The human system naturally produces various quantities of insulin at various times. Slighter and steady amounts are generated between lunch and overnight, sometimes termed as background or basal insulin. Larger quantities are generated when individual eat, termed as bolus insulin (Lillian F. Lien, 2011). Collectively, these can manage the level of glucose within the blood stream throughout the day (Ahmad, 2014). When the human system cannot make adequate amount of insulin, for instance during the diabetic conditions, individual may require taking manufactured insulin from outside as dosage modes to obtain the equal effect.
Basal insulin comprises longer functioning and intermediate functioning insulin. These types of insulin lower the level of blood glucose more gradually and stay longer than the rapid acting insulin. A physician can recommend taking basal dosage once or twice in a day.
Detemir insulin is considered as soluble, recombinant and long-functioning insulin analog that is produced by modification in chemical structure of normal insulin. Fatty acid acylation increases the detemir affinity to albumin, which allows for prolonged period of effect by delayed absorption as a consequence of albumin binding in plasma and adipose tissue of subcutaneous region. Insulin detemir is soluble at neutral pH and is present as liquid after subcutaneous injection, diminish absorption viability and raise surface area, unlike NPH insulin and glargine (Garg, Rosenstock and Ways, 2005). Detemir insulin has equal potential to insulin NPH. Detmir has certain advantages over the NPH insulin and glargine. These advantages are: once or twice regular administration, less inconsistency in patient responses, a smaller amount of weight gain, improvement or similarity in glycemic control and reduction in occurrence of hypoglycemia comprising both severe and night time hypoglycemia. According to the scientists Frier, Jones and Heise (2013) Insulin detemir therapy offered better or similar glycemic control, lesser within-subject inconsistency, lower or similar hypoglycemia frequency and a lesser amount of weight gain while compared with isophane insulin (Frier, Russell-Jones and Heise, 2013).
Insulin degludec is a basal insulin analogue, which is even more long-acting and was developed by Novo Nordisk (NASRALLAH, NASRALLAH and L. Raymond Reynolds, 2012). A doctor can recommend taking this insulin via subcutaneous injection once a day to control the level of the blood sugar. Scientists Garber et al. (2012) have performed a basal-bolus type II trial with insulin degludec (Garber et al., 2012). In the basal-bolus type II trial insulin degludec was examined as a substitute to glargine insulin in type II diabetic patients. Almost 995patients were received either glargine or degludec, along with mealtime aspart insulin or pioglitazone (Chen, 2005). Patients who were involved in this trial had an average of 8.3-8.4% of HbA1c and almost 50% patients were under the treatment of oral anti-diabetic and basal-bolus insulin medications (Garber et al., 2012). At the end of the research study it was found that insulin degludec is more efficient than insulin glargine. It offers good amount of HbA1c lowering effect. Overall hypoglycaemia rates were significantly low with degludec, along with the incidences of night time hypoglycaemia.
Ahmad, K. (2014). Insulin sources and types: a review of insulin in terms of its mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2), pp.234-237.
Chen, J. (2005). Impact of insulin antibodies on insulin aspart pharmacokinetics and pharmacodynamics after 12-week treatment with multiple daily injections of biphasic insulin aspart 30 in patients with type 1 diabetes. European Journal of Endocrinology, 153(6), pp.907-913.
Frier, B., Russell-Jones, D. and Heise, T. (2013). A comparison of insulin detemir and neutral protamine Hagedorn (isophane) insulin in the treatment of diabetes: a systematic review. Diabetes Obes Metab, 15(11), pp.978-986.
Garber, A., King, A., Prato, S., Sreenan, S., Balci, M., Muñoz-Torres, M., Rosenstock, J., Endahl, L., Francisco, A. and Hollander, P. (2012). Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. The Lancet, 379(9825), pp.1498-1507.
Garg, S., Rosenstock, J. and Ways, K. (2005). Optimized Basal-Bolus Insulin Regimens In Type 1 Diabetes: Insulin Glulisine Versus Regular Human Insulin In Combination With Basal Insulin Glargine. Endocrine Practice, 11(1), pp.11-17.
Lillian F. Lien, M. (2011). Glycemic Control in the Hospitalized Patient. Springer Science+Business Media, LLC.
Nasrallah, Nasrallah, and L. Raymond Reynolds, (2012). Insulin Degludec, The New Generation Basal Insulin or Just another Basal Insulin?. CMED, p.31.