What's "New" with Insulin?

Innovation is moving faster than ever. However developing new medicines is a complex and challenging process. But each discovery in diabetes research brings hope to the more than 30 million Americans who battle the disease.  Each year, new medications are introduced with the hope of the improvement of diabetes management and as well as to offer more affordable products. 

Several new insulin products have been launched recently, including high-strength, fixed combination and biosimilars insulins. It is important to be aware of the differences between these products. Concentratedinsulins work through the same mechanisms as other insulin products. They vary from each other in concentrations and pharmacokinetic/pharmacodynamics profiles but are each similar to their U-100 concentration counterparts. Biosimilarsare almost identical copy of the original product. Combination insulinswhich are Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonist

Type 1 diabetes is caused by a loss or malfunction of the insulin producing cells, called pancreatic beta cells. Damage to beta cells results in an absence or insufficient production of insulin produced by the body. Type 1 diabetes is managed through use of a variety of insulins. Since insulin is necessary to sustain life, the missing insulin has to be replaced. The replacement insulin is administered by injection using a syringe or an insulin pump, which delivers the insulin under the skin. People with T1D must work closely with their medical team to find the right insulin treatment for their condition. 

Type 2 diabetes is characterized by insulin resistance and relative insulin insufficiency. Over time individuals with type 2 diabetes may require the addition of insulin to their therapeutic regimen due to progressive β-cell failure.  Also improved recognition and management of the cardiovascular risk factors associated with type 2 diabetes have allowed more patients to survive longer, eventually requiring insulin as part of their treatment. Unfortunately, the growing rates of obesity among this population have also increased insulin requirements and insulin resistance. The availability of various concentrated insulin products represents a much more comfortable means of delivering large doses than through the multiple injections that would be required for large doses of U-100 insulin. Also, incorporation of these new products into pen delivery systems eliminates previous medication errors related to volume calculations.

As patients continue to gain weight and experience progressive β-cell failure over their lifespan, their demand for insulin increases. The concentration of traditional insulin products is 100 units/mL (U-100). However, the growing number of patients who require very high insulin doses created a market for more concentrated insulin products.

The first concentrated insulin to be marketed in the United States was U-500 regular insulin. As with U-100 insulin, higher doses of U-500 insulin result in prolonged duration of action. Several new insulin products have also been launched recently, including high-strength, fixed combination and biosimilars insulins..

Review of the characteristics of insulins:

  1. Source. All insulin is made in a laboratory. It is similar to the insulin produced by your pancreas.
  2. Strength. All insulin used in the U.S. is U-100 insulin. This means that there are 100unitsof insulin in each milliliter. You must use a U-100 syringe with U-100 insulin. With the newer concentrated insulin you must use the correct pen use a U-500 syringe 
  3. Actiontime. There are four (4) types of insulin, each with a different action time. The four types of insulin are rapid-regular-, intermediate-, and long-acting insulin.
    1.  onset- how long it takes from the time of injection until the insulin starts to work
    2. peak- the period of time the insulin is most effective at lowering blood sugar
    3. duration- how long the insulin lasts in your body

Here is a summary of the most common insulins on the market as well as some of the newer insulins. More information can be found on the various products website. 

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With so many insulin products now available, it is essential that health care providers, diabetes educators, and pharmacists clearly inform patients and providers about the advantages and safety concerns with new products, the concentrated insulin and the ways in which they differ from traditional insulin products. Insulin stacking, especially when it results from an unanticipated prolonged duration of effect, may result in severe hypoglycemia.

Patients should be instructed to only use insulin in the way they have been trained because using it any other way may result in a dangerous overdose or underdose. Be sure to check with your physician or pharmacist if you have any questions or concerns about your medication.