insulin (medication)

insulin (medication)
Name	Insulin
Routes of administration	Subcutaneous, intravenous, intraperitoneal, inhaled
Atc prefix	A10
Legal status	Prescription-only

insulin (medication) Insulin is a peptide hormone preparation used to regulate blood glucose in disorders of carbohydrate metabolism. It is essential for treatment of Diabetes mellitus and acute hyperglycaemic crises, and is administered in multiple formulations for basal and prandial control. Insulin therapy intersects with developments in Toronto research, regulatory actions by agencies like the Food and Drug Administration and the European Medicines Agency, and commercialization by companies such as Novo Nordisk, Eli Lilly and Company, and Sanofi.

Medical uses

Insulin treats Type 1 diabetes, advanced Type 2 diabetes, gestational diabetes when glycaemic targets are unmet, and hyperglycaemic emergencies including Diabetic ketoacidosis and Hyperosmolar hyperglycemic state. It is used perioperatively for glycaemic control in patients undergoing procedures such as Coronary artery bypass grafting and in intensive care units where management follows protocols influenced by work from Leuven studies and guidance from bodies like the American Diabetes Association and International Diabetes Federation. Insulin also supports management in transplant recipients on regimens from centers like Mayo Clinic and in neonatal hyperglycemia after research at institutions such as Johns Hopkins Hospital.

Types and formulations

Insulin products include rapid-acting analogues (e.g., insulin lispro developed by collaborations tied to Bristol-Myers Squibb), short-acting regular insulins, intermediate-acting formulations like NPH insulin with protamine dating to work in Harvard Medical School circles, long-acting analogues (e.g., insulin glargine from Sanofi and insulin detemir from Novo Nordisk), and ultra-long agents such as insulin degludec from Novo Nordisk. Premixed insulins combine basal and bolus components and are marketed worldwide including by Eli Lilly and Company and Sanofi Aventis. Inhaled insulin was developed by companies like MannKind Corporation and underwent review by the Food and Drug Administration. Biosimilar insulins and follow-on biologics have been approved in markets overseen by the European Medicines Agency and national agencies, affecting formularies in systems such as the National Health Service.

Pharmacology

Insulin binds to the insulin receptor tyrosine kinase on target tissues, initiating signalling cascades involving PI3K and AKT that increase glucose uptake via translocation of GLUT4 transporters in skeletal muscle and adipose tissues, and inhibit hepatic gluconeogenesis, a mechanism explored in laboratories at Massachusetts Institute of Technology and University of Cambridge. Pharmacokinetics vary: rapid-acting analogues have onset and peak profiles characterized in clinical pharmacology trials at centers like Cleveland Clinic and University of California, San Francisco, while long-acting analogues provide prolonged time-action curves owing to modifications informed by structural studies at institutions such as the Max Planck Society. Factors affecting absorption include injection site and temperature, principles tested in studies at Stanford University and University of Oxford.

Administration and dosing

Insulin is delivered subcutaneously using syringes, insulin pens developed with industry partners like Roche and Novo Nordisk, infusion pumps pioneered in research from University of Virginia and University of Cambridge, or intravenously in hospital settings per protocols from American Association of Clinical Endocrinologists. Dosing strategies include basal-bolus regimens, sliding-scale approaches historically used in hospitals such as Mayo Clinic, carbohydrate-counting taught in programs at Joslin Diabetes Center, and closed-loop systems (artificial pancreas) developed through collaborations including UC San Diego and Cambridge University Hospitals. Dosing must consider renal and hepatic impairment, influences studied at Mount Sinai Hospital.

Adverse effects and contraindications

Hypoglycaemia is the most common adverse effect, with severe episodes requiring resuscitation protocols used in emergency departments like those at Massachusetts General Hospital; awareness and prevention programs have been promoted by organizations such as the American Diabetes Association. Weight gain and local injection-site reactions have been reported in trials conducted at centers including Vanderbilt University Medical Center. Rare immune-mediated reactions, including insulin allergy or antibody formation, were characterized in immunology research at Rockefeller University. Contraindications include hypoglycaemia unawareness and acute hypoglycaemic episodes; caution is advised in patients with conditions treated at specialty centers such as Mayo Clinic and Cleveland Clinic.

History and society

Discovery and therapeutic development trace to work in Toronto by researchers affiliated with University of Toronto and commercial partnerships that led to production by companies such as Eli Lilly and Company; Nobel recognition was awarded to figures associated with that era. The 20th and 21st-century evolution of insulin involved advances at institutions including Harvard Medical School, Columbia University, and University of Chicago, and regulatory milestones from agencies like the Food and Drug Administration. Societal debates about affordability and access have involved policy discussions in venues such as the United States Congress, executive actions referenced by administrations in Washington, D.C., and advocacy by organizations like Health and Human Services and patient groups modeled after initiatives from American Diabetes Association. The rise of biosimilars and pricing controversies has impacted procurement in national systems like the National Health Service and prompted investigative reporting by media outlets based in New York City and London.

Category:Drugs