Insulin, glucagon, and hypoglycemic drugs

Abstract

This chapter discusses adverse effects of insulin, glucagon, and hypoglycemic drugs. Severe hypoglycemia with bilateral cortical blindness and cerebral infarction has been reported in patient whose blood glucose control had never been tight. Apneic periods necessitated mechanical ventilation. The warning symptoms occur at lower blood glucose concentrations and the reaction of hormones under the control of the hypothalamus is delayed, suggesting less well functioning hypothalamic glucoreceptors. Immediate local reactions and general urticaria develops after the institution of human regular insulin and human neutral protamine Hagedorn (NPH) insulin. Insulin-induced lipoatrophy has been reported in a patient who had never used insulins other than human insulin. Lispro insulin, an analog in which the 28th and 29th amino acid of the B chain are interchanged, does not differ in antigenicity compared with recombinant human insulin. An insulin analog, in which proline on the B28 site is substituted with arginine, is faster absorbed and gives less hyperinsulinemia than regular short-acting insulin.