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Insulins

Insulin lispro, aspart

lispro: reversal of sequence of lysine and proline on B chain. Eliminates hydrophobic interactions and weakens the hydrogen bonds that contribute to the stability of insulin dimers. The zinc hexamers are therefore less stable and dissociate more rapidly into monomers. Onset and clearance are therefore more rapid. Often used with a long acting insulin (e.g., isophane insulin, insulin zinc, &c.) Reduced frequency of hypoglycaemic episodes in patients with type 1 DM.

Soluble insulin

= short acting insulin

The only insulin appropriate for treating diabetic ketoacidosis or hyperosmolar non-ketotic hyperglycaemia. Also used in hyperkalaemia. Subcutaneously, onset 30–60 min, peak 2–4 h, duration 8 h. Intravenously, t½=5 min.

Hyperkalaemia

50 ml 50% glucose + 15 units soluble insulin over 30 min.

Intermediate & long-acting insulins

Onset 1–2 h, peak 4–12 h, duration 16–36 h.