INSULIN DVUHFAZNY [CHELOVECHESKY GENNO- INZHENERNY] (Insulin biphasic [biosynthetic human])

     Description : Insulin-like hormone beta cells of pancreatic islets rights LM special rust laboratory strains of Escherichia coli, in which the gene is integrated human insulin gene. 1 ml of sterile transparent aqueous suspensions or injectable human insulin containing 40 or 100 ED insulin. The solution is pH 7,0-7,8.

     Pharmacology : The drugs-hypoglycemic effect.

Regulates blood glucose level, exchange and deposit carbohydrates, proteins, lipids in organah- target : liver, skeletal muscles, fat, the properties Anabolika. Making contact with the membrane receptor-tetramerom consisting of four DNA, two of which (alpha) located ekstramembranno responsible for the binding of hormones, and the other two (Beta) loaded in tsitoplazmaticheskuyu membranes and are carriers tirozinproteinkinaznoy activity is the insulin-receptor complex, subject autofosforilirovaniyu . In intact cells of the complex fosforiliruet serinovye and treoninovye ends proteinkinaz (C AMF- dependent), which leads to secondary broker-fosfatidil inozitolglikana and starts Tiofat, activates the enzyme activity in patients target. In muscle and other tissues (with the exception of the brain) to the intracellular transport of glucose and amino acids stimulate synthetic processes and inhibits protein catabolised. Has accumulation of glucose in the liver as glycogen and suppresses glyukoneogenez (glikogenoliz).

Absolute bioavailability after S / to the introduction (healthy individuals and patients with diabetes mellitus insulinzavisimym) in the dose of 0,1-0,2 ED / kg of 55-77%, Cmax achieved through 30-90 minutes. The volume of distribution-0,26-0,36 l / kg. T1 / 2 S / 1-1,5-introduction to the hour, as in / in a dose dependent on : the dose of 0.1 U / kg 26 minutes, a dose of 0.2 U / kg, 52 min . The degradation occurs in the liver caused by glyutationinsulintransgidrogenazy (insulinazy), which hydrolyzation disulfidnye connection between A and B chains, making them accessible to proteolytic enzymes; 35-40% of exogenous insulin excreted in feces, about 60% of urine.

     Application : Ketoatsidoz, diabetic, and molochnokislaya giperosmolyarnaya coma, insulinzavisimy diabetes mellitus (type 1), incl. when interkurrentnyh condition (infection, trauma, operative intervention, increased chronic illness), diabetic nephropathy and / or violations of liver function, pregnancy and childbirth, insulinnezavisimy diabetes mellitus (type 2) in the resistance of oral antidiabetics, dystrophic skin (trophic ulcers, carbuncles, abrasions), expressed astenizatsiya patient with severe leaking pathology (disease, burn disease, injury, Frostbite), a long process of infection (tuberculosis medicine).

     Contraindications : Giperchuvstvitelnost, hypoglycemia, liver disease and / or kidney (possible accumulation), breast-feeding (there is a high risk of insulin excretion in breast milk).

     Side Effects : Gipoglikemiya, postglikemicheskaya hyperglycemia (Somogyi phenomenon), swelling, visually impaired insulinrezistentnost (daily needs of more than 200 ED), allergic reactions : skin itch with nausea, sometimes accompanied by dispnoe and hypotension, anaphylactic shock; Local reaction : redness, swelling and soreness of the skin and subcutaneous tissue (being alone in the next few days, weeks), postinektsionnaya lipodistrofiya (zhiroobrazovaniya increase in injection-site gipertroficheskaya form, or atrophy fat-atroficheskaya form), with the intake of insulin, a pain when changing atmospheric pressure.

     Networking : The effect of oral antidiabetics increase means alcohol, Androgens, anabolic steroids, dizopiramid, guanetidin, MAO inhibitors, musk (in high doses) and others NPVS, beta adrenoblokatory (mask symptoms of hypoglycemia, tachycardia, increased AD, etc.) lower-AKTG, glucocorticoids, amphetamines, Baclofen, estrogen, oral contraceptives, thyroid hormones, and others tiazidnye Diuretics, triamterene, simpatomimetiki, Glucagon, phenytoin. The concentration in the blood increase (speed suction) nikotinsoderzhaschie drugs and smoking.

     Overdosing : Symptoms : hypoglycemia varying degrees, until hypoglycemic coma.

Treatment : with a light hypoglycemia glucose orally, in the heavy-w / struyno (50 ml 40% solution) simultaneously with the glyukagona or contests.

     Dosing and Administration : P / as Hospitalized whose hyperglycemia and glyukozuriya not eliminated diet during 2-3 days, the rate of ED 0,5-1 / kg, and then adjust the dose according to the university and glyukozuricheskim Profile; For pregnant women in the first 20 weeks of insulin dose was 0 6 ED / kg. Multiplicity of it may be different (usually used to select doses 3-5-fold), while the total dose is divided into several parts (depending on the number of meals) in proportion to the energy value : Breakfast-25 parts, the second of the 15-breakfast, lunch 30-part, 10-part lunch, dinner-20 parts. Injections to 15 minutes before eating. In the future, perhaps twice introduction (most convenient for patients).

     Precautions : Development of hypoglycemia to overdose, diet, exercise, fatty infiltration of the liver, kidney organic defeat. To prevent postinektsionnoy lipodistrofii to change places injections, the treatment is the introduction of insulin (6-10 ED), mixed with 0,5-1,5% 0,25-0,5 ml solution novocaine, in the transition zone lipodistrofii closer to the healthy cloth, to a depth of 1/2-3/4 fat layer thickness. In developing resistance to be transferred to the patient monopikovye and highly monocomponent insulin temporarily appoint glucocorticoids and antipruritic drugs. Allergizatsiya patient requires hospitalization, identification of drugs, the allergen, the appointment of adequate treatment and replacement of insulin.

     Special instructions : Reducing the number of daily injections is combining insulinov varying duration.

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