FDA Insulin Booklet
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Protection of Insulin‑Like Growth Factor 1 on Experimental Peripheral Neuropathy in Diabetic Mice
MOLECULAR MEDICINE REPORTS 18: 4577-4586, 2018 Protection of insulin‑like growth factor 1 on experimental peripheral neuropathy in diabetic mice HUA WANG, HAO ZHANG, FUMING CAO, JIAPING LU, JIN TANG, HUIZHI LI, YIYUN ZHANG, BO FENG and ZHAOSHENG TANG Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China Received December 24, 2017; Accepted July 19, 2018 DOI: 10.3892/mmr.2018.9435 Abstract. The present study investigated whether insulin-like the IGF-1-PPP group compared with the IGF-1 group; however, growth factor-1 (IGF-1) exerts a protective effect against no significant difference was observed in the expression neuropathy in diabetic mice and its potential underlying levels of p-p38 following treatment with IGF-1. The results mechanisms. Mice were divided into four groups: Db/m of the present study demonstrated that IGF-1 may improve (control), db/db (diabetes), IGF-1-treated db/db and neuropathy in diabetic mice. This IGF-1-induced neurotrophic IGF-1-picropodophyllin (PPP)-treated db/db. Behavioral effect may be associated with the increased phosphorylation studies were conducted using the hot plate and von Frey levels of JNK and ERK, not p38; however, it was attenuated by methods at 6 weeks of age prior to treatment. The motor nerve administration of an IGF-1R antagonist. conduction velocity (NCV) of the sciatic nerve was measured using a neurophysiological method at 8 weeks of age. The Introduction alterations in the expression levels of IGF-1 receptor (IGF-1R), c-Jun N-terminal kinase (JNK), extracellular signal-regulated An epidemiological survey demonstrated that the prevalence kinase (ERK), p38 and effect of IGF-1 on the sciatic nerve of diabetes in adults ≥18 years old in China was ≤11.6% (1). -
Combining a Glucagon-Like Peptide-1 Receptor Agonist with Basal Insulin: the Why and How
Combining a Glucagon-like Peptide-1 Receptor Agonist with Basal Insulin: The Why and How Case Study Mary is a 61 year-old female diagnosed with type 2 diabetes mellitus (T2DM) 8 years ago. She was initially managed with the combination of lifestyle modification and metformin. Since that time she was treated with a sulfonylurea, but it was discontinued due to symptomatic hypoglycemia. She was also treated with pioglitazone, but significant fluid retention led to it discontinuation. A year-and-a- half ago, basal insulin was added to her lifestyle and metformin management. She now administers 52 units (0.62 units/kg) once daily at bedtime. Since starting basal insulin, she has experienced 3 episodes of mild hypoglycemia. Since her diagnosis, Mary’s HbA1c has never been <7.0%; her current HbA1c is 7.9%. Over the past month, her fasting plasma glucose (FPG) has ranged from 103 mg/dL to 136 mg/dL and her postprandial glucose (PPG) from 164 mg/dL to 213 mg/dL. She has gained 2.6 kg since starting basal insulin and her body mass index is now 31 kg/m2. Her blood pressure is 134/82 mmHg. She experiences occasional tingling in her feet. Eye examination reveals grade 1 retinopathy. Current medications are: metformin 1000mg twice daily, basal insulin 52 units once daily at bedtime, and hydrochlorothiazide 25 mg once daily. Her family physician notes that Mary’s FPG is reasonably well-controlled, yet her HbA1c and PPG remain elevated. He is also concerned about her episodes of hypoglycemia and weight gain and the evidence indicating microvascular damage. -
Receptor Activity Modifying Proteins (Ramps) Interact with the VPAC2 Receptor and CRF1 Receptors and Modulate Their Function
British Journal of DOI:10.1111/j.1476-5381.2012.02202.x www.brjpharmacol.org BJP Pharmacology RESEARCH PAPER Correspondence David R Poyner, School of Life and Health Sciences, Aston University, Birmingham, Receptor activity modifying B4 7ET, UK. E-mail: [email protected] ---------------------------------------------------------------- proteins (RAMPs) interact Current address: *Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, 381 with the VPAC2 receptor Royal Parade, Parkville, Victoria 3052 Australia; †Discovery Sciences, AstraZeneca R&D, and CRF1 receptors and Mölndal, Sweden; ‡R&I iMED, AstraZeneca R&D, Mölndal, Sweden. modulate their function ---------------------------------------------------------------- Keywords D Wootten1*, H Lindmark2†, M Kadmiel3, H Willcockson3, KM Caron3, receptor activity-modifying proteins (RAMPs); RAMP1; J Barwell1, T Drmota2‡ and DR Poyner1 RAMP2; RAMP3; VPAC2 receptor; +/- CRF1 receptor; Ramp2 mice; 1 2 School of Life and Health Sciences, Aston University, Birmingham, UK, Department of Lead G-protein coupling; biased Generation, AstraZeneca R&D, Mölndal, Sweden, and 3Department of Cellular and Molecular agonism Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ---------------------------------------------------------------- Received 10 July 2012 Revised 15 August 2012 Accepted 28 August 2012 BACKGROUND AND PURPOSE Although it is established that the receptor activity modifying proteins (RAMPs) can interact with a number of GPCRs, little is known about the consequences of these interactions. Here the interaction of RAMPs with the glucagon-like peptide 1 receptor (GLP-1 receptor), the human vasoactive intestinal polypeptide/pituitary AC-activating peptide 2 receptor (VPAC2) and the type 1 corticotrophin releasing factor receptor (CRF1) has been examined. EXPERIMENTAL APPROACH GPCRs were co-transfected with RAMPs in HEK 293S and CHO-K1 cells. -
Performance of the Insulin-Only Ilet Bionic Pancreas and The
e118 Diabetes Care Volume 44, June 2021 Performance of the Insulin-Only Luz E. Castellanos,1 Courtney A. Balliro,1 Jordan S. Sherwood,1 Rabab Jafri,1 iLet Bionic Pancreas and the Mallory A. Hillard,1 Evelyn Greaux,1 Rajendranath Selagamsetty,2 Hui Zheng,3 Bihormonal iLet Using Firas H. El-Khatib,2 Edward R. Damiano,2,4 and Dasiglucagon in Adults With Type Steven J. Russell1 1 Diabetes in a Home-Use Setting Diabetes Care 2021;44:e118–e120 | https://doi.org/10.2337/dc20-1086 Reductions in blood glucose levels in with insulin lispro (Eli Lilly) or aspart (Table 1). The mean CGM glucose and people with diabetes are often achieved (Novo Nordisk), the bihormonal iLet for time in range (70–180 mg/dL) were 149 at the expense of increased hypoglyce- 7dayswithdasiglucagon(4mg/mL) ±13mg/dLand72±8%,respectively,in mia. A novel approach is to automati- and insulin lispro or aspart, or both, us- the insulin-only period, and 139 ± 11 cally deliver microdose glucagon when ing the same glucose target (110 mg/ mg/dL and 79 ± 9%, respectively, in the automation of insulin delivery alone is dL), in random order. There were no re- bihormonal period. The mean daily car- not sufficient to prevent hypoglycemia. strictions on diet or exercise. The prima- bohydrates consumed to prevent or The approach requires a bihormonal de- ry outcomes were prespecified iLet treat hypoglycemia were 16 ± 13 g and vice and a stable form of glucagon or operational thresholds. The key second- 18 ± 21 g in the insulin-only and bihor- glucagon analog. -
TRULICITY, INN-Dulaglutide
ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Trulicity 0.75 mg solution for injection in pre-filled pen Trulicity 1.5 mg solution for injection in pre-filled pen Trulicity 3 mg solution for injection in pre-filled pen Trulicity 4.5 mg solution for injection in pre-filled pen 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Trulicity 0.75 mg solution for injection in pre-filled pen Each pre-filled pen contains 0.75 mg of dulaglutide* in 0.5 ml solution. Trulicity 1.5 mg solution for injection in pre-filled pen Each pre-filled pen contains 1.5 mg of dulaglutide* in 0.5 ml solution. Trulicity 3 mg solution for injection in pre-filled pen Each pre-filled pen contains 3 mg of dulaglutide* in 0.5 ml solution. Trulicity 4.5 mg solution for injection in pre-filled pen Each pre-filled pen contains 4.5 mg of dulaglutide* in 0.5 ml solution. *produced in CHO cells by recombinant DNA technology. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Solution for injection. Clear, colourless solution. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Type 2 Diabetes Mellitus Trulicity is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise • as monotherapy when metformin is considered inappropriate due to intolerance or contraindications • in addition to other medicinal products for the treatment of diabetes. For study results with respect to combinations, effects on glycaemic control and cardiovascular events, and the populations studied, see sections 4.4, 4.5 and 5.1. -
Alteration in Phosphorylation of P20 Is Associated with Insulin Resistance Yu Wang,1 Aimin Xu,1 Jiming Ye,2 Edward W
Alteration in Phosphorylation of P20 Is Associated With Insulin Resistance Yu Wang,1 Aimin Xu,1 Jiming Ye,2 Edward W. Kraegen,2 Cynthia A. Tse,1 and Garth J.S. Cooper1,3 We have recently identified a small phosphoprotein, P20, insulin action, such as the activation of insulin receptors, as a common intracellular target for insulin and several postreceptor signal transduction, and the glucose trans- of its antagonists, including amylin, epinephrine, and cal- port effector system, have been implicated in this disease citonin gene-related peptide. These hormones elicit phos- (3,4). Defective insulin receptor kinase activity, reduced phorylation of P20 at its different sites, producing three insulin receptor substrate-1 tyrosine phosphorylation, and phosphorylated isoforms: S1 with an isoelectric point (pI) decreased phosphatidylinositol (PI)-3 kinase activity were value of 6.0, S2 with a pI value of 5.9, and S3 with a pI observed in both human type 2 diabetic patients as well as value of 5.6 (FEBS Letters 457:149–152 and 462:25–30, animal models, such as ob/ob mice (5,6). 1999). In the current study, we showed that P20 is one In addition to the intrinsic defects of the insulin receptor of the most abundant phosphoproteins in rat extensor digitorum longus (EDL) muscle. Insulin and amylin an- and postreceptor signaling components, other circulating tagonize each other’s actions in the phosphorylation of factors, such as tumor necrosis factor-␣, leptin, free fatty this protein in rat EDL muscle. Insulin inhibits amylin- acids, and amylin, may also contribute to the pathogenesis evoked phosphorylation of S2 and S3, whereas amylin of insulin resistance (7–11). -
Type 2 Diabetes Adult Outpatient Insulin Guidelines
Diabetes Coalition of California TYPE 2 DIABETES ADULT OUTPATIENT INSULIN GUIDELINES GENERAL RECOMMENDATIONS Start insulin if A1C and glucose levels are above goal despite optimal use of other diabetes 6,7,8 medications. (Consider insulin as initial therapy if A1C very high, such as > 10.0%) 6,7,8 Start with BASAL INSULIN for most patients 1,6 Consider the following goals ADA A1C Goals: A1C < 7.0 for most patients A1C > 7.0 (consider 7.0-7.9) for higher risk patients 1. History of severe hypoglycemia 2. Multiple co-morbid conditions 3. Long standing diabetes 4. Limited life expectancy 5. Advanced complications or 6. Difficult to control despite use of insulin ADA Glucose Goals*: Fasting and premeal glucose < 130 Peak post-meal glucose (1-2 hours after meal) < 180 Difference between premeal and post-meal glucose < 50 *for higher risk patients individualize glucose goals in order to avoid hypoglycemia BASAL INSULIN Intermediate-acting: NPH Note: NPH insulin has elevated risk of hypoglycemia so use with extra caution6,8,15,17,25,32 Long-acting: Glargine (Lantus®) Detemir (Levemir®) 6,7,8 Basal insulin is best starting insulin choice for most patients (if fasting glucose above goal). 6,7 8 Start one of the intermediate-acting or long-acting insulins listed above. Start insulin at night. When starting basal insulin: Continue secretagogues. Continue metformin. 7,8,20,29 Note: if NPH causes nocturnal hypoglycemia, consider switching NPH to long-acting insulin. 17,25,32 STARTING DOSE: Start dose: 10 units6,7,8,11,12,13,14,16,19,20,21,22,25 Consider using a lower starting dose (such as 0.1 units/kg/day32) especially if 17,19 patient is thin or has a fasting glucose only minimally above goal. -
Clinical Policy: Mecasermin (Increlex) Reference Number: ERX.SPA.209 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log
Clinical Policy: Mecasermin (Increlex) Reference Number: ERX.SPA.209 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Mecasermin (Increlex®) is an insulin growth factor-1 (IGF-1) analogue. FDA Approved Indication(s) Increlex is indicated for the treatment of growth failure in children with severe primary IGF-1 deficiency or with growth hormone (GH) gene deletion who have developed neutralizing antibodies to GH. Limitation(s) of use: Increlex is not a substitute to GH for approved GH indications. Policy/Criteria Provider must submit documentation (which may include office chart notes and lab results) supporting that member has met all approval criteria It is the policy of health plans affiliated with Envolve Pharmacy Solutions™ that Increlex is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Severe Primary IGF-1 Deficiency (must meet all): 1. Diagnosis of IGF-1 deficiency growth failure and associated growth failure with one of the following (a or b): a. Severe primary IGF-1 deficiency as defined by all (i through iii): i. Height standard deviation score (SDS) ≤ –3.0; ii. Basal IGF-1 SDS ≤ –3.0; iii. Normal or elevated GH level; b. GH gene deletion with development of neutralizing antibodies to GH; 2. Prescribed by or in consultation with an endocrinologist; 3. Age ≥ 2 and <18 years; 4. At the time of request, member does not have closed epiphyses; 5. Dose does not exceed 0.12 mg/kg twice daily. -
Safety of Insulin Lispro and a Biosimilar Insulin Lispro When
DSTXXX10.1177/1932296817753644Journal of Diabetes Science and TechnologyThrasher et al 753644research-article2018 Original Article Journal of Diabetes Science and Technology 2018, Vol. 12(3) 680 –686 Safety of Insulin Lispro and a Biosimilar © 2018 Diabetes Technology Society Insulin Lispro When Administered Reprints and permissions: sagepub.com/journalsPermissions.nav Through an Insulin Pump DOI:https://doi.org/10.1177/1932296817753644 10.1177/1932296817753644 journals.sagepub.com/home/dst James Thrasher, MD1, Howard Surks, MD2, Irene Nowotny, PhD3, Suzanne Pierre, MSc4, Baerbel Rotthaeuser, PhD3, Karin Wernicke-Panten, MD3, and Satish Garg, MD5 Abstract Background: SAR342434 (U100; SAR-Lis; insulin lispro) is a biosimilar/follow-on to insulin lispro (U100; Ly-Lis). Similar pharmacokinetics/pharmacodynamics between the two products has been demonstrated in a hyperinsulinemic euglycemic clamp study. The current study evaluated the safety of SAR-Lis and Ly-Lis when administered by continuous subcutaneous insulin infusion (CSII; insulin pumps). Methods: This was a randomized, open-label, 2 × 4-week, two-arm crossover study in 27 patients with type 1 diabetes mellitus (NCT02603510). The main outcome was the incidence of infusion set occlusions (ISOs), defined as failure to correct hyperglycemia (plasma glucose ≥≥ 300 mg/dl) by 50 mg/dl within 60 minutes by insulin bolus via the pump. Secondary outcomes included intervals between infusion set changes, treatment-emergent adverse events (TEAEs) including infusion site, hypersensitivity reactions and hypoglycemic events, and safety. Results: The number of patients reporting at least one ISO was small: 6/25 patients on SAR-Lis reported 14 ISOs and 4/27 on Ly-Lis reported nine ISOs. The estimated difference in ISO risk for SAR-Lis versus Ly-Lis was 7.9% (95% CI, –1.90 to 17.73). -
Insulin Products and the Cost of Diabetes Treatment
November 19, 2018 Insulin Products and the Cost of Diabetes Treatment Insulin is a hormone that regulates the storage and use of would involve a consistent insulin level between meals sugar (glucose) by cells in the body. When the pancreas combined with a mealtime level of insulin that has a rapid does not make enough insulin (type 1 diabetes) or it cannot onset and duration of action to match the glucose peak that be used effectively (type 2 diabetes), sugar builds up in the occurs after a meal. The original insulin, also called regular blood. This may lead to serious complications, such as heart insulin, is a short-acting type of product with a duration of disease, stroke, blindness, kidney failure, amputation of action of about 8 hours, making it less suitable for toes, feet, or limbs. Prior to the discovery of insulin providing 24-hour coverage. treatment, type 1 diabetics usually died from this disease. In the late 1930s through the 1950s, regular insulin was There were 23.1 million diagnosed cases of diabetes in the altered by adding substances (protamine and zinc) to gain United States in 2015 according to the Centers for Disease longer action; these are called intermediate-acting insulins. Control and Prevention (CDC). Adding an estimated 7.2 One such advance (neutral protamine Hagedorn, or NPH) million undiagnosed cases brings the total to 30.3 million was patented in 1946 and is still in use today. It allowed for (9.4% of U.S. population). People with type 1 diabetes, the combination of two types of insulin in premixed vials about 5% of U.S. -
Insulin-Induced Hypoglycemia Stimulates Corticotropin-Releasing
Insulin-induced hypoglycemia stimulates corticotropin-releasing factor and arginine vasopressin secretion into hypophysial portal blood of conscious, unrestrained rams. A Caraty, … , B Conte-Devolx, C Oliver J Clin Invest. 1990;85(6):1716-1721. https://doi.org/10.1172/JCI114626. Research Article Insulin-induced hypoglycemia (IIH) is a strong stimulator of pituitary ACTH secretion. The mechanisms by which IIH activates the corticotrophs are still controversial. Indeed, in rats the variations of corticotropin-releasing factor (CRF) and arginine vasopressin (AVP) secretion in hypophysial portal blood (HPB) during IIH have been diversely appreciated. This may be due to the stressful conditions required for portal blood collection in rats. We studied the effects of IIH on the secretion of CRF and AVP in HPB and on the release of ACTH and cortisol in peripheral plasma in conscious, unrestrained, castrated rams. After the injection of a low (0.2 IU/kg) or high dose (2 IU/kg) of insulin, ACTH and cortisol levels in peripheral plasma increased in a dose-related manner. After injection of the low dose of insulin, CRF and AVP secretion in HPB were equally stimulated. After injection of the high dose of insulin, CRF secretion was further stimulated, while AVP release was dramatically increased. These results suggest that when the hypoglycemia is moderate, CRF is the main factor triggering ACTH release, and that the increased AVP secretion potentiates the stimulatory effect of CRF. When hypoglycemia is deeper, AVP secretion becomes predominant and may by itself stimulate ACTH release. Find the latest version: https://jci.me/114626/pdf Insulin-induced Hypoglycemia Stimulates Corticotropin-releasing Factor and Arginine Vasopressin Secretion into Hypophysial Portal Blood of Conscious, Unrestrained Rams A. -
A Direct Comparison of Insulin Aspart and Insulin Lispro in Patients with Type 1 Diabetes
Pathophysiology/Complications ORIGINAL ARTICLE A Direct Comparison of Insulin Aspart and Insulin Lispro in Patients With Type 1 Diabetes 1 1 JOHANNES PLANK, MD BARBARA SEMLITSCH, RN human soluble insulin is performed as 1 1 ANDREA WUTTE, MSC ROMANA SOMMER, MD standard treatment regimen by a majority 1 2 GERNOT BRUNNER, MD SABINE HIRSCHBERGER, MD 1 1 of patients (2,3). However, postprandial ANDREA SIEBENHOFER, MD THOMAS R. PIEBER, MD blood glucose peaks and excursions are not comparable with nondiabetic sub- jects. Absorption of unmodified insulin from the injection site is a complex pro- cess affected by only partially changeable OBJECTIVE — Both rapid-acting insulin analogs, insulin aspart and lispro, attenuate pran- factors, such as anatomic area, blood dial glucose excursion compared with human soluble insulin. This trial was performed to study flow, injection volume, concentration of the pharmacokinetic and pharmacodynamic profiles of insulin aspart and insulin lispro in type 1 diabetic patients in a direct comparison and to investigate whether the administration of one insulin, and possible local degradation analog results in favorable effects on prandial blood glucose control. process (4–6). Therefore, considerable attention has been devoted to the devel- RESEARCH DESIGN AND METHODS — A total of 24 type 1 diabetic patients (age opment of insulin molecules with accel- 36 Ϯ 8 years, 16 men and 8 women, BMI 24.3 Ϯ 2.6 kg/m2, diabetes duration 17 Ϯ 11 years, erated absorption kinetics (7–9). This Ϯ HbA1c 7.9 0.8%) on intensified insulin therapy were recruited into a single-center, random- more physiological profile of these short- ized, double-blind, two-period, cross-over, glucose clamp trial.