GENERALITIES ON INSULIN
DEFINITION
Today all of the insulin market are synthesized human insulin by genetic engineering (recombinant DNA). Insulins of bovine or swine have virtually disappeared from the market. All are highly purified and contain only protein of insulin and other non-contaminated. The single factor that differentiates them is the duration of action.
As the insulin is active only in the blood for short periods (less than 15 minutes), have used various ways to delay its release and its action.
These systems are based on injectable preparations that retard the release:
* By binding to other proteins (protamine).
* By a crystallization: Zinc is added as the particles are made larger slow-soluble, so it will be released gradually.
Depending on the system delay of its action insulins can be fast, intermediate and slow.
All insulins should be injected subcutaneously delayed, and delayed not only can be given intravenous route.
Administration of insulin
The usual route of administration is subcutaneous insulins. Exceptionally (diabetic coma) is used to track IV.
The most common method of administration is using special syringes graduated in units of insulin. Devices have achieved acceptance in the form of injector pen, which provide various schemes shots a day.
There are also pre-filled syringes can accurately measure in increments of 2 IU and tiles for various applications (changing the needle).
The pumps that run on a quota of a basal insulin dose via SC, supplemented by extra doses before meals. Are less widely used: they are especially useful for highly motivated patients. Are ascribed to a certain increase in frequency of episodes of ketoacidosis, possibly related to a malfunction.
The Spanish insulin syringe for administration are standardized to the dose of 40 IU / ml in 10 ml vials. Cartridges for pumps and injectors have a concentration of 100 IU / ml and the volume is adjusted to the specifications of the device.
Dosage
The spread of the idea that the strict control of blood glucose can prevent long-term complications of diabetes (recently demonstrated by clinical trials) has created a tendency to use dosing regimen designed to align as closely as possible to the administration insulin to the diurnal variations in blood glucose.
This involves several regimens of daily injections and blood glucose control by the patient. The patterns most frequently used at present are:
* Two doses (before breakfast and evening) of a mixture of intermediate insulin and insulin quickly. The popularity of this scheme explains the spread of biphasic insulin preparations.
* A daily dose of long-acting insulin (morning or evening, sometimes replaced by a dose of intermediate insulin at bedtime) and three insulin injections a day fast before the main meals. The drawback of this regime decreases if you use a pen type injector. We need motivated patients, but has the advantage of allowing a more flexible mealtimes.
FUNDING FOR THE NATIONAL SYSTEM OF HEALTH
All insulins are prescribed by Social Security.
With regard to the application equipment, syringes and needles can not be dispensed through pharmacies but are distributed free in primary care and outpatient care.
As a general rule do not repay the SS insulin pump or pen injection equipment type. Some areas of health can do so only occasionally, depending on budget availability. The needles of the equipment can be obtained free of charge in primary care.
Injection equipment in the form of pre-filled syringe are considered medicinal products and are prescribed as such. The needles are being distributed free in primary care.