DEFINITION

Nowadays all the insulins of the market are human insulins synthesized by genetic engineering (DNA recombinante). The insulins of bovine or porcine origin have disappeared practically of the market. All of them are much purified and only they contain proteins of insulin and not contaminations of another type. The nico factor that differentiates them is the action duration.

As the insulin only stays active in the blood during short periods (less than 15 minutes), diverse ways have been used to slow down his liberation and for it his action.

These systems are based on injectable preparations that slow down the liberation:

• By means of the union to other proteins (protamina).
• By means of a crystallization: Zinc is added and as the particles are bigger they are late in becoming soluble, by what it goes being liberated little by little.

Depending on every system of delay of his action the insulins can be rapid, intermediate and slow.

All the simple-minded insulins must inject subcutaneous route, and only not slowed down it is possible to administer route endovenosa.

ADMINISTRATION OF INSULINS

The usual route of administration of insulins is the subcutaneous one. Exceptionally (comma diabetic) appeals to the route IV.

The most current administration method is by means of special syringes graduated in units of insulin. They have reached acceptance the devices injectors in the shape of ballpoint, which facilitate the systems of several injections a day.

There exist also preloaded syringes capable of dosing exactly in increases of 2 UI and tiles for several applications (changing the needle).

The bombs of infusion that administer of form contina a basal insulin dose route SC, suplementada for extra dose before the meals. They are less widely used: they are tiles especially for very motivated patients. They are assigned by a certain increase of frequency of episodes of cetoacidosis, perhaps related to functioning mistakes.

The Spanish insulins for administration by syringe are standardized to the dose of 40 UI/ml in 10 ml roads. The cartridges for injectors and bombs of infusion have a concentration of 100 UI/ml and the volume is exact to the technical characteristics of the device.

RULES OF DOSAGE

The diffusion of the idea of that that the strict control of the glycemia can prepare the long-term complications of the diabetes (recently demonstrated by clinical essays) has created a tendency to use rules posológicas faced to fit more closely that the administration of insulin one could to the day changes of the glycemia.

This implies systems of several daily injections and glycemia control for the proper patient. The rules most used at present are:

• Two doses (before the breakfast and in the evening), of a miscellany of intermediate insulin and rapid insulin. The popularity of this diet explains the diffusion of prepared of two-phase insulins.
• A daily dose of insulin of long action (in the morning or in the night replaced sometimes with a dose of intermediate insulin on having gone to bed) and three injections of rapid insulin a day before the principal meals. The unsuitabilities of this diet diminish if type uses an injector fountain pen. In any case he needs motivated patients, but it has the advantage of allowing schedules of more flexible meals.

FINANCING FOR THE NATIONAL SYSTEM OF HEALTH

All the insulins are prescribibles for Social security.

As for the teams of application, the syringes and needles cannot be excused across drugstores but they are distributed free in centers of primary health care and ambulatory.

As a general rule the SS reimburses neither bombs of insulin nor teams of injection type fountain pen. Some health areas can do it occasionally, depending on his budgetary availability. The needles of the teams can be obtained free in centers of primary health care.

The teams of injection in the shape of preloaded syringe are considered to be pharmaceutical specialties and are prescribibles as such. The additional needles are distributed free in centers of primary health care.

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