"Insulin/Insulin Analogues" Medication Knowledge of Type 2 Diabetes Medication Manual

Edited by Yimaitong, please do not reprint without authorization
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Introduction: How much do you know about dozens of antidiabetic drugs for type 2 diabetes? Endocrinologists deal with diabetes and hypoglycemic drugs almost every day, but it is not enough to know the categories of drugs and their effects.
The trend of refined diabetes management requires doctors to master more
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➤What is the usual dosage range of "fast-acting insulin"? ➤What are the possible interactions between "insulin" and other drugs? How to deal with it? ➤Except for hypoglycemia, what adverse effects of "insulin" should we pay attention to? Based on the latest information, this article summarizes the medication information of insulin/insulin analogues for your reference
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Related reading: [1] "Classic Oral Hypoglycemic Drugs" in Type 2 Diabetes Medication Manual [2] "DPP-4i, SGLT-2i, GLP-1RA" 6 Principles of Type 2 Diabetes Medication in Type 2 Diabetes Medication Manual (Slidable) 1.
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Those who are not suitable for metformin can choose α-glycosidase inhibitors or insulin secretagogues
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2.
If metformin is used alone but the blood sugar still fails to reach the target, dual therapy should be carried out, plus insulin secretagogues, α-glycosidase inhibitors, thiazolidinediones (TZDs), dipeptidyl peptidase-IV (DPP-4) inhibitor, sodium-glucose cotransporter 2 (SGLT2) inhibitor, glucagon-like peptide-1 (GLP-1) receptor agonist, or insulin
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3.
Triple therapy, the above-mentioned hypoglycemic drugs with different mechanisms can be used in combination with three drugs
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4.
If the triple therapy is still not up to standard for blood sugar control, the treatment plan should be adjusted to multiple insulin therapy (basic insulin plus meals insulin or multiple premixed insulin daily)
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Insulin secretagogues should be discontinued when using multiple insulin treatments
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5.
Patients with type 2 diabetes with atherosclerotic cardiovascular disease or high-risk cardiovascular risk, regardless of whether their glycosylated hemoglobin (HbA1c) meets the standard, as long as there is no contraindication, should be added to metformin with atherosclerotic GLP-1RA or SGLT-2i with evidence of benefit in sclerosing cardiovascular disease
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6.
Patients with type 2 diabetes with chronic kidney disease or heart failure, regardless of whether their HbA1c meets the standard, as long as there is no contraindication, should add SGLT-2i on the basis of metformin; patients with type 2 diabetes with chronic kidney disease, such as Can not use SGLT-2i, consider using GLP-1RA
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 Fast-acting, short-acting insulin/insulin analogs 1.
Aspart (rapid-acting insulin analogs) takes effect 10-20 minutes after injection, and reaches the maximum plasma concentration in 1 to 3 hours, and the duration of action can reach 3 to 5 hours
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2.
Insulin lispro (rapid-acting insulin analogue) takes effect in about 15 minutes, the action time is 2 to 5 hours, and the peak concentration is reached in 30 to 70 minutes
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 3.
After subcutaneous injection of biosynthetic human insulin (short-acting human insulin), the maximum blood drug concentration is reached within 1.
5~2.
5h, and the half-life is about 2~5h.
There are differences in the maximum blood concentration of patients of different ages, and the drug should be administered to the individual The dose is adjusted
.

 Intermediate-acting insulin 1.
After subcutaneous injection of protamine biosynthesis human insulin (intermediate-acting human insulin), it takes effect 2.
5 to 3.
0 hours, and reaches the maximum plasma concentration in 5 to 7 hours, lasting 13 to 16 hours
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  Long-acting insulin analogues 1.
Insulin glargine (long-acting insulin analogue) After subcutaneous injection, it takes effect within 6 hours without an obvious peak, and lasts 36 hours
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Serum insulin concentration can reach a steady state 2~4 days after the first injection
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  2.
Insulin detemir (long-acting insulin analogue) After subcutaneous injection, it takes effect within 3 to 4 hours, and reaches the maximum serum concentration in 6 to 8 hours, lasting as long as 24 hours
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It is injected twice a day, and the steady-state serum concentration is reached after 2-3 injections
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Depending on the dose, the terminal half-life is 5~7 hours
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  3.
After subcutaneous injection of insulin degludec (long-acting insulin analogue), it takes 1 hour to take effect, with a half-life of 25 hours and a duration of up to 42 hours
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  Premixed insulin 1.
Insulin Aspart 30 (premixed human insulin) Insulin Aspart 30 takes effect 10-20 minutes after injection, and reaches the maximum solubility within 1 to 4 hours, and the duration of action can reach 14-24 hours
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  2.
Insulin Aspart 50 (premixed human insulin) Insulin Aspart 50 takes effect 15 minutes after injection, reaches the maximum blood concentration in 30 to 70 minutes, and the duration of action can reach 16 to 24 hours
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  3.
30/70 mixed recombinant human insulin (premixed human insulin) After subcutaneous injection of 30/70 mixed recombinant human insulin, it takes effect within 30 minutes and reaches the maximum blood concentration in 2 to 12 hours, and the duration is 14 to 24 hours
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  4.
50/50 Mixed Recombinant Human Insulin (Premixed Human Insulin) After subcutaneous injection of 50/50 Mixed Recombinant Human Insulin, it takes effect within 30 minutes, reaching the maximum blood concentration in 2 to 3 hours, and lasts for 10 to 24 hours
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  Reference materials: [1] Chinese Medical Association, Chinese Medical Association Clinical Pharmacy Branch, Chinese Medical Association Journal, etc.
Guidelines for rational use of type 2 diabetes at the grassroots level[J].
Chinese Journal of General Practitioners, 2021, 20(6): 615 -630.
DOI: 10.
3760/cma.
j.
cn114798-20210318-00257.
[2] Liu Jian, Li Yue.
Prescriptions for the treatment of endocrine system diseases[M].
People's Medical Publishing House.
Beijing, 2019.