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Talk:Insulins

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Changing categories Edit

The current categories are rapid acting, regular/short-acting, intermediate, and long-acting. Those are human categories that I don't believe apply to both canine and feline insulin usage. For example, N is short-acting for cats, but is apparently intermediate acting for dogs. To get around this problem, I suggest that we reduce the categories to short, intermediate, and long. I've also expanded the categories introduction to include (see below). Any comments before I publish this change?


Insulin Basics

Origin: Injected insulin is produced from the pancreas of pigs and cows, or from human DNA (origin).

Characteristics:

· Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose. · Peak is the time during which insulin is at maximum strength in terms of lowering blood glucose. · Duration is how long insulin continues to lower blood glucose.

Types:

· Rapid-acting insulin begins to work shortly after injection, peaks in about 1 hour, and continue to work for 2 to 4 hours. · Regular or short-acting insulin reach the bloodstream 30 minutes to an hour after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 6-8 hours. · Long-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 8 hours later and is effective for about 12 to 18 hours.

Strength: Injected insulins are diluted or suspended in liquid. Those dilutions/suspensions have different strengths. U-100 means 100 units of insulin per milliliter of fluid. U-40 has 40 units of insulin per milliliter of fluid. Insulin strength must be matched to the correct syringe size.

Since your definitions still have a gap (Regular has duration up to 8 hours, Long-acting has duration from 12-18 hours), it makes sense to continue to fill that gap with Intermediate-acting. Especially since these are already medically-established definitions, not just ours. If we don't have any insulin to go in the category, that's ok, we just leave the category unpopulated for now (though by your implied definition, intermediate in cats could include PZI and sometimes even N).
You're right that each insulin may have a different category for cats, so why can't we just include up to 4 new wiki categories: Category:Rapid-acting in cats, Category:Short-acting in cats, Category:Intermediate-acting in cats, and Category:Long-acting in cats ? Each of the 10 or so insulins that we cat lovers are familiar with can get one or more of these categories, a listing page is made, and Terri's problem is solved. --Steve and Jock 12:13, 10 December 2006 (UTC)
Terri, I liked your intro so much I couldn't wait. I copied it into the Insulins category page, added interlinks, and (since we're using it all over the wiki) added the Intermediate-acting category. If you want to continue to make a case for omitting it, please continue that discussion here. --Steve and Jock 13:42, 10 December 2006 (UTC)

Steve,

I don't think we have the research to differentiate between intermediate and long acting insulins (in cats). Those categories work, and can be defined, for humans because there has been research into baseline onset, peak, and duration. I understand you have already established those 4 categories and the hassle it would be to undo anything so I'll go along with the decision to keep them all, but there needs to be some serious discussion about how to move forward with refining the insulin descriptions using those categories. We also need to use the same terminology. For example, the first sentence on the rapid acting insulins uses the term absorption. Is that the same as onset? If so, then it needs to be listed as a synomyn on the intro page: "Onset, or speed of absorption, is the length of time before insulin reaches the bloodstream and begins lowering blood glucose." Or maybe the concept of absorption should simply be eliminated as a defined term because it isn't important to the everyday caregiver.--Terri

Terri, thanks for your additions. Did you notice that your text was added twice (both on this page and later on the first paragraph of the Insulins category?) Something about your editing software seems to do that.
Happy to discuss and refine terminology. "Onset" is pretty narrowly defined as "time to first lowering of blood sugar", or some such. It's part of the action profile. "Absorption" is a broader term that covers speed of absorption from the beginning to the end of the action profile, and so affects onset, peak, and duration. It's the sum of the times for the insulin to dissociate, find the bloodstream, find the tissues, and be accepted. And it covers absorption of all the insulin in the shot, not just the first part to reach the cells. So they're not synonymous. Please look through the absorption article Absorption and there's lots to learn.
I agree that being consistent in terminology is key. But there's more terminology here on the wiki than everyday caregivers need to know -- the wiki must be available for people doing advanced research too. Beth found it very helpful when she had unusual problems with Pickles, because we keep on searching out the more advanced topics too.
About refining the categories (and refining them for feline users), this is not difficult technically, but I'm not sure we have the data either. I tried with Bev for a while to collect data on the action profiles of various insulins but we didn't complete the project. I think it's pretty easy to categorize these things in the wiki, but more difficult to get everyone to agree on those categorizations later. Even within the feline world.
For example, PZI seems to me to last 8-12 hours in cats. (Let's exclude unusual cases for all of these discussions.) That would place it firmly into "Intermediate-acting" for cats. Levemir in contrast lasts (I assert) 10-22 hours in cats, depending on dose, which would make it Long-acting. But you might see it differently. And without lots of data, we wouldn't know who was right.
I don't think removing the category really solves the problem -- only more data will. A survey on FDMB for each insulin type might help. Looking through raw numbers might help more. I'm hoping this will happen.
Or simply getting enough collaborators into the effort that we can collectively agree on some "wikiality" (Thanks Stephen Colbert) might be the answer. --Steve and Jock 23:07, 10 December 2006 (UTC)

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