ABSTRACT
A variety of insulin preparations are now available that differ in times of onset, peak effect, and duration of action, enabling the clinician to more appropriately satisfy their patients’ requirements in a safe and effective manner (1,2). Insulin, which first became available for patients with diabetes mellitus in 1922 (3,4), was originally extracted from porcine and bovine pancreases and differed in structure from human insulin by one and three amino acids, respectively. The early preparations were dilute (1 unit/ml), of crude purity, and short-acting. Patients had to inject themselves four to six times a day with relatively large volumes, which made the injections painful. Local cutaneous reactions at injection sites (inflammation, lipoatrophy, and lipohypertrophy) were common due to contaminants. Moreover, because the preparations were antigenic, most patients developed insulin antibodies, which delayed the onset and prolonged the duration of insulin action. Development of antibodies sometimes caused severe immune insulin resistance that necessitated desensitization and the use of corticosteroids or specifically modified insulins (e.g., sulfated insulins).
