Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-29 the pharmacokinetic and dynamic properties are the same regardless of what pen needle size is used in people with and without obesity( 46). The table below includes many of the factors that may contribute to the variance in insulin absorption. As illustrated in the above examples many of these factors are specific to certain types of insulin.

Factors contributing to variance in insulin absorption

• Insulin concentration

• Associative state: hexamer, dimener, monomer

• Volume

• Skin temperature

• Site and depth of injection

• Level of antibody binding

• Preparation of insulin

44-46

• Lipodystrophy

• Tissue blood flow

Biologic Biosimilars

During this past century we have seen many additions to our insulin repertoire. Research and technology have partnered to provide us with a more secure supply of insulin as the demand has consistently increased. We have progressed from the limited supply of beef and pork pancreas to the recombinant DNA technology and now on to the biologic biosimilars (Hirsch) . Recognizing that the price of insulin has become an international concern, efforts are being made to provide insulins that are more affordable and more sustainable (47). Insulin is referred to as ‘biologic’ because it is made from cells of a living organism. In the past, because biologics are usually more complicated and complex in their formation, they were more difficult to produce. This made them less likely to be duplicated (Health Canada). However with the advancement in biotechnology we have seen an influx of biologic biosimilar insulins into the international and Canadian market (47, 48,49,). The Canadian uptake of biosimilars has been slower to date than our American counterparts where Sarkar et al looked at the trends in insulin use in the United States and concluded that the use of biosimilar insulins had increased 200% between 2017 and 2020,. (47, 50,51) There are currently four biosimilar insulins approved by Health Canada. These drugs were developed with the intent to provide insulin that is highly similar to the biologic reference drug with the same efficacy and safety profile (48, 49, 51).