Regular Human Insulin Research Articles

A Case Report of Bardet Biedl Syndrome in a Patient from Pakistan who Presented with Osmotic Symptoms associated with Diabetes Mellitus

Background: The primary features of Bardet Biedl syndrome (BBS) are characterized by retinal degeneration, central obesity, post-axial polydactyly, intellectual impairment, hypogonadism, and renal anomalies. The secondary clinical features are syndactyly, delay in the achievement of developmental milestones, diabetes insipidus, diabetes mellitus, congenital heart disease and liver involvement. It is diagnosed when a patient has either four primary or three primary and two secondary clinical features and the management depends upon those predominant features. Case presentation: A 12-year-old boy presented with polyuria, polydipsia and polyphagia. His developmental milestones were delayed and had syndromic features on physical exmination. Ultrasound of the abdomen and pelvis showed mild right-side hydronephrosis. His BMI was 28 and HbA1c was 18.3%, and values of LH and FSH were decreased. As a result, he was diagnosed with a case of BBS. He was commenced on insulin therapy with Insulin Regular (Human Insulin)and Insulin NPH (Human Insulin). Conclusion: Patients presenting with polyuria, polydipsia, polyphagia along with the presence of syndromic features, should be assessed for BBS as osmotic symptoms associated with diabetes mellitus can be initial clinical presentation of BBS. Its management depends upon the signs and symptoms of the patient. Various options including weight loss, exercise, oral hypoglycemic drugs, and insulin are available to treat diabetes mellitus in BBS. Some cases can have very high levels of HbA1c on initial presentation, which may require insulin without trying oral hypoglycemic drugs to treat diabetes mellitus in BBS.

Evaluating insulindysregulation in horses: A two-step insulin-tolerance test using porcine zinc insulin

In insulin dysregulation, hyperinsulinemia (HI) can be accompanied by peripheral insulin resistance (IR) in horses, which can be diagnosed with an insulin-tolerance test (ITT). The administration of 0.1 IU/kg body weight of recombinant regular human insulin (RHI) should elicit a 50 % reduction of the initial blood glucose concentration at 30 min after insulin administration in insulin sensitive horses. Compared to RHI, porcine zinc insulin (PZI) is veterinary-approved and therefore easier accessible for many practitioners. The aim of this study was to compare the insulin and glucose dynamics during a standard ITT with RHI to an ITT performed with PZI. Twelve Icelandic horses were subjected to an ITT with RHI (ITT-RHI) and with PZI (ITT-PZI) at same dosages in a randomised crossover design. The insulin and glucose dynamics that resulted from these tests were compared, and the consistency of classification into insulin-sensitive and IR categories was evaluated. No complications were observed with the use of either RHI or PZI in ITT. A good correlation of the test results was observed (r = 0.88; P < 0.001). The blood glucose concentrations and the percentage reduction in glucose concentration did not differ significantly between the two tests (P = 0.053), but four out of twelve horses were classified as IR in the ITT-RHI whereas with the ITT-PZI seven out of twelve horses were classified as IR with the 50 % glucose reduction from baseline. Based on the Youden index, when using the ITT-PZI, an adjusted cut-off value for blood glucose reduction of 40 % at 30 min resulted in better test performance. With consideration for the seemingly weaker effect of PZI and the adjusted cut-off value, PZI can be an appropriate substitute to RHI in an ITT.

Prandial Insulins: A Person-Centered Choice.

Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management. Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.

Continuous improvement of quality of care in pediatric diabetes: the ISPED CARD clinical registry

Abstract Aim In Italy, the ISPED CARD initiative was launched to measure and improve quality of care in children and adolescents with type 1 diabetes. Methods Process and outcome indicators and the related information derived from electronic medical records were identified. A network of pediatric diabetes centers was created on a voluntary basis. Results Overall, 20 centers provided data on 3284 patients aged &lt; = 18 years. HbA1c was monitored ≥ 2/year in 81.2% of the cases. BMI was monitored ≥ 1/year in 99.0%, lipid profile in 45.3%, and blood pressure in 91.7%. Pubertal status, albuminuria, eye examination, and screening of celiac disease and thyroiditis were underreported. From 2017 to 2021, average HbA1c levels decreased from 7.8 ± 1.2 to 7.6 ± 1.3%, while patients with LDL cholesterol &gt; 100 mg/dl increased from 18.9 to 36.7%. Prevalence of patients with elevated blood pressure and BMI/SDS values also increased. In 2021, 44.7% of patients were treated with the newest basal insulins, while use of regular human insulin had dropped to 7.7%. Use of insulin pump remained stable (37.9%). Conclusions This report documents the feasibility of the ISPED CARD initiative and shows lights and shadows in the care provided. Improving care, increasing number of centers, and ameliorating data recording represent future challenges.

Patterns and Outcomes of Polypharmacy and Effect of Potentially Inappropriate Medications in Elderly Patients undergoing Orthopaedic Surgeries: A Retrospective Observational Study

Introduction: Prescription of Potentially Inappropriate Medication (PIM) among elderly patients is becoming a global concern. There has been an increase in the number of elderly patients coming for operative procedures, especially in orthopaedic surgery, due to the association of advanced age with chronic musculoskeletal conditions, such as osteoarthritis, and an increased incidence of fragility fractures. Aim: To determine the prevalence of polypharmacy and PIMs among elderly patients undergoing orthopaedic surgery. Materials and Methods: A retrospective observational study was conducted from February 2022 to April 2022 in the Orthopaedic Department of Anaesthesiology, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India. Hospital records of 130 patients aged 65 years and above, who underwent orthopaedic surgeries from January 2016 to December 2021, were included. The prescriptions during the perioperative period were analysed for polypharmacy, defined as the use of five or more drugs. The American Geriatric Society (AGS) 2019 Beers criteria were used to identify PIMs, drug interactions, and drugsyndrome interactions. Chi-square tests were performed on clinically significant variables to assess their effect on hospital stay, with a p-value of &lt;0.05 considered significant. Results: Polypharmacy was highest on postoperative day 1, with 119 patients (91.5%) experiencing it. The study observed a high prevalence of PIMs, with 106 patients (81.53%) affected. The most commonly used PIMs were Pantoprazole, followed by Piroxicam, Regular human Insulin, and Glimepride. A significant association was observed between hospital stay ≥10 days, postoperative Intensive Care Unit (ICU) stay, and preoperative polypharmacy (p-value=0.002). Conclusion: Polypharmacy and PIMs in patients above 65 years of age admitted for surgeries remain major concerns. Further exploration of current pharmacologic practices in the perioperative period and interventions, such as physician education programs regarding PIMs, are needed.

Expected Basal Insulin Requirement during CSII therapy by Age Group, Sex and BMI, based on 25,718 Young People with Type 1 Diabetes in the DPV Registry.

Background Since the introduction of insulin pumps into the therapy of paediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods We included all recent basal profiles from T1D patients between 1 and 25 years from the DPV 2021 data pool. We excluded night-time-only pump users, human regular insulin users, and daily basal rates < 0.05 U/kgBW/d and >1.0 U/kgBW/d. Results In the analysis of profiles from 25,718 young persons with T1D, differences in the daily pattern of basal rates were found between age groups. In addition, we saw significant (p<0.001) differences in total daily basal dose between genders in all age groups except adults. In addition, the shape of the expected basal-rate pattern differed by BMI, HbA1c and use of continuous glucose monitoring. Discussion This analysis demonstrates multiple factors influencing basal patterns and insulin requirement, including age group, gender, overweight, HbA1c, bolus frequency and sensor use. As circadian basal rates are still mandatory for initiating insulin pump therapy with or without automation, a multimodal approach is necessary to estimate optimal basal rates.

In Silico Investigation of the Clinical Translatability of Competitive Clearance Glucose-Responsive Insulins.

The glucose-responsive insulin (GRI) MK-2640 from Merck was a pioneer in its class to enter the clinical stage, having demonstrated promising responsiveness in in vitro and preclinical studies via a novel competitive clearance mechanism (CCM). The smaller pharmacokinetic response in humans motivates the development of new predictive, computational tools that can improve the design of therapeutics such as GRIs. Herein, we develop and use a new computational model, IM3PACT, based on the intersection of human and animal model glucoregulatory systems, to investigate the clinical translatability of CCM GRIs based on existing preclinical and clinical data of MK-2640 and regular human insulin (RHI). Simulated multi-glycemic clamps not only validated the earlier hypothesis of insufficient glucose-responsive clearance capacity in humans but also uncovered an equally important mismatch between the in vivo competitiveness profile and the physiological glycemic range, which was not observed in animals. Removing the inter-species gap increases the glucose-dependent GRI clearance from 13.0% to beyond 20% for humans and up to 33.3% when both factors were corrected. The intrinsic clearance rate, potency, and distribution volume did not apparently compromise the translation. The analysis also confirms a responsive pharmacokinetics local to the liver. By scanning a large design space for CCM GRIs, we found that the mannose receptor physiology in humans remains limiting even for the most optimally designed candidate. Overall, we show that this computational approach is able to extract quantitative and mechanistic information of value from a posteriori analysis of preclinical and clinical data to assist future therapeutic discovery and development.

Integrated Care for Type 1 Diabetes: The West Bengal Model.

A structured dedicated health programme for Type 1 diabetes mellitus (T1DM) has been initiated in the state of West Bengal, India. The aim is to provide comprehensive healthcare to all children, adolescents and young adults living with T1DM, along with the provision of free supply of insulin, glucose measuring devices, blood glucose test strips, and other logistics. The strategic framework for programme implementation is to utilise the infrastructure and manpower of the already existing non-communicable disease (NCD) clinic under National Health Mission. Establishing dedicated T1DM clinics in each district hospital by utilising existing healthcare delivery systems, intensive training and hand-holding of named human resources; providing comprehensive healthcare service and structured diabetes education to all T1DM patients; and building an electronic registry of patients are important components of the programme. T1DM clinics run once a week on the same day throughout the state. All T1DM patients are treated with the correct dose of insulin, both human regular insulin and glargine insulin. Patients are routinely monitored monthly to ensure good glycaemic control and prevent complications of the disease. Routine anthropometric examination and required laboratory investigations are conducted in the set-up of the already existing NCD clinic. Ongoing monitoring and evaluation of the T1DM programme are being conducted in terms of glycated haemoglobin (HbA1c) values, growth and development, complication rates, psychological well-being, quality of life, and direct and indirect expenditure incurred by families. Through this programme, any bottlenecks or gaps in service delivery will be identified and corrective measures will be adopted to ensure better health outcomes for those living with T1DM.

Insulin Requirements for Patients With COVID-19 Presenting With Diabetic Ketoacidosis.

Introduction Recent literature has shown that patients with COVID-19 and diabetic ketoacidosis may require more aggressive treatment than those with diabetic ketoacidosis alone. The primary objective of this study was to assess if intravenous regular human insulin infusion requirements in patients with diabetic ketoacidosis differed between patients with or without COVID-19. Methods This retrospective cohort study evaluated patients with diabetic ketoacidosis who received intravenous regular human insulin infusion during the COVID-19 pandemic. The primary outcome was the amount of intravenous regular human insulin infusion requirements needed during the diabetic ketoacidosis episode. Results Of the 77 patients that met inclusion criteria, 35 were positive for COVID-19 and 42 were negative. The primary outcome of total intravenous regular human insulin infusion requirements needed during the diabetic ketoacidosis episode was not statistically significant and resulted in 1.79±0.61 units/kg/day in the COVID-19 positive group and 1.81±0.6 units/kg/day in the negative group (p=1). Secondary outcomes that were statistically significant between groups were the amount of fluids received in the first 24 hours, potassium supplementation, phosphate supplementation, acute kidney injury, and hypokalemia. Conclusion There was no difference in intravenous regular human insulin infusion requirements in the setting of diabetic ketoacidosis (DKA) between COVID-19 positive and negative patients.

Role of New Insulin Analogs in the Management of Diabetes. A Clinical Review

This paper has reviewed different insulin analogs currently available in the market and pharma industry, their safety, efficacy and their roles in the diabetes management, comparing with human regular and NPH insulin. Traditional insulins (human regular and NPH insulins) do not have constant or smoother pharmacokinetic and pharmacodynamic profiles and are usually associated with erratic blood glucose profiles with hypoglycemia or hyperglycemia when compared with analog insulins. Similarly they do not match physiologic insulin profiles with basal bolus format. According to the medical literature, current insulin analogs are more efficacious and also it has been documented in research trials that recent insulin analogs are better and safer as compared to human regular and NPH insulin in terms of hypoglycemia and HbA1c reductions. Hence this paper has reviewed these insulins analogs (longer acting basal and rapid acting insulin analogs) for their safety and efficacy in terms of hypoglycemia and HbA1c control, for the management of both type-1 and type-2 diabetics in hospitals and clinics.

Audit of Safety Profile of Drugs Being Used to Treat Elderly Type II Diabetics: Observations from a Tertiary Care Hospital

ABSTRACT Background and Objective: The treatment of elderly people who have developed Type II diabetes is a major challenge. Therefore, this study was conducted to ascertain the drug prescription pattern and the adverse effects of drugs in a tertiary care hospital. Methodology: This was a cross-sectional, observational study. This study was carried out on 164 elderly patients with diabetes mellitus attending inpatient and outpatient of the institute. This study assesses the prescribing pattern of antidiabetic drugs and adverse drugs reaction to the drugs administered. Naranjo-Algorithm Probability of American depositary receipt (ADR) scale and WHO prescribing indicators were used for assessment. This study also identifies the drug utilization in diabetic patients associated with other co-morbidities. Results: Mean age of the patient was 72.5 in both inpatient and outpatient and male:female ratio among inpatient and outpatient 1.5:1 and 1:1.3, respectively. Metformin (biguanide) was the most commonly prescribed antidiabetic drug and was followed by glimepiride. Insulin was used in 65% of inpatient. Potential drug-drug interactions were noted in 71% of inpatient and 50.8% of outpatient. The incidence of ADR observed in this study was3.6%. Conclusion: Metformin and glimepiride were the most common drugs used in both inpatient and outpatient groups. Human regular insulin analog was commonly used in both patients group. The poor reporting in pharmacovigilance although mandated by the Indian Council of Medical Research is falling short; in preempting ADR. Effective pharmacovigilance will improve the quality of life in geriatric patients and would help the treating physicians to steer towards safe and effective healthcare.

321: OUTPATIENT DIABETES MANAGEMENT INFLUENCES GLYCEMIC CONTROL IN ICU PATIENTS DURING NUTRITION SUPPORT

Introduction: Appropriate glycemic control improves clinical outcomes during critical illness. We proposed that outpatient diabetes management would influence glycemic control in critically ill patients who require nutrition support (NS). Methods: Adult patients admitted to the trauma intensive care unit (ICU), who required NS, and exhibited hyperglycemia (blood glucose concentration (BG) > 150 mg/dL) or had diabetes mellitus (DM), were retrospectively evaluated. Outpatient DM pharmacotherapy was discontinued upon ICU admission. NS was initiated on day 3 + 3 following ICU admission. A serum hemoglobin (Hgb) A1c was obtained on day 3 + 3. The daily amount/mode of insulin therapy, carbohydrate intake, and point of care BGs for the first 7 days of NS were recorded. Patients were classified as controlled DM (Hgb A1c < 7%), uncontrolled DM (Hgb A1c >/= 7%), or as hyperglycemic patients without DM (Hgb A1c < 6.5%). Target BG was 70 to 150 mg/dL. Hypoglycemia was defined as a BG < 70 mg/dL. Regular human insulin sliding scale (SSI), subcutaneous NPH insulin with concurrent SSI, or continuous intravenous insulin infusion (CIVI) were used for glycemic control at the discretion of the NS service or primary service. Continuous data were given as mean + S.D. Chi-square analysis or ANOVA were used to compare groups. Results: Seventy-eight (14 controlled DM, 21 uncontrolled DM, and 43 non-DM) patients were studied. Maximum BG prior to initiation of NS was significantly different between groups (201 + 54 vs. 334 + 192 vs. 191 + 57 mg/dL, respectively, P < 0.001). The proportion of patients who required higher intensity insulin therapy (NPH + SSI or CIVI) was different among groups (50% vs. 86% vs. 15%, respectively, P < 0.001). The amount of insulin given per gram of carbohydrate intake was 0.45 + 0.50, 1.24 + 1.21, and 0.15 + 0.21 units/g, respectively, P < 0.001. Time within the target BG range was 11 + 6, 12 + 5, and 17 + 6 hrs/day, respectively, P < 0.001. Hypoglycemia occurred in 1 (7%), 5 (24%), and 3 (7%) patients, respectively (P = 0.120). Conclusions: Glycemic control during NS in the ICU is more challenging for those patients whose outpatient DM was uncontrolled compared to those with controlled DM and those with stress-induced hyperglycemia without DM.

Safety and efficacy of an oral insulin (Capsulin) in patients with early-stage type 2 diabetes: A dose-ranging phase 2b study.

To compare the pharmacodynamic properties of different doses of regular human insulin administered in capsule form twice daily in a randomised twelve-week open-label study. A total of 100 individuals (48 males, 52 females) with type 2 diabetes on metformin completed the study according to the protocol. The mean (SD) age was 48.5 (6.7) years, body mass index 25.7 (2.8) kg/m2 and HbA1c 8.10% (0.65%). Subjects randomized upon admission were assigned to one of three groups receiving formulated regular insulin at dose levels of 75 iu BD, 150 iu insulin BD, or 300 iu BD, all in enteric-coated capsules. The primary and secondary endpoints were change from baseline in HbA1c and fasting plasma glucose (FPG), respectively. The study met its primary clinical endpoint of a decrease in HbA1c of 0.5% or higher (least square mean decrease 0.52%; P= .004, median decrease 0.6%) in the dose group receiving 150 iu BD. In a subset of this population, with starting HbA1c values of 9% to 9.5%, an average decrease of 1.575% was observed. In the total population, least square mean decreases in HbA1c for the 75 and 300 iu BD groups were -0.11% and -0.42%, respectively. Mean change in FPG in the 150 iu BD dose group was -18.8 mg/dl (P= .017) and -14.8 and -2.7 mg/dl for the 75 and 300 iu BD groups, respectively. A decrease of 20% for triglycerides (-40 mg/dl) was observed in the 150 iu BD dose group. No significant increases in body weight were observed, and significant decreases in systolic blood pressure were seen in all groups. No serious treatment-related adverse events were recorded, and no incidence of hypoglycaemia was reported throughout the entire 12-week study period. Capsulin oral insulin administered twice per day at a dose of 150 iu per capsule is safe, with no confirmed treatment-linked hypoglycaemic events, and results in significant decreases from baseline in HbA1c, FPG and triglycerides.

Formulation Excipients and Their Role in Insulin Stability and Association State in Formulation.

While excipients are often overlooked as the "inactive" ingredients in pharmaceutical formulations, they often play a critical role in protein stability and absorption kinetics. Recent work has identified an ultrafast absorbing insulin formulation that is the result of excipient modifications. Specifically, the insulin monomer can be isolated by replacing zinc and the phenolic preservative metacresol with phenoxyethanol as an antimicrobial agent and an amphiphilic acrylamide copolymer excipient for stability. A greater understanding is needed of the interplay between excipients, insulin association state, and stability in order to optimize this formulation. Here, we formulated insulin with different preservatives and stabilizing excipient concentrations using both insulin lispro and regular human insulin and assessed the insulin association states using analytical ultracentrifugation as well as formulation stability. We determined that phenoxyethanol is required to eliminate hexamers and promote a high monomer content even in a zinc-free lispro formulation. There is also a concentration dependent relationship between the concentration of polyacrylamide-based copolymer excipient and insulin stability, where a concentration greater than 0.1g/mL copolymer is required for a mostly monomeric zinc-free lispro formulation to achieve stability exceeding that of Humalog in a stressed aging assay. Further, we determined that under the formulation conditions tested zinc-free regular human insulin remains primarily hexameric and is not at this time a promising candidate for rapid-acting formulations.

Prescribing errors for high-risk medications in a hospital

Medication errors are classified into prescription errors, dispensing errors and medication administration errors. Prescription errors are the most frequent and those that most adversely impact clinical outcomes. This study aimed to evaluate the quality and safety in the prescription of high-risk medication in a hospital. It was a cross-sectional study with a quantitative approach, carried out through the evaluation of drug prescriptions. The study followed the rules of the Ethics and Research Committee of the Federal University of Mato Grosso do Sul (CEP/UFMS) and was approved by means of opinion number 3,727,522. The high-risk medications most commonly associated with prescription errors were regular human insulin (40.8%), tramadol (21.53%) and 50% glucose solution (13.82%). The types of prescription errors that were most present were the use of incorrect dose expressions (n=529; 38.47%), use of contraindicated abbreviations (n=520; 37.82%) and the absence of time and speed of infusion (n=184; 13.38%). The results found can guide the construction of indicators related to high-risk medications prescription errors in the institution, in order to contribute to the optimization of internal processes and pharmaceutical interventions with the health team, in order to strengthen patient safety and use rational use of drugs in the hospital environment.

What is the value of faster acting prandial insulin? Focus on ultra rapid lispro.

Rapid‐acting insulins (RAIs) have been instrumental in the management of diabetes because of their improved postprandial glucose (PPG) control compared with regular human insulin. However, their absorption rate and time action following subcutaneous administration still falls short of the normal physiological response to meal consumption, increasing the risk of early postmeal hyperglycaemia and late postmeal hypoglycaemia. Increased demand for faster acting insulins, which can quickly control PPG excursions without increasing the risk of late hypoglycaemia, led to the development of ultra‐rapid–acting insulins, including ultra‐rapid lispro (URLi). URLi is a novel formulation of insulin lispro with accelerated absorption driven by two excipients: treprostinil, which increases local vasodilation, and citrate, which increases local vascular permeability. Clinical pharmacology studies consistently showed an earlier onset and shorter duration of action with URLi compared with Lispro. In a head‐to‐head study with Faster aspart, Aspart and Lispro, URLi was absorbed faster, provided earlier insulin action, and more closely matched physiological glucose response than the other insulins tested. URLi's unique pharmacokinetic properties increase its potential for improved PPG control beyond that achieved with RAIs. Indeed, in pivotal phase 3 trials, URLi was superior to Lispro for PPG control both at 1 and 2 hours after a meal in type 1 and type 2 diabetes with multiple daily injections, and in type 1 diabetes with continuous subcutaneous insulin infusion. This was achieved without increasing the risk of hypoglycaemia. In this review, we focus on the clinical and pharmacological evidence for URLi in the treatment of diabetes and discuss the potential benefits and considerations with URLi compared with RAIs.

Potentially inappropriate medication use in hospitalized elderly patients.

SUMMARYOBJECTIVE:This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria.METHODS:This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021.RESULTS:A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65–99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients’ prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%).CONCLUSION:The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Insulin analogs in the treatment of type II diabetes and future perspectives

The discovery of insulin by Banting and Best marked 100 years in 2021, and it was a life-saving treatment modality for type II diabetes mellitus (T2DM). Insulin is a natural hormone that has been used extensively in T2DM patients since its discovery. Currently, insulin analogs are also available in different formulations for T2DM management, overcoming the limitations of human insulin with better safety and side effect profiles. The insulin analogs like the rapid-acting analogs (Aspart, lispro, glulisine), the long-acting basal analogs (Glargine, detemir), the ultra-long acting (Insulin degludec), and the premixed insulin analog formulations (75% Neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been prepared through genetic engineering while preserving the basic insulin profile. A large number of studies have demonstrated their clinical effects on glycated hemoglobin test (HbA1c) in achieving glycemic control and thereby lowering the microvascular and macrovascular complications of T2DM with less traditional side effects of regular human insulin, mainly the risk of hypoglycemia, postprandial glycemic excursions, and weight gain. This review explores the currently available insulin analogs, their clinical implications, pharmacokinetics (PK), pharmacodynamics (PD), safety profile, and cost-effectiveness. We also discuss the future developments in the management of T2DM, especially the scientific advancements surrounding the novel insulin formulations, including the biosimilar insulin, and the innovative insulin delivery methods, such as oral and inhaled insulin.

Insulin aspart dimer dissociation in water

The insulin hormone is stored in the hexameric form and dissociates to the dimeric form and finally to the active monomeric form. When insulin secretion is impaired, thereby affecting various metabolic processes, as a final response, insulin analogs are subcutaneously injected before meals to facilitate glucose metabolism. Depending on the molecular details, analogs are rapid or slow acting based on the dissociation rate of the dimer to monomer. Insulin aspart is a recombinant human insulin analog, acting faster than regular human insulin. Despite its practical and elementary importance, the process of insulin aspart dimer dissociation is relatively unknown. Here, we combined molecular dynamics simulations and umbrella sampling to characterize the energetic and structural features of dissociation of the insulin aspart dimer. Like previous studies on human insulin (another well studied analog), insulin aspart can also display a wide spectrum of pathways for dimer dissociation from dissociation happening without a major change in the monomer structure to dissociation that is coupled with unfolding of a protein. Additionally, water plays a vital role in the dissociation of the insulin aspart by stabilizing the monomers in the dissociated state. Our study shows the molecular details, such as the variation in the structure and orientation and conformational changes along the minimum energy pathways in the process of dissociation of the insulin aspart dimer.

Use of Fast-Acting Insulin Analog for Preparing a Pharmaceutical Composition for Preventing, Treating, or Alleviating Diabetes

Diabetes is the most common disease in India that mostly affects adult people and reduces physical strength. Diabetes decreases insulin production in the human body that creates various physical disturbances such as damage to the heart, stroke, and others. In the past decades, medical treatments have followed long-acting insulin that reduces life expectancy rate and increases mortality rate in India. Along with that, in the present time, India's medical treatment has adopted the pharmaceutical composition of insulin to prevent diabetes and manage blood sugar in the human body. In this regard, this research study has selected some previous research papers to understand the importance of fast-acting insulin analogue to prevent diabetes. According to the secondary information, most of the medical treatment process in India has adopted fast-acting insulin analogue to prevent diabetes. Moreover, though fast-acting insulin analogue India reduces mortality rate and increases the life expectancy of adult people in India. Keyword : Metabolic disturbances, E-bacteria, amino acids, Regular Human Insulin (RHI).