1978 Genentech produces biosynthetic human insulin in Escherichia coli bacteria using recombinant DNA techniques, licenses to Eli Lilly
1981 Novo Nordisk chemically and enzymatically converts porcine to human insulin
1982 Genentech synthetic human insulin (above) approved
1983 Eli Lilly and Company produces biosynthetic human insulin with recombinant DNA technology, Humulin
1985 Axel Ullrich sequences a human cell membrane insulin receptor. 1988 Novo Nordisk produces recombinant biosynthetic human insulin
1996 Lilly Humalog "lispro" insulin analogue approved. 2000 Sanofi Aventis Lantus insulin "glargine" analogue approved for clinical use in the US and Europe. 2004 Sanofi Aventis Apidra insulin "glulisine" insulin analogue approved for clinical use in the US. 2006 Novo Nordisk Levemir "detemir" insulin analogue approved for clinical use in the US. Medical uses
Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. It is also used along with glucose to treat high blood potassium levels. Use during pregnancy is relatively safe for the baby. Insulin was formerly used in a psychiatric treatment called insulin shock therapy. Side effects
Some side effects are hypoglycemia (low blood sugar), hypokalemia (low blood potassium), and allergic reactions. Allergy to insulin affected about 2% of people, of which most reactions are not due to the insulin itself but to preservatives added to insulin such as zinc, protamine, and meta-cresol. Most reactions are Type I hypersensitivity reactions and rarely cause anaphylaxis. A suspected allergy to insulin can be confirmed by skin prick testing, patch testing and occasionally skin biopsy.
It is uncertain if additional dietary advice interventions help to reduce the risk of gestational diabetes. However, data from the Nurses Health Study shows that adherence to a healthy plant-based diet is associated with lower risk for GDM.Diet and physical activity interventions designed to prevent excessive gestational weight gain reduce the rates of gestational diabetes. However, the impact of these interventions varies with the body-mass index of the person as well as with the region in which the studies were performed.Moderate-quality evidence suggest that there is a reduced risk of gestational diabetes mellitus and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care.It has been suggested that for women who have had gestational diabetes, support between pregnancies may lower their chances of having gestational diabetes again in future pregnancies. This support might include diet and exercise, education, and lifestyle advice. However, there is no research to show whether interventions between pregnancies lower the number of women who develop gestational diabetes again.Theoretically, smoking cessation may decrease the risk of gestational diabetes among smokers. Management
Treatment of GDM with diet and insulin reduces health problems mother and child. Treatment of GDM is also accompanied by more inductions of labour.A repeat OGTT should be carried out 6 weeks after delivery, to confirm the diabetes has disappeared. Afterwards, regular screening for type 2 diabetes is advised.Lifestyle interventions include exercise, diet advice, behavioural interventions, relaxation, self-monitoring glucose, and combined interventions.