Longacting Insulin Preparations

There are three long-acting insulin preparations:

• Insulin glargine (brand name Lantus)

• Insulin detemir (brand name Levemir)

Mixing regular insulin with a fish protein called protamine forms a crystal (neutral protamine Hagedorn, NPH), which dissolves slowly when injected subcutane-ously, so that the effect on average lasts for about eight hours (shorter duration for very small doses and longer duration for large doses). The crystals of NPH insulin appear white to the naked eye, and they tend to settle in the insulin vial. This is why you should mix the NPH insulin (by rolling the bottle between the palms of your hands) before drawing it up in the syringe.

Insulin glargine is human insulin that is modified so that it is soluble in a more acidic solution. It looks clear in the bottle, and when injected it precipitates in the tissues and is then slowly released into the bloodstream. Since it is acidic, the manufacturer recommends it should be given as a separate injection and not mixed in the syringe with the regular or fast-acting insulin analogs. For most people, insulin glargine works for twenty-four hours. For some individuals (especially small children and small adults who take low doses of insulin), the effect does not last for twenty-four hours, and in these cases, doses have to be given twice a day.

Insulin detemir is a human insulin modified to have a fatty acid chain attached to it. This fatty acid chain binds to the blood protein albumin, and this complex acts as a storage form of insulin in the blood, with the insulin being slowly released for its effect, which lasts up to eighteen hours. It usually needs to be given twice a day to cover the twenty-four hours.

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