Handbook of Insulin Therapies

Handbook of Insulin Therapies

Winston Crasto Janet Jarvis Melanie J. Davies Handbook of Insulin Therapies

Winston Crasto George Eliot Hospital NHS Trust, Nuneaton United Kingdom Janet Jarvis Leicester Diabetes Centre Leicester General Hospital Leicester United Kingdom Melanie J. Davies Leicester Diabetes Centre Leicester General Hospital Leicester United Kingdom ISBN 978-3-319-10938-1 ISBN 978-3-319-10939-8 (ebook) DOI 10.1007/978-3-319-10939-8 Library of Congress Control Number: 2016946349 Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Adis imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland

This book is dedicated to the people living with diabetes, their families, friends and carers and to those who work tirelessly to support, deliver and improve care for people with diabetes. Winston Crasto Janet Jarvis Melanie J. Davies

Contents 1 Introduction to Insulin Therapies................. 1 1.1 Introduction............................... 1 1.2 Classification.............................. 1 1.3 The Global Burden of Diabetes.............. 4 1.4 The Human Insulin Molecule................ 5 1.4.1 Effect of Insulin on Metabolism......... 6 1.5 History of Insulin Therapy................... 8 1.5.1 The New Era of Insulin Therapies...... 10 1.5.2 Insulin Management: Combining Art with Science...................... 11 1.6 Summary.................................. 12 References.................................... 13 Further Reading................................ 14 2 Existing Insulin Therapies....................... 15 2.1 Introduction............................... 15 2.2 Animal Insulin............................. 16 2.3 Human Recombinant Insulin................. 19 2.3.1 U-500 Insulin......................... 20 2.3.2 Animal Versus Human Insulin.......... 20 2.4 Insulin Analogs............................ 23 2.4.1 Rapid-Acting Analogs................. 24 2.4.2 Long-Acting Insulin Analogs........... 25 2.4.3 Premixed Insulin...................... 44 2.5 Summary.................................. 49 References.................................... 50 3 Emerging Insulin Therapies...................... 55 3.1 Injectable Insulin Products................... 55 3.1.1 Ultra-Rapid-Acting Insulin............. 55 vii

viii Contents 3.1.2 Long-Acting Basal Insulin Peglispro..... 55 3.1.3 Glargine U300 Insulin................. 59 3.1.4 Fixed Ratio Combinations.............. 60 3.2 Non-injectable Insulin Products.............. 64 3.2.1 Inhaled Insulin....................... 64 3.2.2 Oral Insulin.......................... 65 3.2.3 Buccal Insulin........................ 70 3.3 Biosimilar Insulin........................... 71 3.4 Summary.................................. 76 References.................................... 76 Further Reading................................ 82 4 Insulin Management in Type 2 Diabetes........... 83 4.1 Introduction............................... 83 4.2 Insulin Therapy in Type 2 Diabetes............ 84 4.2.1 Factors Impacting on Insulin Initiation and Clinical Inertia........... 85 4.2.2 Patient Education..................... 86 4.2.3 Early Use of Insulin in Type 2 Diabetes..................... 88 4.3 Insulin Regimens........................... 88 4.3.1 Basal Insulin Regimen................. 93 4.3.2 Combination Therapy with Conventional Oral Glucose-Lowering Agents.............. 93 4.3.3 Combination Therapy with Newer Classes of Glucose-Lowering Agents.... 102 4.3.4 Basal-Plus Insulin Regimen............. 107 4.3.5 Twice-Daily Premixed Insulin Regimen... 111 4.3.6 Prandial-Only Insulin Regimen......... 113 4.3.7 Basal Bolus Insulin Regimen........... 118 4.4 Intensifying Insulin Therapy with Inadequately Controlled Type 2 Diabetes...... 123 4.5 Summary.................................. 124 References.................................... 126 Further Reading.................................131 5 Insulin Management in Type 1 Diabetes........... 133 5.1 Overview.................................. 133 5.2 The Benefits of Tight Glycemic Control in Type 1 Diabetes.......................... 134

Contents ix 5.2.1 Adherence to Insulin Therapy in Individuals with T1DM.............. 136 5.2.2 Role of Continuous Glucose Monitoring for Intensive Insulin Therapy....................... 136 5.2.3 Sensor-Augmented Insulin Pump Therapy........................ 137 5.3 Insulin Regimens in Type 1 Diabetes.......... 139 5.3.1 Conventional Insulin Regimen.......... 140 5.3.2 Multiple-Daily Injections or Basal Bolus Insulin Regimen........... 144 5.4 Continuous Subcutaneous Insulin Infusion or Insulin Pump Therapy............. 146 5.4.1 Determining Appropriateness and Indications of CSII Therapy......... 148 5.5 Technological Advances in Insulin Pump Therapy: Moving Close to the Artificial Pancreas.................... 149 5.5.1 Non-closed-Loop Systems (First Generation)..................... 154 5.5.2 Predictive Low-Glucose Management System.............................. 156 5.5.3 Closed-Loop Control Systems (Second Generation).................. 158 5.5.4 Third-Generation APD Systems......... 160 5.6 Summary.................................. 161 References.................................... 162 Further Reading............................... 167 6 Practical Aspects of Insulin Therapy.............. 169 6.1 Introduction............................... 169 6.2 Insulin Injection Practices in Diabetes......... 170 6.3 Insulin Initiation........................... 170 6.3.1 Verification.......................... 171 6.3.2 Storage.............................. 171 6.3.3 Injection Technique and Administration... 172 6.3.4 Common Problems Encountered with Insulin Injections................. 177 6.4 Insulin Delivery Devices..................... 181 6.4.1 Insulin Syringes....................... 181

x Contents 6.4.2 Insulin Pens.......................... 181 6.4.3 Insulin Needles....................... 185 6.5 Common Problems with Insulin Therapy....... 188 6.5.1 Weight Gain.......................... 188 6.5.2 Hypoglycemia with Insulin Therapy...... 188 6.6 Insulin Therapy in Special Groups............ 191 6.6.1 Insulin Therapy in Older Patients........ 191 6.6.2 Insulin Therapy and Pregnancy.......... 194 6.6.3 Insulin Therapy in Gestational Diabetes Mellitus..................... 195 6.6.4 Insulin Therapy in Chronic Kidney Disease....................... 196 6.6.5 Insulin Therapy and Long-Distance Travel............................... 197 6.6.6 Driving and Insulin-Treated Diabetes.... 199 6.6.7 Insulin Therapy During Prolonged Religious Fasting...................... 200 6.6.8 Insulin Therapy at End of Life.......... 202 6.7 Summary.................................. 202 References.................................... 203 Further Reading............................... 209

Author Biographies Winston Crasto, MBBS, MRCP, MD is a Consultant Physician in Diabetes and Endocrinology at the George Eliot Hospital NHS Trust, Nuneaton, UK and a Honorary Clinical lecturer at the University of Leicester. His specialist research interests are diabetic nephropathy, new therapies, and new types of insulin. He has a wide list of publications and is a lecturer and advisor to the MSc Diabetes program of study at the University of Leicester. He is Co-Principal Investigator for the GP Prompt study, an implementation strategy for reducing cardiac and renal complications in people with type 2 diabetes and microalbuminuria. Janet Jarvis, RN, BSc (Hons), MSc is a Nurse Research Fellow and Specialist Nurse at the Leicester Diabetes Centre at the University Hospitals of Leicester NHS Trust. She has specialized in diabetes for 15 years and has been involved in major trials in diabetes prevention and screening. Her specialist research areas are patient education, microalbuminuria, and disease prevention. She is an associate clinical teacher at the University of Leicester and played a pivotal role in developing the MSc degree program in diabetes. Melanie J. Davies, CBE, MB, ChB, MD, FRCP is an honorary Consultant Diabetologist at the University Hospitals of Leicester NHS Trust, Leicester, UK, and is Professor of Diabetes Medicine at the University of Leicester. She trained in Sheffield and completed her training in Cambridge, Ipswich, and Leicester. Her research is focused around the cause of xi

xii Author Biographies type 2 diabetes, screening and prevention of type 2 diabetes, self-management, structured education, insulin management (particularly in type 2 diabetes), and new antidiabetics, including incretin-based therapies. Professor Davies has over 25 years of clinical experience and has published over 300 articles in high-impact journals, as well as over 350 published abstracts and 10 book chapters. Professor Melanie Davies has been responsible for major advances in diabetes and received the Commander of the Most Excellent Order of the British Empire (CBE) award for services to diabetes research in 2016.