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Immunologic side effects have included the formation of anti-insulin antibodies, particularly when animal insulin formulations were used. In one retrospective study of 600 randomly selected patients with insulin-treated diabetes mellitus, the only reliable predictors of severe hypoglycemia were a history of hypoglycemia, a history of hypoglycemia-related injury or convulsion, and the duration of insulin therapy. Human insulin does not appear to be associated with hypoglycemic episodes more often than animal insulin. Controversy and continued study surround the role of hyperinsulinemia as the precursor of hypertension. 3 years in the insulin-treated patients without a history of hypoglycemia. The risk for developing hypoglycemia has been higher in patients receiving intensive or continuous infusion insulin therapy. Desensitization kits and protocols are available from some insulin manufacturers. Intensive insulin therapy causes an increase in body fat as a result of the elimination of glycosuria and reduction in 24-hour energy expenditure. HypersensitivityA diabetic patient with true allergy to insulin can undergo desensitization. True allergy to insulin has been rare, and sensitization was usually associated with specific animal proteins in bovine and less pure forms of porcine insulins. ImmunologicImmunologic analysis of anaphylaxis to some insulin preparations in some cases has revealed markedly elevated serum levels of lgE and lgG to protamine, but not to regular insulin. Hematologic side effects have included an increase in the concentration of von Willebrand factor due to insulin-induced hypoglycemia. The association between insulin and dyslipidemia is currently being evaluated. DermatologicDermatologic side effects of insulin have included lipohypertrophy (insulin is lipogenic) and lipoatrophy (probably immunologically-mediated). Caution is recommended when switching from animal (either bovine or pork) to purified porcine insulin or biosynthetic human insulin, however, because of increased potency or bioavailability. Patients on intensive insulin therapy have been more likely to experience weight gain. Insulin may stimulate heart rate in the absence of hypoglycemia. Those with a history of hypoglycemia had been treated with insulin for 17. It starts working relatively quickly, produces a peak in insulin levels, and then drops off relatively quickly. These reactions are becoming rare (less than 1% of patients) due to the use of purer forms of pork insulin or biosynthetic human insulin. Novolog Mix70/30 contains insulin aspart, a rapid-acting insulin, mixed with insulin aspart protamine, an intermediate-acting insulin. The reduction in 24-h energy expenditure is the result of an insulin-associated decrease in triglyceride/free fatty acid cycling and nonoxidative glucose and protein metabolism. Insulin may contribute to the pathogenesis of hypertension by stimulating the sympathetic nervous system, promoting renal sodium retention, and/or stimulating vascular smooth muscle hypertrophy.



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