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U-500 Insulin Pharmacokinetics

A Primer On Concentrated Insulins: What An Internist Should Know

A Primer On Concentrated Insulins: What An Internist Should Know

Get access/doi/full/10.1080/00325481.2016.1159909?needAccess=true The common insulin concentration in most preparations of insulin is 100 units per mL or U-100. Human regular U-500 insulin was the first concentrated insulin introduced and it has been available in the United States since the 1950s. Humulin R is the only human regular U-500 available on the market. Human regular U-500 is five times more concentrated than U-100 and because of its pharmacodynamic properties, works as both a basal and a bolus insulin. Human regular U500 allows for delivery of a larger insulin dose with a smaller volume leading to better absorption compared to U-100 and has traditionally been used in patients with moderate to severe insulin resistance. More recently other forms of concentrated insulin have become available and the newer concentrated insulin preparations can be used in diabetic patients with or without insulin resistance. Our intent is to provide primary care physicians with a review of the pharmacology and current literature on concentrated insulins as well as recommendations for patient selection, dose initiation, and dose adjustment. Continue reading >>

Concentrated Insulin Human Regular (u-500) For Patients With Diabetesp

Concentrated Insulin Human Regular (u-500) For Patients With Diabetesp

aTDD = total daily dose, CSII = continuous subcutaneous insulin infusion, SMBG = self-monitored blood glucose, 50/50 = 50% of TDD prebreakfast and 50% of TDD predinner, 60/40 = 60% of TDD prebreakfast and 40% of TDD predinner, 33/33/33 = one-third of TDD before each meal. bEmpirically reduce the conversion dose from U-100 by 1020% if baseline glycosylated hemoglobin (HbA1c) is 8%; increase the dose by 1020% if HbA1c is 10%. cU-500 bolus doses recommended 30 minutes before a meal; adjust dosage according to latest SMBG value. U-500 has prandial and basal timeaction profile characteristics. dBasal insulin (glargine, detemir, or isophane [NPH]) may be substituted for bedtime U-500 insulin to adjust fasting blood glucose values according to physician judgment. eBased on percentage of TDD. May initially use fixed ratios or distribute boluses according to proportion of carbohydrates with meal or carbohydrate-counting according to patient preference and physician judgment. aThe following dosing formulas may also be used: dose (actual units) 0.2 = unit markings in a U-100 insulin syringe, dose (actual units) 0.002 = volume (mL) in a tuberculin syringe. Alissa R. Segal, Pharm.D., CDE, Jack E. Brunner, M.D., F. Taylor Burch, Pharm.D., M.H.A. and Jeffrey A. Jackson, M.D., CDE Alissa R. Segal, Pharm.D., CDE, is Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, and Clinical Pharmacist and Diabetes Educator, Joslin Diabetes Center, Boston. Jack E. Brunner, M.D., is Director, Endocrine and Diabetes Care Center, Toledo, OH. F. Taylor Burch, Pharm.D., M.H.A., is Endocrine Medical Liaison, U.S. Medical Division, Endocrine, Lilly USA, LLC, Indianapolis, IN. Jeffrey A. Jackson, M.D., CDE, is Adjunct Clinical Associate Professor, Inter Continue reading >>

The Use Of U-500 Insulin For Patients With Severe Insulin Resistance

The Use Of U-500 Insulin For Patients With Severe Insulin Resistance

The use of U-500 insulin for patients with severe insulin resistance March 7 2017, Volume :42 Number 3 , page 12 - 16 [Free] Join NursingCenter to get uninterrupted access to this Article One of the most significant challenges in the management of type 2 diabetes mellitus (T2DM) is the titration of insulin in patients with severe insulin resistance. This is particularly true of obese, sedentary patients whose severe insulin resistance may require daily amounts of 200 units of insulin or more to obtain target A1C levels. 1 This volume of insulin, injected subcutaneously, often leads to inadequate absorption, poor adherence, and increased drug and supply costs. 2 U-500 regular concentrated insulin offers insulin treatment without large volumes of insulin. It is a viable alternative to U-100 insulin formulations in select patients and may result in improved A1C control, enhanced adherence, and increased patient satisfaction. 3,4 However, some primary care providers may be unaware or clinically uncomfortable with the use of U-500 insulin. The purpose of this article is to describe the evaluation and management of a patient with T2DM with severe insulin resistance who is a candidate for U-500 regular concentrated insulin. This case-based approach will highlight important considerations, describe the dosing of U-500 insulin, and review potential challenges. Mr. D, 47, presents as a new patient to an NP-managed health center. His medical history is significant for the following: T2DM, onset age 36 with associated peripheral neuropathy and nonproliferative retinopathy; morbid obesity; and chronic lower back pain with L4-5 radiculopathy. Mr. D is currently taking metformin hydrochloride, 1,000 mg twice daily; insulin glargine, 95 units twice daily; and insulin lispro, 70 units Continue reading >>

Regular U-500 Insulin May Have Longer Duration Of Action

Regular U-500 Insulin May Have Longer Duration Of Action

Home / Resources / Articles / Regular U-500 Insulin May Have Longer Duration of Action Regular U-500 Insulin May Have Longer Duration of Action Although the pharmacokinetics and pharmacodynamics of high-dose human regular U-500 and human regular U-100 insulin are similar, the U-500 formulation may have a longer duration of action. The use of regular U-500 insulin (U-500R) (500 units/mL) is rising in the face of increasing numbers of patients requiring high insulin doses, but PK/PD data for the higher doses of U-500R typically used in clinical practice are scarce. Dr. Amparo de la Pena from Eli Lilly and Company in Indianapolis and colleagues evaluated the relative exposure after two clinically relevant doses (50 units and 100 units) of U-500R versus U-100 human regular insulin (U-100R) (100 units/mL) in a crossover study of 24 healthy obese subjects. Overall insulin exposure based on AUC(0-t) was similar between U-500R and U-100R formulations at both doses. At both doses, the maximum concentration of insulin achieved (Cmax) was significantly lower for U-500R (50 units: 548 pmol/L; 100 units: 1,020 pmol/L) than for U-100R (50 units: 809 pmol/L; 100 units: 1,400 pmol/L) (p<0.05). For the 100-unit dose, the time of maximum concentration (Tmax) was significantly longer for U-500R than for U-100R (8 hours vs. 3 hours, p<0.05). There was no significant difference in Tmax for the lower dose. As expected from these PK data, time variables reflective of duration of action were prolonged for U-500R versus U-100R at both doses, although the time of onset was similar for both doses of both formulations. At the 100-unit dose, the duration of action was 18.3 hours for U-100R and 21.5 hours for U-500R (p<0.05). The investigators noted that the findings have potential clinical implica Continue reading >>

A Case Report Of Continuous Subcutaneous U-500 Insulin Administration In A Patient With Insulin Resistant Lipodystrophy

A Case Report Of Continuous Subcutaneous U-500 Insulin Administration In A Patient With Insulin Resistant Lipodystrophy

1From the Division of Endocrinology and Molecular Medicine, University of Kentucky, Lexington, Kentucky 2Department of Veterans Affairs, Lexington, Kentucky. Objective: To report the clinical outcome of a patient with lipodystrophy complicated by insulin-resistant diabetes mellitus who was changed from traditional multiple daily injection U-500 dosing to off-label continuous subcutaneous insulin infusion (CSII) of U-500 insulin in a V-Go® Disposable Insulin Delivery device (V-Go®). Methods: Case report with literature review. Results: After initiation of V-Go® the patient was able to reduce her total daily insulin dose from 415 U to 280 U with a concomitant reduction in glycated hemoglobin (HbA1c) from 9.3 to 6.8% over a 3-month period. The reported frequency of hypoglycemia was also significantly reduced. The patient reported increased satisfaction and improved insulin administration compliance. Conclusion: U-500 delivered via CSII in patients with highly resistant type 2 diabetes, as can be seen in lipodystrophy, may be beneficial when patient becomes difficult to manage on insulin administered by multiple daily injections. The use of a V-Go® insulin delivery device can facilitate continuous insulin delivery in patients who are not able to use an insulin pump. Continue reading >>

[full Text] Concentrated Insulins: The New Basal Insulins | Tcrm

[full Text] Concentrated Insulins: The New Basal Insulins | Tcrm

U-500R insulin has been the only concentrated insulin available for use since the 1950s and delivers 500 units of insulin in 1 mL of solution. It is approved for use in individuals with T1DM and T2DM and provides mealtime and basal coverage. U-500R prescriptions have increased dramatically in the USA, increasing by 137% from June 2007 to June 2009 7 and >70% in vials prescribed per month from January 2007 to June 2008 (equal to 5,720 vials per month) based on IMS Health, National Audit Database information. 8 Insulin degludec (Tresiba) or insulin degludec/insulin aspart (Ryzodeg) are novel insulin analogs available at 100 units/mL and 200 units/mL. Insulin glargine U300 (Toujeo) is a highly concentrated form of the U100 strength insulin glargine at 300 units/mL. Additional new concentrated insulin formulations are under preclinical investigation including insulin Fluorolog at 500 units/mL, concentrated insulin lispro at 200 units/mL, both with short-acting properties, and insulin BIOD-531 at 400 units/mL, which has mixed action properties. U-500R is five times more concentrated than U100 regular insulin (U-100R). U-500R has previously been available as beef and pork regular insulin. However, since the 1990s, recombinant DNA technology has been allowed for the development of the current commercially available human insulin preparation. U-500R is formulated with human insulin (of recombinant DNA origin) at 500 units/mL in a solution of glycerin, metacresol (a preservative), zinc oxide, and water. There is a reduced tendency to form hexamers that allow for faster disassociation and absorption in the circulation compared with longer-acting insulin formulations that form multihexamers. U-500R peaks around 30 minutes, and insulin action and glucose-lowering effect are prolon Continue reading >>

Severe Insulin Resistance In A Patient With Type 2 Diabetes

Severe Insulin Resistance In A Patient With Type 2 Diabetes

Severe insulin resistance in a patient with type 2 diabetes Severe insulin resistance in a patient with type 2 diabetes The patient should increase her intake of non-caloric beverages to counteract dehydration secondary to persistent hyperglycemia. Reinforce the elements of a diabetic diet, and recommend a low-carbohydrate diet with portion control to help improve glycemic control. Make sure that the patient's insulin is not expired and is stored according to the manufacturers' specified conditions to promote consistent pharmacokinetics. Increase her dose of lantus to 65 units twice daily, and increase her dose of aspart to 45 units before each meal with continued glucose monitoring. A diabetes specialist colleague should be contacted, and if possible, he or she should schedule an appointment for the patient within 3 days. The patient was seen by her new diabetes specialist as scheduled. Per the glycemic management consultation note, her blood glucose minimally improved after the previous suggested insulin dose titration. Furthermore, the patient's insulin was not expired and was stored appropriately. The consultant switched the patient to U-500 regular insulin 29 units before breakfast and 19 units before dinner with continued glycemic monitoring and insulin titration. Her blood glucose level improved to 96-215 mg/dL with return of baseline vision, normal urinary pattern, and decreased thirst. It is common for primary care clinicians to be contacted by their patients with glycemic management challenges, especially when the specialist caring for them is not available. In this complex patient scenario, the clinician was comfortable with titrating the insulin regimen while scheduling an expedited appointment with a diabetes management specialist. Another option would be Continue reading >>

Embracing Concentrated Insulins: With A Focus On Humulin R U-500

Embracing Concentrated Insulins: With A Focus On Humulin R U-500

Embracing Concentrated Insulins: With a Focus On Humulin R U-500 April D. Taylor, MSN, CNS, BC-ADM; Cynthia S. Brusko, PharmD; Karen M. Paulsrud, RPH; and Michael McShea, RPH The number of concentrated insulin products available to treat patients with diabetes has expanded over the last several years in theUnited States (table).1-4These products contain a greater number of units of insulin in each milliliter than standard U-100 insulins and may provide options for patients to improve glycemic control with treatment regimens that may enhance their adherence to therapy.5All concentrated insulins are available in distinctive prefilled pen devices for simple product recognition and accurate dose administration. In addition, a new dedicated BDTM U-500 insulin syringe must be prescribed to administer human regular insulin U-500 (U-500R) from the multiple dose vial.4 Findings from recent market research among pharmacists and other health care professionals identified a need for a deeper understanding of all concentrated insulins.6Increased knowledge of concentrated insulins among pharmacists would expand clinical skills and address patient safetyin the use of these agents, especially U-500R. Pharmacists should be able to recognize the appropriate use of, risks involved with, and the best practices for prescribing, dispensing, and patient education on concentrated insulins. This article discusses concentrated insulins; who may be the appropriate patient; the transition from U-100 insulin therapy; clinical considerations, with a deeper focus on U-500R; and the challenges and opportunities for pharmacists within the insulin prescription journey. WHY DO SOME PATIENTS WITH DIABETES NEED CONCENTRATED INSULINS? The American Diabetes Association5and the American Association of Clinic Continue reading >>

Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects

Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects

Pharmacokinetics and Pharmacodynamics of High-Dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin in Healthy Obese Subjects 1Eli Lilly and Company, Indianapolis, Indiana 2Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon 3Profil Institute for Clinical Research, Chula Vista, California Received 2011 Apr 15; Accepted 2011 Aug 31. Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been corrected. See the correction in volume 37 onpage2414. This article has been cited by other articles in PMC. Human regular U-500 (U-500R) insulin (500 units/mL) is increasingly being used clinically, yet its pharmacokinetics (PK) and pharmacodynamics (PD) have not been well studied. Therefore, we compared PK and PD of clinically relevant doses of U-500R with the same doses of human regular U-100 (U-100R) insulin (100 units/mL). This was a single-site, randomized, double-blind, crossover euglycemic clamp study. Single subcutaneous injections of 50- and 100-unit doses of U-500R and U-100R were administered to 24 healthy obese subjects. Both overall insulin exposure (area under the serum insulin concentration versus time curve from zero to return to baseline [AUC0-t]) and overall effect (total glucose infused during a clamp) were similar between formulations at both 50- and 100-unit doses (90% [CI] of ratios contained within [0.80, 1.25]). However, peak concentration and effect were significantly lower for U-500R at both doses (P < 0.05). Both formulations produced relatively long durations of action (18.3 to 21.5 h). Time-to-peak concentra Continue reading >>

The Pharmacist's Guide To U-500 Insulin Tl;dr Pharmacy

The Pharmacist's Guide To U-500 Insulin Tl;dr Pharmacy

Family photograph of U-500 insulin (yellow) and U-100 (green) ( Image ) So.what is this dinosaur and why do we need it for managing diabetes?? Humulin R U-500 is a concentrated Regular insulin used as a basalinsulin. So instead of the typical U-100 insulin (100 units/ml), this beast is 500 units/ml5x as concentrated. In contrast, Humulin R U-100 insulin is considered a short-acting, prandialinsulin. Cant you already see the potential for mix-ups?! They're both regular insulins, but U-500 is used for basal coverage while U-100 is used for prandial coverage. Our use of concentrated insulin has increased over the past 10 years due to the high incidence of insulin resistance and obesity. The obesity rate in 2015 was 30% ! On top of this, the diabetes rate in 2015 was 9.4% (30.3 million people) and another 84 million have pre-diabetes. Insulin resistance is the hallmark characteristic for type 2 diabetes. As diabetes progresses and people with type 2 diabetes get older, insulin resistance continues to become problematic, resulting in higher insulin needs. When do you need to switch your patient to U-500 insulin? When a patient requires more than 200 units of insulin a day, moving to a concentrated insulin can improve BG control and provide more comfort with fewer injections. I'll get more into the "how to transition your patient to U-500" later in this post. Understanding the normal pancreas function helps to understand how to use injectable insulin safely and effectively. The pancreas has exocrine and endocrine functions. The exocrine functions basically help you digest food. This is the amylase and lipaseyou've heard about. These enzymes get secreted whenever you eat, and they help us break down dietary proteins and fats into something usable for the body. The endocrine f Continue reading >>

Humulin R U-500 (insulin Human Injection): Pharmacokinetics And Pharmacodynamics

Humulin R U-500 (insulin Human Injection): Pharmacokinetics And Pharmacodynamics

Independent Research Clinical Trial Investigational Drugs You are now leaving the LillyMedical.com Web site The link you clicked on will take you to a site maintained by a third party, which is solely responsible for its content. Lilly USA, LLC does not control, influence, or endorse this site, and the opinions, claims, or comments expressed on this site should not be attributed to Lilly USA, LLC. Lilly USA, LLC is not responsible for the privacy policy of any third-party Web sites. We encourage you to read the privacy policy of every Web site you visit. Click "Continue" to proceed or "Return" to return to LillyMedical.com. You are now leaving the LillyMedical.com Web site The link you clicked on will take you to a site maintained by a third party, which is solely responsible for its content. Lilly USA, LLC does not control, influence, or endorse this site, and the opinions, claims, or comments expressed on this site should not be attributed to Lilly USA, LLC. Lilly USA, LLC is not responsible for the privacy policy of any third-party Web sites. We encourage you to read the privacy policy of every Web site you visit. Click "Agree" to proceed or "Cancel" to return to LillyMedical.com. as a sterile, aqueous, and colorless solution Thetime action characteristics reflect both prandial and basal activity,consistent with clinical experience. This effect has been attributedto the high concentration of U-500R. 1 Thetime course of action of U-500R, as with any insulin, may vary In aeuglycemic clamp study of 24 healthy obese subject with a BMI of 30to 39 kg/m2,single doses of SC U-500R at 50 units (0.4 - 0.6 units/kg) and 100units (0.8 - 1.3 units/kg) resulted in a mean time of onset of action was < 15 minutes at both doses mean duration of action of 21 hours with a range of 13 Continue reading >>

(pdf) Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects. Diabetes Care 2011;34:24962501:

(pdf) Pharmacokinetics And Pharmacodynamics Of High-dose Human Regular U-500 Insulin Versus Human Regular U-100 Insulin In Healthy Obese Subjects. Diabetes Care 2011;34:24962501:

OBJECTIVEdHuman regular U-500 (U-500R) insulin (500 units/mL) is increasingly being used clinically, yet its pharmacokinetics (PK) and pharmacodynamics (PD) have not been well studied. Therefore, we compared PK and PD of clinically relevant doses of U-500R with the same doses of human regular U-100 (U-100R) insulin (100 units/mL). RESEARCH DESIGN AND METHODSdThis was a single-site, randomized, double- blind, crossover euglycemic clamp study. Single subcutaneous injections of 50- and 100-unit doses of U-500R and U-100R were administered to 24 healthy obese subjects. RESULTSdBoth overall insulin exposure (area under the serum insulin concentration versus time curve from zero to return to baseline [AUC ]) and overall effect (total glucose infused during a clamp) were similar between formulations at both 50- and 100-unit doses (90% [CI] of ratios contained within [0.80, 1.25]). However, peak concentration and effect were signicantly lower for U-500R at both doses (P,0.05). Both formulations produced relatively long durations of action (18.3 to 21.5 h). Time-to-peak concentration and time to maximum effect were sig- nicantly longer for U-500R than U-100R at the 100-unit dose (P,0.05). Time variables ) were prolonged for U-500R versus U-100R CONCLUSIONSdOverall exposure to and action of U-500R insulin after subcutaneous injection were no different from those of U-100R insulin. For U-500R, peaks of concentration and action proles were blunted and the effect after the peak was prolonged. These ndings may help guide therapy with U-500R insulin for highly insulin-resistant patients with diabetes. U-500 (500 units/mL) insulin (Iletin; Eli in the United States in 1952. The current The primary objective was to evaluate the doses in healthy obese subjects. The study cccccccccccccccc Continue reading >>

Humulin R (u-500) (insulin Human) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Humulin R (u-500) (insulin Human) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Concentrated Insulins with Short and Intermediate Actions Hormone secreted by pancreatic beta-cells of the islets of Langerhans; essential for the metabolism and homeostasis of carbohydrate, fat, and protein Regular insulin 100 units/mL is a "short-acting" insulin; concentrated regular insulin 500 units/mL exhibits different pharmacokinetics Used for the treatment of diabetes mellitus type 1 and type 2; also used for blood glucose management due to hyperglycemia in critical care and other care settings Injectable regular insulin is available in 2 concentrations: 100 units/mL and 500 units/mL; clinicians and patients must ensure that the correct concentration is used to avoid severe overdose and hypoglycemia Humulin R, Novolin R, ReliOn, Velosulin BR Humulin R Subcutaneous Inj Sol Conc: 1mL, 500U Humulin R/Novolin R Subcutaneous Inj Sol: 1mL, 100U For the treatment of type 1 diabetes mellitus or for type 2 diabetes mellitus inadequately managed by diet, exercise, and oral hypoglycemics. When used for intermittent subcutaneous injection, the total daily dose is given as 2 to 4 injections per day, typically administered 30 to 60 minutes before meals; or administer as a sliding scale based on blood glucose monitoring several times per day. Regular U-500 insulin has a longer duration of action (up to 24 hours) compared to regular 100 units/mL, and is usually administered 2 to 3 times per day; regular 100 units/mL is usually administered 3 or more times per day and may also be used in combination with oral antihyperglycemic agents or longer-acting insulin products. A common regimen is to give an intermediate insulin (NPH or Lente) and regular insulin concomitantly and give two injections per day. About 2/3 of the daily insulin dose is given before breakfast and about 1/3 is Continue reading >>

The Pharmacokinetics And Pharmacodynamics Of Regular U500 Insulin In Health Non-obese Subjects

The Pharmacokinetics And Pharmacodynamics Of Regular U500 Insulin In Health Non-obese Subjects

The Pharmacokinetics and Pharmacodynamics of Regular U500 Insulin in Health Non-Obese Subjects Regular U-500 insulin is being Regular U-500 insulin is being used with increasing frequency in individuals with type 2 diabetes mellitus, but the onset, peak, and duration of its effect are unclear. The objective of this study was to evaluate the pharmacokinetic and pharmacodynamic properties of regular U-500 insulin in healthy subjects. Three subjects (ages 25-35 yrs) were studied using the euglycemic clamp technique. Regular U-500 insulin (0.2 units/kg body weight) was injected subcutaneously in the abdomen. A 20% dextrose infusion was initiated and titrated to maintain the serum glucose level between 90-110 mg/dl. Pharmacokinetic and pharmacodynamic measurements were derived from blood sample measurements of glucose, insulin, and C-peptide levels. Subjects A and B were females weighing 50 kg (BMI 18 kg/m2) and 60 kg (BMI 23 kg/m2) respectively and subject C was male weighing 81 kg (BMI 26 kg/m2). Time to onset was within 30 minutes in all subjects. In subject A, maximum insulin concentration (Cmax) was 609 picomoles/liter, time to reach maximum insulin concentration (Tmax) was 105 minutes, insulin residence time (total duration of insulin action) was 390 minutes with area under the curve (AUC) of 125000 picomoles.min.l-1. In subject B, Cmax was 136 picomoles/liter, Tmax was 210 minutes and AUC was 46000 picomoles.min.l-1. In subject C, Cmax was 151 picomoles/liter, Tmax was 240 minutes and AUC was 58000 picomoles.min.l-1. The insulin residence time in subjects B and C was [gt] 480 and [gt] 570 minutes respectively and the corresponding insulin concentration at those times was 33% and 37% of the peak insulin concentration respectively. The pharmacodynamic data showed that t Continue reading >>

Regular Insulin

Regular Insulin

Regular insulin, also known as neutral insulin and soluble insulin is a type of short acting insulin.[1] It is used to treat diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but may also be used by injection into a vein or muscle.[1] Onset of effect is typically in 30 minutes and they last for 8 hours.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Regular insulin can be made from the pancreas of pigs or cows.[1] Human versions can be made either by modifying pig versions or recombinant technology.[1] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The wholesale cost in the developing world is about 2.39 to 10.61 USD per 1,000 iu of regular insulin.[7] In the United Kingdom 1,000 iu costs the NHS 7.48 pounds, while in the United States this amount is about 134.00 USD.[1][8] Versions are also available mixed with longer–acting versions of insulin, such as NPH insulin.[1] Medical uses[edit] It is used for the long term management of diabetes.[3] Regular insulin is the treatment of choice for the two diabetic emergencies diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It may also be used in combination with glucose to lower potassium leve Continue reading >>

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