World Diabetes Day: The promise of Insulin Therapy for Diabetes Mellitus

Insulin as we know it today is quite different from when it was discovered.

By Dr. Mala Dharmalingam,

In the last century, advances in the field of insulin therapy have brought us closer to the goal of optimal glycaemic control along with a reduction in diabetes-related complications. However, despite these advances, there are several shortcomings in that the treatment needs to be more flexible, iatrogenic hypoglycemia (drop in sugar level below healthy range) needs to be reduced, and the quality of life of patients need to be addressed.

Ongoing innovations in insulin therapy including new insulin analogs and better insulin delivery systems aims to overcome these shortcomings, and usher in a new era of diabetes management. Insulin analogs are basically genetically modified insulin in the labs to deliver insulin quicker and in a more uniform and effective way.

Fast-acting insulin analogs: The amino acid substitutions in fast-acting insulin help in faster absorption of the insulin, The first such variety of insulin was developed in 1996 and is called insulin lispro. Insulin aspart is another fast-acting insulin. The time for onset of action of this insulin is 15 mins, while peak action is between 45–90 mins, and the duration is around 3–5 hrs. With its rapid onset and shorter duration of effectiveness it is advisable to administer insulin aspart along with long-acting insulin. The newer insulin fiasp works even faster than aspart

Patients with Type-2 Diabetes (T2D) usually need a combination of fast-acting insulin with every meal and slow-acting basal insulin. Most premixed insulin analogs have a rapid-acting analog (prandial requirements) as well as protaminated analog (basal requirements). Premixed insulin preparations are beneficial as they do away with the chances of self-mixing and also minimizes the number of injections to be taken by the patient.

Long-acting insulin analogs: Two new basal insulin analogs namely U300 insulin glargine and insulin degludec are what is known as long-acting insulin analogs. These come with a duration of action which lasts beyond 24 hours. This makes them longer acting analogs as opposed to some basal insulin products. Both of these products are available as pre-filled pens only. It is to prevent the patients from an insulin overdose. Longer-acting insulins are administered so that patients don’t forget to take insulin, and there is a consistent timing of injections to be able to get consistent basal insulin and to prevent hyperglycemia linked with wearing off of the end-of-dose.

Advances in insulin therapy

Insulin as we know it today is quite different from when it was discovered. The various forms of insulin available today include long-lasting, rapid-acting and premixed formulas. These can be administered using various tools like pumps, syringes, and pens. And these are not the end as innovations are ongoing. Just some time ago insulin pens were being hailed as comfortable and portable, but now they have an added feature of being able to remember the time of your last dose, a very helpful innovation for working patients who tend to forget to take their next dose. Smart insulin pens have similar features as seen in insulin pumps but they are less expensive and are convenient as they do not need to be attached to the patient’s body. Some of these can also be connected to smartphones and smartwatches and can keep note of the amount of insulin to be administered with each dose, and tell the patient about the expiry date of the insulin.

(The author is Professor, MS Ramaiah Medical College & Hospital, Director, BEDRC. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)

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