GM Vs animal insulin

Choices – The Evidence
Evidence from people with diabetes
A little bit of history
Facts
Action and duration times of animal and GM ‘human’ insulins
Hypoglycaemia and loss of warnings
‘Dead in Bed Syndrome’
The concerns of patients are justified
Availability of animal insulins in the UK
Changing your insulin
What to do if your consultant refuses to change your insulin
Availability of animal insulin if you admitted to hospital
Frequently asked questions
Allergic reactions to insulin

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Action and duration times of animal and GM ‘human’ insulins

Table 1 shows the different insulins according to their origin and their length of action.

Table 1

insulin

Rapid

Short

Intermediate

Long

Analogue

Apidra
Humalog
NovoRapid

 

 

Lantus
Levemir

Animal

 

Hypurin Bovine Neutral
Hypurin Porcine Neutral

Hypurin Bovine Isophane, Hypurin Porcine Isophane

Hypurin Bovine lente
Hypurin Bovine PZI

Human

 

Actrapid,
Humulin S,
Insuman Rapid

Humulin I,
Insuman basal,
Insulatard

 

Also available are pre-mixed insulins of rapid-acting or short-acting insulins with an intermediate-acting insulin. These are usually used where only two injections are day are required.
Table 2 shows the different pre-mixed insulins.

Insulin

Pre-mixed

Analogue

Humalog Mix 25 and Mix 50, NovoMix 30

Animal

Hypurin Porcine 30/70

Human

Humulin M3, Insuman Comb 15, 25 and 50,
Mixtard 30

Table 3 shows the relative activity curves of animal, ‘human’ and analogue insulins. It must be noted that these times are a rough guide of peak activity and duration as the action peaks and duration of action will vary in different people.
Table 3

Insulin type

Onset

Peak [hours]

Effective duration
[hours]

Maximum duration [hours]

ANIMAL

 

 

 

 

Regular [short]

0.5 – 2 hours

3 – 4

4- 6

6 – 8

NPH
[intermediate]

4- 6 hours

8 – 14

16 – 20

20- 24

‘HUMAN’

 

 

 

 

Regular
[short]

0.5 – 1 hour

2 – 3

3 – 6

6 – 10

NPH
[Intermediate]

2- 4 hours

4 – 10

10 – 16

14 – 18

ANALOGUES

 

 

 

 

Rapid

Immediate

Immediate to about 1 hour

Tails off from peak over 3- 4 hours

About 4 hours

Lantus
[long]

2 hours

None

24hours

 

Levemir
[long]

2 hours

None

14 or more hours

 

Note: Long-acting beef insulins [Bovine lente and Bovine PZI] are available but they are not included in this table as they are rarely used.

 

Key facts about insulins and their actions:

  • The manufacturers’ profiles of the speed of onset, peak of action and duration of action are only a rough guide and may vary. Insulins act differently in different people.
  • The speed of action of injected insulin varies at different injection sites. For example, if Hypurin Porcine Neutral is injected above the umbilicus [tummy button] its speed of action is much quicker, and similar to a rapid-acting analogue, than if it is injected below the tummy button.
  • The depth of the injection also affects the speed of action and it is important to have the correct sized needle for the amount of fat at injection sites.
Content

HbA1c Converter

This is just to remind you that the HbA1c measurements have changed. Well, they were supposed to change everywhere but predictably this doesn't appear to be the case. Some people and some articles are still using the old measurements so it is important that we are aware of both.

Here is a table showing the current DCCT measurements, the proposed new IFCC measurements, and the average blood glucose measurements you can expect to be associated with each particular level of HbA1c

HbA1c (DCCT) Current measurement (%)

HbA1c (IFCC) Measurement from June 2011 (mmol/mol)

Average blood glucose level for this HbA1c, mmol/L

6

42

7.0 (range 5.5-8.5)

7

53

8.6 (range 6.8-10.3)

8

64

10.2 (range 8.1-12.1)

9

75

11.8 (range 9.4-13.9)

10

86

13.4 (range 10.7-15.7)

11

97

14.9 (range 12.0-17.5)

12

108

16.5 (range 13.3-19.3)

13

119

18.6 (range 14.6-21.1)