Pharmacology for Dentistry

276 Section 8/ Drugs Acting on Endocrine System

In diabetes mellitus, there is either insulin
deficiency or insulin resistance in peripheral
tissues which lead to hyperglycemia and
glycosuria. Insulin corrects the various
abnormalities of carbohydrate metabolism by
its action on various tissues.

Pharmacokinetics

Insulin is not given orally. After IV or SC
injection, it circulates as free, monomer in blood
and has a short plasma half life. Insulin is
degraded mainly in liver, muscle and kidney.

Adverse Reactions

The most frequent and serious adverse

reaction is hypoglycemia. It can occur in any

diabetic patient due to heavy dose of insulin,

failure to eat or missing a meal, performing

extensive exercise or by consuming alcohol.

The hypoglycemia caused by insulin is

characterized by neuroglucopenic

symptoms that include confusion, dizziness,

behavioural changes, visual disturbances,

fatigue, muscle incoordination and may be

fall in blood pressure.

The other side effects include insulin

allergy which consists of local itching,

swelling, redness at the site of injection.

Urticaria and anaphylactic reactions are rarely

seen. Other rare side effects include insulin

Table 8.2.1: Classification of insulin preparations.

I. Conventional preparations

Regular (soluble) insulin (HUMINSULIN-R) 40, 80 IU/ml; SC/IV

Insulin zinc suspension ‘prompt’ (Semilente) 40, 80 IU/ml; SC

Insulin zinc suspension (Lente insulin; HUMINSULIN-L) 40-80 IU/ml; SC

Isophane or Neutral Protamine Hagedorn (NPH) insulin 40 IU/ml; SC

(HUMINSULIN-N)

Globin zinc insulin 40 IU/ml; SC

Insulin zinc suspension ‘extended’ (Ultralente; HUMINSULIN-U) 40 IU/ml; SC

Protamine zinc insulin (PZI) 40 IU/ml; SC

II. Newer purified insulin preparations

i. Regular-ILETIN (Purified by gel filtration)

ii. Regular-ILETIN-II (Purified by gel filtration and

ion exchange chromatography)

iii. Single peak insulins (Purified by gel filtration and

then recrystallization)

Pork regular insulin (ACTRAPID) 40 U/ml

Pork lente insulin (LENTARD) 40 U/ml

Pork regular and isophane insulin (in a ratio of 30:70; RAPIMIX) 40 U/ml

iv. Monocomponent insulin (Purified by gel filtration and then by ion

exchange chromatography; ACTRAPID MC and MONOTRAD MC) 40 U/ml

III.Biosynthetic human insulins (by recombinant DNA technique)

Human soluble insulin (HUMAN ACTRAPHANE) 40 U/ml

Human regular insulin (HUMAN ACTRAPID) 40 & 100 U/ml

Human lente insulin (HUMAN MONOTRAD) 40 & 100 U/ml