargine and insulin detemir are the most popular. They are supposed to have blunted peaks and are given at regular intervals such as every 24 hours. They mimic the baseline insulin secretion. Insulin pumps are also available that monitor blood sugar and secrete insulin to keep it controlled. There are also experimental “artificial pancreases” that will also secrete glucagon. Another comment mentions that cheap insulin can be just as good. This is true but it requires a careful lifestyle. Messing up is more common and if you’re on your own you may be unable to help yourself, e.g. comatose. Currently, insulin-N and -R are cheap. Detemir and glargine are constantly going up in price despite the existence of multiple suppliers of glargine. (This sort of implicit agreement without actual price fixing is common in the pharmaceutical industry). Essentially, the competitor is a small fraction cheaper, can take some of the market, but most people will continue writing and filling scripts for the incumbent because it’s what they know, on the formulary, etc. I’m not sure of the use of PZI in human medicine. It’s popular in my patients, as is glargine.

m348e912 7y ago

This was one of the comments posted below the article that may answer your question: Epistemologist2: As a physician myself, with Type I diabetes for the past 56 years, I have lived through quite a lot of change in the management of my diabetes. I am particularly concerned about the discussion in Myth #2. The inexpensive insulin, U-100 Regular Insulin, is readily available and it is just as potent, unit for unit, as the newer synthetic insulins. What is different is the rate of onset of action. Regular Insulin does not "turn on" as quickly as the others, but if taken in advance of a meal will do the job sufficiently well that you can maintain reasonable blood sugars. The over-riding intent with insulin therapy is to mimic natural insulin production/action in one's body. The expensive modified insulins become active much faster and consequently will more closely mimic natural insulin release, but it is critical to note that once injected, those insulins do not turn off as promptly as naturally produced insulin from the pancreas, and this can be a serious problem! In my case, I had had my diabetes for about twenty years and was adequately controlled using those "old" insulin products extracted from beef and pork pancreas after which we got the now inexpensive Human Insulin, chemically identical to that from the human pancreas, and it did not "turn on" any faster than the predecessor products. It was not until 1996, 33 years into my own diabetes, that we saw the introduction of a synthetic insulin with much faster onset of action. Bottom line is that the price of the fancy new insulins should not be such a barrier that it leads to one's death. The inexpensive older products work, just like you old "dumb" phone works to do its basic job. Newer is better, but not critical, and neither doctors nor patients should forget that using older techniques and products is a viable option. It is the doctor's failure to think outside the box to adequately educate the patient that causes death.

projektfu 7y ago

Broadly speaking, there’s insulin in solution (insulin-R or regular insulin) and crystalline insulin. Insulin-R is relatively short acting and is frequently used in acute therapy or intensive care. It used to be the only type, and can be used in a mode where it’s given before a meal and as needed. Insulin-N (NPH, neutral protamine Hagedorn insulin) and protamine zinc insulin (PZI) are the first generation crystalline insulins. They have longer lasting (baseline) effects as well as peaking effects that allow them to be given easily on schedule based on the sizes of meals. There’s a variety of modern insulins now, which are substituted with different amino acids to give them different effects. Insulin glargine and insulin detemir are the most popular. They are supposed to have blunted peaks and are given at regular intervals such as every 24 hours. They mimic the baseline insulin secretion. Insulin pumps are also available that monitor blood sugar and secrete insulin to keep it controlled. There are also experimental “artificial pancreases” that will also secrete glucagon. Another comment mentions that cheap insulin can be just as good. This is true but it requires a careful lifestyle. Messing up is more common and if you’re on your own you may be unable to help yourself, e.g. comatose. Currently, insulin-N and -R are cheap. Detemir and glargine are constantly going up in price despite the existence of multiple suppliers of glargine. (This sort of implicit agreement without actual price fixing is common in the pharmaceutical industry). Essentially, the competitor is a small fraction cheaper, can take some of the market, but most people will continue writing and filling scripts for the incumbent because it’s what they know, on the formulary, etc. I’m not sure of the use of PZI in human medicine. It’s popular in my patients, as is glargine.