iam Good With Insulatard but after fighure out Diabetes solution for Dr.Brenstien
i found this
AVOID INSULINS THAT
CONTAIN PROTAMINE
There are a confusing number of brands and types of insulins being
marketed today—andeven more areon theway. Insulins maybecat
egorized by how long they continue to affect blood sugars after injec
tion. There are most-rapid-acting, rapid-acting, intermediate-acting,
and long-acting insulins. Until recently, the rapid-acting insulins ap
peared clear, like water, and the other insulins appeared cloudy. The
cloudiness is caused by an additive that combines with the insulin to
form particles that slowly dissolve under the skin. The one remaining
intermediate-acting insulin, called NPH, is modified with an animal
protein caUed protamine. Insulins that contain protamine may stimu
late the immune system to make antibodies to insulin. These antibod
ies can temporarily bind to some of the insulin, renderingit inactive.
Then, unpredictably, they can release the insulin at a time when it's
not necessarily needed. This effect, although small,impairs the metic
ulous control of blood sugars that weseek.Protamine can present an
other, more serious problem ifyou ever require coronary angiography
for the study of arteries that feed your heart (acommon procedure
nowadays). Just before such a study, you would be given aninjection
of the anticoagulant heparin to prevent the formation of bloodclots.
When the procedure is over, protamine is injected into a blood vessel
to"turn off" the heparin. This can cause severe aUergic reactions, even
death, in a smaU percentage of people who have previously been
treated withinsulin containing protamine. Thus, even if an insulin is
marketed as a "human" insulin, its effects upon antibody production
may besignificant if it contains the animal protein protamine.
As you may guess, I strongly oppose the use ofinsulins containing
protamine. In theUnited States, theonly oneiscaUed NPH(elsewhere
it may be caUed isophane insulin). NPH or mixtures of NPH and
other insulins are widely avaUable and should beavoided. People who
require very smaU doses of insuUn, such as chUdren, may be best
treated with dUuted insulin (page 272) for accurate dose measure
ment. Unfortunately, there isnodUuting fluid made for glargine, one
of ourtwo remaining long-acting insulins.* I therefore amnowreluc
tantly obUged to prescribe three daUy doses of dUuted NPH on rare
occasions. More commonly, however, I'U dUute thelong-acting insulin
detemir with saline, as described onpage 272.
AUst of the insuUns that I consider possibly suitable appears on
page 269.
