Type 1 diabetes, insulin types

Type 1 diabetes is still treated with insulin injections. Insulin is supplied in a variety of long, intermediate and short-acting preparations. The duration of action of insulin preparations required to give optimal control varies from patient to patient. This means that individual patients are established on particular regimens which are not changed unless they are not working.

In the early days of insulin treatment, animal insulin was used—bovine and porcine, of which porcine became the favorite as the molecule differed from human insulin by only a single amino acid. Bovine insulin was phased out as the purification and supply of porcine insulin was scaled up. This helps to explain why the Danish company Novo Nordisk became the leading insulin manufacturer in Europe, given the strength of the Danish pig industry.

Ultimately, it became possible to make "humanized" insulin from pig insulin by replacing the pig-specific amino acid with the human-specific amino acid. Human insulin is now manufactured from cloned human insulin genes. Genentech and Eli Lilly devised a means of achieving this for the U.S. market and Novo Nordisk followed suit in Europe. The bulk of the market is now converted to human insulin.

The second major innovation in insulin has been the development of ultra fast-acting insulin derivatives. The introduction of recombinant production methods of human insulins made it possible to alter the insulin molecule in order to tailor the pharmacokinetics. Thus, insulin analogues such as insulin lispro (Humalog, Eli Lilly) and insulin aspart (NovoRapid, Novo Nordisk) are absorbed very rapidly and the variability of their effect is minimized.

There is a great variety of insulin formulations on the market; as summarized in the following tables.

Rapid acting (onset less than 15 minutes)

YearFundings
($millions)
Growth over prior year
2013 (run rate)$6,22143%
2012$5,014-2%
2011$5,12143%
2010$3,5939%
2009$3,290--

Short acting (onset 1⁄2-2 hours)

CompanyProduct(s)Key FeaturesRegulatory Status
AbbottFreeStyle NavigatorAdvanced hypo- and hyperglycenia alarms. Has integrated FreeStyle meter for calibrationApproved
AiMedics Pty Ltd.HypoMonNoninvasive, electro-physiological, chest skinÐbasedIn development
ArKal Medical(Unnamed)Improved convenience and easeIn development
Biorasis Inc. (aka Bio-Orasis)GlucowizzardImplantable sensorIn development
Cascade Matrix, Inc.Based on the AutoSampler automated vascular blood sampling systemNoninvasive mid-infrared/microfluidDevelopmental
DexCom, Inc.SEVEN, SEVEN PLUSCan be worn up to 7 daysApproved
Echo Therapeutics (formerly Sontra Medical)Symphony tCGSNoninvasive (needle-free), wireless, transdermal, sonophoresisIn pilot trials
GluMetrics, Inc.GluCathSingle-use catheter and sensor system for real-time intravenous monitoring of patientÕs glucose; for hospital useIn development
MedtroniciPro 2 ProfessionalDisposable glucose sensor. Small automatic data recorder. Small, lightweight, watertight. Allows 288 readings in 24 hour period, uploadable via internet for remote accessCE Mark, launched outside the U.S.in June 2010, approval pending in 22 other countries
MedtronicParadigm REAL-TimeParadigm CGM combined with Minimed pumpApproved
MedtronicGuardian REAL-TimeCGM onlyApproved
MenariniGlucoDay SFor type 1 and type 2 diabeticsApproved in Europe
RocheSCGM1Glucose measurement at 5 min intervals for up to 4 days. Microdialysis-based measurementInvestigational
Ultradian DiagnosticsBiologueWireless, predict and alarm user 20 minutes of a high or low glucose level, calibration-free interface to an insulin pumpIn development

Intermediate acting (onset 2-4 hours)

CompanyProduct NameDescription/
(Status*)
Asahi Kasei MedicalCryoSeal FS SystemFibrin sealant system comprising an automated device and sterile blood processing disposables that enable autologous fibrin sealant to be prepared from a patient's own blood plasma in about an hour.
BaxterArtissFibrin sealant spray
BaxterTisseelBiodegradable fibrin sealant made of human fibrinogen and human thrombin. For oozing and diffuse bleeding.
BaxterFloSealHemostatic bioresorbable sealant/glue containing human thrombin and bovine-derived, glutaraldehyde-crosslinked proprietary gelatin matrix. For moderate to severe bleeding.
BaxterGelFoam PlusHemostatic sponge comprising Pfizer's Gelfoam hemostatic sponge, made of porcine skin and gelatin, packaged with human plasma-derived thrombin powder.
Behring/NycomedTachoCombFleece-type collagen hemostat coated with fibrin glue components.
Bristol-Myers Squibb/ZymoGenetics (Sold by The Medicines Company in the US and Canada)RecothromFirst recombinant, plasma-free thrombin hemostat.
CSL BehringBeriplast P/Beriplast P Combi-SetFreeze dried fibrin sealant. Comprised of human fibrinogen-factor XIII and thrombin in aprotinin and calcium chloride solution.
CSL BehringHaemocomplettan P, RiaSTAPFreeze-dried human fibrinogen concentrate. Haemocomplettan (US) and RiaSTAP (Europe).
J&J/EthiconEvicelEvicel is a new formulation of the previously available fibrin sealant Quixil (EU)/Crosseal (US). Does not contain the antifibrinolytic agent tranexamic acid, which is potentially neurotoxic, nor does it contain synthetic or bovine aprotinin, which reduces potential for hypersensitivity reactions.
J&J/EthiconEvarrestAbsorbable fibrin sealant patch comprised of flexible matrix of oxidized, regenerated cellulose backing under a layer of polyglactin 910 non-woven fibers and coated on one side with human fibrinogen and thrombin.
J&J/EthiconBIOSEAL Fibrin SealantLow-cost porcine-derived surgical sealant manufactured in China by J&J company Bioseal Biotechnology and targeted to emerging markets.
J&J/EthiconEvithromHuman thrombin for topical use as hemostat. Made of pooled human blood.
Pfizer/King PharmaceuticalsThrombin JMIBovine-derived topical thrombin hemostat.
Stryker/OrthovitaVitagel SurgicalBovine collagen and thrombin hemostat.
Takeda/NycomedTachoSilAbsorbable surgical patch made of collagen sponge matrix combined with human fibrinogen and thrombin.
Teijin Pharma Ltd/Teijin Group (Tokyo, Japan)KTF-374Company is working with Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN) to develop a sheet-type surgical fibrin sealant. Product combines KAKETSUKEN's recombinant thrombin and fibrinogen technology with Teijin's high-performance fiber technology to create the world's first recombinant fibrin sealant on a bioabsorbable, flexible, nonwoven electrospun fiber sheet.
The Medicines Company (TMC)Raplixa (formerly Fibrocaps)Sprayable dry-powder formulation of fibrinogen and thrombin to aid in hemostasis during surgery to control mild or moderate bleeding.
The Medicines Company (TMC)In development: Fibropad patchFDA accepted company's BLA application for Fibrocaps in April 2014 and set an action date (PDUFA) in 2015. In November 2013, the European Medicines Agency agreed to review the firm's EU marketing authorization application. Status update in report #S192.
Vascular SolutionsD-Stat FlowableThick, but flowable, thrombin-based mixture to prevent bleeding in the subcutaneous pectoral pockets created during pacemaker and ICD implantations.

Long acting (onset 4-6 hours)

CompanyProduct NameDescription/Status
BaxterCoSealSynthetic, translucent gel for cardiovascular and peripheral vascular surgery applications. Consists of two polyethylene glycol (PEG) polymers that rapidly crosslink with proteins in the tissues, forming a covalent bond. Also mechanically adheres to synthetic graft materials. Intended for adjunctive use to seal areas of leakage.
Cohera MedicalTissuGlu Surgical AdhesiveSynthetic, resorbable adhesive based on companyÕs proprietary lysine-derived urethane polymer technology. Used for surgeries involving large flap tissue approximation, such as mastectomy and abdominoplasty, to reduce wound drainage and reduce or eliminate the need for wound drains and lower the risk of seroma formation.
Cohera MedicalSylys Surgical SealantSynthetic sealant designed specifically to help reduce leaks at the anastomosis in gastrointestinal surgery procedures. Used in conjunction with standard closure techniques to protect suture or staple line during first few days of healing.
CR Bard/DavolProgel (obtained via BardÕs 2012 acquisition of Neomend)Hydrogel sealant made of human serum albumin and PEG.
CryoLifeBioGlueBovine serum albumin (BSA)-based surgical adhesive delivered in dual-chamber system.
CryoLifeBioFoam Surgical MatrixDual-action sealant and hemostat. Delivered as liquid and sets into soft foam for difficult to access spaces.
EndomedixN/AIn early-stage development with a surgical sealant designed to help control bleeding during brain surgery procedures. Product is a hydrogel comprised of two biocompatible polysaccharides that are simultaneously mixed and sprayed onto the surgical site.
Gecko Biomedical (France)N/ABiodegradable, biocompatible hydrophobic light-activated adhesive made by combining glycerol and sebacic acid. Applied in liquid form and solidifies into leak-proof, flexible seal after a few seconds exposure to UV light.
Hyperbranch Medical TechnologyAdherus Dural SealantHydrogel comprised of two synthetic components: activated PEG and polyethyleneimine. Designed for adjunctive use with standard methods of dural repair during neurosurgery and spinal surgery.
Integra LifeSciences*DuraSealAbsorbable hydrogel dural sealant comprised of synthetic PEG ester solution and trilysine amine solution. Delivered via double barrel system.
Integra LifeSciences*VascuSealSimilar in composition to DuraSeal but intended for use in arterial and venous reconstruction procedures to seal suture lines.
J&J/EthiconOmnex Surgical SealantCyanoacrylate sealant for prevention of leakage along suture lines in vascular reconstruction procedures.
LifeBond (Israel)LifeSeal/LifePatch Surgical SealantsCrosslinked gelatin sealants applied as an adhesive hydrogel matrix. In development for internal wounds and staple-line reinforcement.
Medical Adhesive Revolution GmbH (Aachen, Germany)N/AIn development with a high-strength, biodegradable surgical adhesive that can be used instantaneously to stop bleeding within seconds..
Ocular Therapeutix (formerly I-Therapeutix)ReSureHydrogel sealant designed specifically for use during ophthalmic surgery (such as cataract surgery) as an alternative to sutures.
Sapheon Inc. (being acquired by Covidien)VenaSeal Sapheon Closure SystemProprietary catheter-based system that delivers a specially formulated cyanoacrylate medical adhesive to embolize and close the saphenous vein in patients with venous reflux disease. Eliminates the need for surgery, thermal ablation, sedatives, tumescent anesthesia, post-procedure compression stockings, and chemical sclerosants.
Sealantis LtdSeal-VProtein-free, biodegradable vascular surgery sealant made with Alga-Mimetic Adhesive Technology: mimics algae underwater adherence mechanism.
Tenaxis Medical (being acquired by The Medicines Company)ArterX Vascular SealantBioresorbable, gluteraldehyde-based prophylactic synthetic sealant with unique, noninflammatory crosslinking agent that mechanically seals human tissue and artificial grafts in wet or dry field.
Xcede Technologies Inc. (subsidiary of Dynasil Biomedical Corp.)Xcede PatchFirst product based on platform of ready-to-use, high-strength, fast-acting combination of hemostat/sealant technology initially invented by Dr. Daniel Ericson and acquired by Dynasil in 2011.

Very long acting (24+ hours)

TypeTissue CharacteristicsEtiologyPrognosis for Healing
Partial thicknessInvolves entire epidermis and portions of dermis.Friction, pressure, small cuts, minor burns.Heal within 10-18 days, epidermal element germinates and migrates up to the epithelial layer. Heals without significant scarring or functional impairment.
Deep partial thicknessInvolves entire epidermis and almost entire dermis.Friction, cuts, significant burns.Healing within 20-35 days.
Full thicknessInvolves epidermis and dermis; may extend into subcutaneous tissue. Sweat glands and hair follicles are destroyed.Severe deep cuts, surgical incisions, most chronic wounds, and third-degree burns.Heals by granulation, formation of new blood vessels, new biomaterial deposition, and new cells over many weeks. Scarring usually results.
Underlying tissue damageConsidered more extensive than full- thickness wounds. Involves subcutaneous tissue, muscle, fascia, bone, and other organs.Surgery of organs, electrical burns and certain thermal burns, such as molten metal or severe scalding, massive traumatic injury, and untreated chronic damage.May require debridement or removal of all necrotic tissue to expose viable bleeding tissue. Systemic antibiotic therapy and grafts/flap skin replacement.

Mixtures

YearFundings
($millions)
Growth over prior year
2013 (run rate)$6,22143%
2012$5,014-2%
2011$5,12143%
2010$3,5939%
2009$3,290--

Source: MedMarket DIligence, LLC; Report #D510, "Diabetes Management Worldwide, 2009-2018".

2 thoughts on “Type 1 diabetes, insulin types”

  1. It is an informative post about type 1 diabetes. There are total two types of diabetes. The insulin injection is one of the easy treatment for type 1 diabetes. 

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  2. People who are overweight and not exercising regularly are at risk of diabetes. And high-density lipoprotein cholesterol, high blood pressure and low numbers of certain ethnic groups.
     
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