Insulins and analogues (general card; individual products require separate cards)
ATC code: A10A (Insulins and analogues)
Brand names
Humulin, Lantus, Toujeo, Tresiba, NovoRapid, Humalog, Apidra, Levemir, Fiasp
Insulin is a hormone of pancreatic beta cells. It binds the insulin receptor and initiates a phosphorylation cascade that increases glucose uptake in muscle and adipose tissue, stimulates hepatic glycogen synthesis, and suppresses gluconeogenesis and lipolysis. Modern preparations are recombinant human insulins and analogues with modified pharmacokinetics: ultra-short (lispro, aspart, glulisine), short (regular), intermediate (NPH), long (glargine, detemir), and ultra-long (degludec). Important: this is a general card; each specific insulin will have its own card in Evigrade.
First line
Insulin therapy is the only life-sustaining treatment for type 1 diabetes. Recommended by 2024, ISPAD 2022, ESPE, and the Russian Ministry of Health. Modern standard is basal-bolus (long-acting analogue as basal plus ultra-short before meals) or pump therapy; in children and adolescents, sensor-augmented and closed-loop systems. Target < 7% in most adults; individual targets in children, adolescents, older adults, and pregnancy.
Initial daily requirement in a newly diagnosed adult is 0.4-0.5 U/kg, higher in ketoacidosis. In children and adolescents – 0.7-1.0 U/kg during puberty. Distribute 40-50% as basal and 50-60% as boluses.
Third line
In type 2 diabetes, insulin is added when control is inadequate on oral and non-insulin injectable therapies, or for decompensation symptoms and catabolism. 2024 and 2022 advise trying GLP-1 agonists and SGLT2 inhibitors before insulin in most patients due to their additional cardiovascular and renal benefits. Initiation is usually basal analogue 10 U/day or 0.1-0.2 U/kg, titrated to fasting glucose.
Not recommended
Insulin is used illicitly by bodybuilders for mass gain based on its anabolic effect via IGF-1-like action and stimulation of muscle amino-acid uptake. The effect on mass is small and the risk of fatal hypoglycaemia is high. Cases of hypoglycaemic coma and sudden death in healthy bodybuilders are reported. Hypoglycaemia is recognised late – during training or sleep. WADA lists insulin as prohibited. Using insulin in a healthy person with normal beta-cell function is Russian roulette with several rounds in the cylinder.
Insulin is the treatment of choice for glycaemic control in gestational diabetes and in pregnant women with type 1/2 diabetes. Human insulin and modern analogues (aspart, lispro, detemir) with confirmed pregnancy safety are used. Glargine is discussed; degludec has limited data.
Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.
insulin is evaluated for the following indications with varying evidence strength: Type 1 diabetes mellitus (evidence tier A), Type 2 diabetes mellitus (evidence tier A), Muscle mass gain (bodybuilding self-use) (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of insulin (≥ 1 in 100): Hypoglycaemia (most common adverse effect), Weight gain (in some patients on intensification), Local injection-site reactions: lipohypertrophy, lipoatrophy, bruising. See the Safety section for uncommon and serious reactions.
Insulin is the treatment of choice for glycaemic control in gestational diabetes and in pregnant women with type 1/2 diabetes. Human insulin and modern analogues (aspart, lispro, detemir) with confirmed pregnancy safety are used. Glargine is discussed; degludec has limited data.
Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.
insulin is contraindicated in: Hypersensitivity to insulin or excipients; Hypoglycaemia. Full list in the Safety section.