The dose of prandial insulin may be static, or may be calculated by the patient using either their current blood sugar, planned carbohydrate intake, or both. This calculation may also be performed by an insulin pump in patients using a pump. Insulin regiments that consist of doses calculated in this manner are considered intensive insulin regimens. Prandial insulin is usually administered no more than 15–30 minutes prior to a meal using a rapid-acting insulin or a regular insulin. In some patients, a combination insulin may be used that contains both NPH (long acting) insulin and a rapid/regular insulin to provide both a basal insulin and prandial insulin. Challenges in treatment
There are several challenges involved in the use of insulin as a clinical treatment for diabetes:
Mode of administration. Selecting the right dose and timing. The amount of carbohydrates one unit of insulin handles varies widely between persons and over the day but values between 7 and 20 grams per 1 IE is typical. Selecting an appropriate insulin preparation (typically on speed of onset and duration of action grounds). Adjusting dosage and timing to fit food intake timing, amounts, and types. Adjusting dosage and timing to fit exercise undertaken. Adjusting dosage, type, and timing to fit other conditions, for instance the increased stress of illness. Variability in absorption into the bloodstream via subcutaneous delivery
The dosage is non-physiological in that a subcutaneous bolus dose of insulin alone is administered instead of combination of insulin and C-peptide being released gradually and directly into the portal vein.
As a medication, insulin is any pharmaceutical preparation of the protein hormone insulin that is used to treat high blood glucose. Such conditions include type 1 diabetes, type 2 diabetes, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. Insulin is also used along with glucose to treat hyperkalemia (high blood potassium levels). Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle. There are various types of insulin, suitable for various time spans. The types are often all called insulin in the broad sense, although in a more precise sense, insulin is identical to the naturally occurring molecule whereas insulin analogues have slightly different molecules that allow for modified time of action. It is on the World Health Organizations List of Essential Medicines. In 2019, regular human insulin was the 298th most commonly prescribed medication in the United States, with more than 1 million prescriptions.Insulin can be made from the pancreas of pigs or cows. Human versions can be made either by modifying pig versions or recombinant technology. It comes in three main types: short–acting (such as regular insulin), intermediate-acting (such as neutral protamine Hagedorn (NPH) insulin), and longer-acting (such as insulin glargine). History
Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.This is a chronology of key milestones in the history of the medical use of insulin.