Long-Acting Insulin - An Overview

Introduction:

Insulin is a hormone manufactured by the pancreas. It is a gland that is situated behind the stomach. Insulin aids the body in using glucose (sugar) for energy. In diabetic patients, the body does not manufacture sufficient insulin, or the insulin that is being produced is inefficiently functioning. Long-acting insulin supplies low levels of insulin throughout the day and is also known as basal insulin. A few people may take long-acting insulin along with other diabetic medications to regulate their blood glucose levels.

What Are the Types of Insulin?

Before learning about long-acting insulin, it is essential to know the types of insulin, which are as follows:

• Short-Acting Insulin: Short-acting insulin starts working about 30 minutes after its administration and peaks at about two to three hours after injection. Its efficacy lingers for about five to eight hours.

• Intermediate-Acting Insulin: This type of insulin starts working in about two to four hours following its administration and peaks at about four to 12 hours after injection. Its efficacy lingers for about 12 to 18 hours.

• Long-Acting Insulin: Long-acting insulin takes several hours to work, but its effect lingers for up to 24 hours or more. The use of longer-duration, long-acting insulins is on the rise, and even long-acting insulins whose effects last for a week are also on the rise.

• Combination Insulin or Pre-mixed or Fixed Combination Insulin: In this type, different types of insulin are combined into a single injection, and it starts to work within five to 60 minutes. The peaks may differ, and the duration of action may last anywhere from 10 to 24 hours.

What Are the Types of Long-Acting Insulin?

The following are the types of long-acting insulin:

• Insulin Glargine.

• Insulin Detemir.

• Insulin Degludec.

These long-acting insulins are used with various types of insulin pen, but all work similarly.

How Should Long-Acting Insulin Be Delivered?

Long-acting insulin is ineffective when taken as a pill since the stomach breaks it down during the process of digestion. Hence, in diabetic people, insulin should be injected into the fatty tissue underneath the skin, which will then progressively travel into the bloodstream. There are some different ways and sites that are safe to inject insulin into the body. Long-acting insulin can be delivered in the following ways, according to the National Institute of Diabetes and Digestive and Kidney Diseases:

• Pump: In this method, an electronic unit is used to deliver timed doses of long-acting insulin with the help of a catheter, which prevents the need for regular injections.

• Pen: Using a pen with a cartridge containing insulin, a premeasured dose of insulin can be set to be delivered. Disposable pens that encompass prefilled levels of insulin are also available.

• Needle and Syringe: In this method, a dose of insulin is drawn from a vial using a syringe, which is then injected into various sites in the body. Mixing different types of insulin in a single syringe should be avoided.

• Injection Port: A short tube in an injection port enters the tissue underneath the skin. Insulin can be delivered through this port by the individual using a pen or syringe. Only a skin puncture may be needed when the tube requires swapping.

In What Sites Can Long-Acting Insulin Be Injected?

Long-acting insulin can be injected in the following sites:

• Under the skin of the abdomen.

• Thighs.

• Upper arms.

Injecting into the abdomen is the fastest insulin delivery route into the blood. On the other hand, the process might take some time if the injection is administered in the upper arms or thighs. The exact site of injection should be changed frequently. Injections that are injected at the same spot can result in the formation of lumps underneath the skin, which will make it difficult for the insulin to exert its action.

What Is the Ideal Dosage of Long-Acting Insulin?

The ideal dosage differs with each type of long-acting insulin. It can also differ based on the type of diabetes and history of insulin use. When an individual begins to use new insulin, the doctor will suggest they start using a smaller percentage of the target dose. This enables the body to get accustomed to the extra insulin. The dosage will then be gradually increased.

Changes in the insulin regimen may be required if there are alterations in the individual’s diet or physical activity or if the individual falls sick. Factors that affect blood sugar might result in an alteration in insulin dosage and can also cause negative reactions to the hormone, like weight gain. Landing upon the suitable long-acting insulin regimen is a trial and error process that needs careful vigilance of blood sugar levels.

How Does Each Long-Acting Insulin Work?

Each long-acting insulin works in the following ways:

• Detemir: This type works for about 18 to 24 hours and is injected once or twice daily at the same time every day.

• Glargine: Injection Glargine forms clusters in the fatty tissue underneath the skin. These clusters disintegrate gradually and slowly release small quantities of insulin into the bloodstream. Its duration of action is up to 24 hours. This long-acting insulin is taken once daily at the same time every day.

• Degludec: This type acts by retarding the rate of absorption of insulin molecules in the bloodstream. Its duration of action is up to 42 hours and should be taken once daily. However, this long-acting insulin does not need to be taken at the same time every day.

Should Long-Acting Insulin Be Taken at Night Before Bedtime?

There is no hard and fast rule about the best time to take long-acting insulin. It can differ with each individual. Injecting the insulin at the same time every day is more crucial than the exact time of the day of injection. Some experts believe that when insulin Glargine is injected during lunch or dinner time, instead of bedtime, the risk of elevated blood sugar in Type 1 diabetic individuals may be lowered. However, one must discuss with their physician about when it would be ideal to take the long-acting insulin.

Ultra-long-acting insulin products like insulin Degludec and insulin Glargine U300 start working within six hours of injection, and their action can extend up to 36 to 42 hours.

What Are the Side Effects Associated With Long-Acting Insulin?

One of the side effects of long-acting insulin can be hypoglycemia (reduced blood sugar levels). Symptoms of hypoglycemia include:

• Chills.

• Dizziness.

• Blurred vision.

• Headache.

• Weakness.

• Fainting.

Other possible side effects include redness, pain, or swelling at the site of injection. At times, insulin is given along with thiazolidinediones, which can elevate the risk of fluid retention and heart failure. Those who take Degludec should take certain precautions due to its long-term effect on the body. In such cases, the physician might increase the dosage gradually at least three to four days apart. Also, a long time may be taken to eliminate the drug from the body.

How Should One Store Insulin and Supplies Appropriately?

The following measures should be taken:

• Insulin bottles and pens should be kept in the refrigerator at around 36 to 46 degrees Fahrenheit until opened.

• It should not be used after the expiration date.

• Unused insulin should be discarded according to the manufacturer’s guidelines.

• When in use, it should be kept at room temperature (not higher than 86 degrees Fahrenheit) or in the refrigerator.

• According to the local guidelines, needles and syringes should be discarded into sharps containers. A sharps container will be easily available at a drugstore.

• It should be protected against very low or high temperatures to make sure that the insulin works properly. An insulated bag can be used to carry the insulin.

Conclusion:

Long-acting insulins are designed to extend the needed effect for a long time. Hence, they can take a longer time than other insulins to initiate their action. Long-acting insulin usually does not ‘peak’, meaning they maintain a steady insulin level all through the day. Long-acting insulin can be used by diabetic individuals once or twice every day, depending on the particular type of insulin. It is often used in the treatment of type 1 and type 2 diabetes. Long-acting insulins are also referred to as basal or background insulins. One must consult their physician to identify the best type of insulin and formulate a dosing schedule that is convenient and effective for an individual.