Human recombinant DNA produced regular insulin has an onset of action between 30 and 60 min after and a peak effect 2-4 h after injection, with a usual duration of action of 6-8 h. Regular insulin was the shortest acting insulin available prior to the availability of the rapid-acting analogs. Its duration of action extends beyond the duration of digestion and absorption of most meals, thereby increasing the risk of hypoglycemia.
220.127.116.11.3.3 Intermediate-acting insulins Neutral Protamine Hagedorn ((NPH), lente, and insulin detemir) Neutral Protamine Hagedorn (NPH) and insulin zinc (lente) are different types of intermediate-acting insulins. NPH is a suspension of medium-sized crystals, which include zinc and protamine. Lente is a suspension of large, zinc-containing crystals that have been precipitated in an acetate buffer. These crystals dissolve slowly after subcutaneous injection. NPH and lente have similar pharmacodynamic profiles, with an onset of action approximately 2 h, a peak effect 6-14 h, and duration of action up to 24 h following subcutaneous injection. Intermediate-acting insulins can provide basal and/or prandial insulin, depending on dose and time of administration.
Insulin detemir is an acylated insulin analog with threonine removed at position B30, and lysine at position B29 is acylated with a 14-carbon myristoyl fatty acid acylation, resulting in delayed action due to increased binding to albumin. It has a longer duration of action (20 h) than NPH or lente insulins, and less intradose pharmacokinetic variability.
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