20.14f Insulin Preparations

three sources

Insulin comes from one of (?).

beef or pork intestines

Initially, it came from either (?) .

recombinant DNA technology

Now, (?) has made human insulin available (that is, insulin synthesized with a human RNA template, not harvested directly from humans).

onset and duration of action

Insulin preparations differ primarily in their (?) and in their incidence of allergic reaction.

short acting

Insulin preparations can be (?), intermediate acting, or long acting, depending on their onset and duration of action.

natural (regular)

(Table 20-27 lists insulin preparations.) Insulin is also classified as (?) or modified.

natural insulins

As their name suggests, the (?) are used as they occur in nature.

modified

The other insulin preparations have been (?) to increase their duration of action and thus decrease the frequency of their administration.

regular insulin

All insulin preparations are given subcutaneously with the exception of (?), which can also be given intravenously.

oral medication

Insulin is not available as an (?) because the digestive enzymes would rapidly render it inactive; therefore, IDDM patients must take multiple injections every day of their lives.

compliance

This can discourage (?) in some patients.

NPH (neutral protamine Hagedorn) insulin

The modified insulin preparations include (?), which is regular insulin attached to a large protein designed to delay absorption, and the Lente series, which is attached to zinc.

Lente and Ultralente

Two preparations of Lente insulin are available by themselves, (?) .

Semilente insulin

A third, (?) , is available only in a combination product with other insulins.

lifelong replacement therapy

Insulin preparations are used for (?) in IDDM and for emergency treatment of hyperglycemia and hyperkalemia in nondiabetics.

hypoglycemia

(Recall that insulin also increases potassium uptake by cells and is therefore useful in lowering potassium levels.) These preparations’ primary side effect is unintended (?).

β2 adrenergic blockers

Because (?) can hide the effects of hypoglycemia, patients cannot recognize the signs of this condition until they cannot care for themselves.

glucagon

Also, beta blockers decrease the release of (?), so these patients’ hypoglycemia can be even worse.

allergic reactions

Insulin preparations derived from beef or pork, as well as the Lentes, can lead to (?).

natural human insulin preparations

The (?) do not have this effect.