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What Are The Routes Of Insulin Administration?

Insulin Therapy During Peritoneal Dialysis: Pros And Cons Of Various Forms Of Administration

Insulin Therapy During Peritoneal Dialysis: Pros And Cons Of Various Forms Of Administration

Abstract ABSTRACT. Major fluctuations of blood glucose, hyperinsulinemia, and the formation of insulin antibodies can be prevented by intraperitoneal insulin administration during peritoneal dialysis in patients with diabetic nephropathy. The reduction in insulin requirement is most pronounced compared with subcutaneous administration when insulin is instilled into the empty abdominal cavity. If insulin is instilled into the abdominal cavity along with the dialysis fluid, there are losses of activity due to delayed absorption consequential to dilution by the fluid and adsorption to the plastic surface of the dialysis solution delivery systems. These may be so pronounced as to make intraperitoneal administration uneconomical. The effectiveness of peritoneal dialysis is not affected by intraperitoneal insulin administration. The frequency of peritonitis during intraperitoneal insulin administration increases slightly only in continuous ambulatory peritoneal dialysis, but not in intermittent peritoneal dialysis. In peritoneal dialysis treatment of patients with diabetic nephropathy, the optimum adjustment of blood glucose values is made more difficult by additional supply of glucose via the peritoneum. As a further difficulty, this occurs discontinuously in intermittent peritoneal dialysis (IPD), in contrast to continuous ambulatory peritoneal dialysis (CAPD). The objective of insulin treatment during peritoneal dialysis is to maintain “euglycemia” during the dwell time, to prevent postprandial hyperglycemia, and to avoid hypoglycemia in the morning. It must be kept in mind that by itself, uremia alters the physiologic insulin response to glucose load. Materials and Methods Comparison of the Routes of Insulin Administration Intraperitoneally administered insulin is abs Continue reading >>

Inhaled Insulin: Overview Of A Novel Route Of Insulin Administration.

Inhaled Insulin: Overview Of A Novel Route Of Insulin Administration.

Abstract Diabetes is a chronic disease characterized by inadequate insulin secretion with resulting hyperglycemia. Diabetes complications include both microvascular and macrovascular disease, both of which are affected by optimal diabetes control. Many individuals with diabetes rely on subcutaneous insulin administration by injection or continuous infusion to control glucose levels. Novel routes of insulin administration are an area of interest in the diabetes field, given that insulin injection therapy is burdensome for many patients. This review will discuss pulmonary delivery of insulin via inhalation. The safety of inhaled insulin as well as the efficacy in comparison to subcutaneous insulin in the various populations with diabetes are covered. In addition, the experience and pitfalls that face the development and marketing of inhaled insulin are discussed. Continue reading >>

Comparison Of The Effectiveness Of Various Routes Of Insulin Injection: Insulin Levels And Glucose Response In Normal Subjects

Comparison Of The Effectiveness Of Various Routes Of Insulin Injection: Insulin Levels And Glucose Response In Normal Subjects

The difference in absorption of insulin and its glucose lowering-effect after the administration of crystalline insulin by the intravenous, intramuscular, and subcutaneous routes was compared in 14 lean normal subjects. Insulin in a dose of 0.1 U/kg body weight was given by the three different routes. Blood was drawn from the opposite ami at regular intervals for the determination of insulin, glucose, glucagon, cortisol, and potassium. Intravenous insulin produced the highest pharmacological level of insulin in 2 minutes (2099 ±414 μU/ml) with marked hypoglycemia at 30 minutes (a 68% drop). Intravenous insulin injection produced an increase in plasma glucagon and cortisol reaching a 2-fold increase above the fasting level 30 minutes after the glucose nadir. An equivalent amount of intramuscular insulin produced a maximal increase in plasma insulin at 50 minutes (45 ± 4 μU/ml) and caused a 35% drop in plasma glucose at 60 minutes, which effects were greater than those caused by subcutaneous injection (highest IRI = 36 ± 3.5μU/ml and 23% glucose drop at 180 minutes). No significant increase in glucagon or cortisol was noted with equivalent amounts of subcutaneous or intramuscular insulin injection. Our studies suggest that, in normal lean subjects, insulin injection by the intramuscular route provides a faster absorption of insulin with a concomitant greater drop in plasma glucose than does injection by the subcutaneous route. Continue reading >>

Comparison Of The Effectiveness Of Various Routes Of Insulin Injection: Insulin Levels And Glucose Response In Normal Subjects.

Comparison Of The Effectiveness Of Various Routes Of Insulin Injection: Insulin Levels And Glucose Response In Normal Subjects.

Abstract The difference in absorption of insulin and its glucose lowering-effect after the administration of crystalline insulin by the intravenous, intramuscular, and subcutaneous routes was compared in 14 lean normal subjects. Insulin in a dose of 0.1 U/kg body weight was given by the three different routes. Blood was drawn from the opposite arm at regular intervals for the determination of insulin, glucose, glucagon, cortisol, and potassium. Intravenous insulin produced the highest pharmacological level of insulin in 2 minutes (2099 +/- 414 muU/ml) with marked hypoglycemia at 30 minutes (a 68% drop). Intravenous insulin injection produced an increase in plasma glucagon and cortisol reaching a 2-fold increase above the fasting level 30 minutes after the glucose nadir. An equivalent amount of intramuscular insulin produced a maximal increase in plasma insulin at 50 minutes (45 +/- 4 muU/ml) and caused a 35% drop in plasma glucose at 60 minutes, which effects were greater than those caused by subcutaneous injection (highest IRI = 36 +/- 3.5 muU/ml and 23% glucose drop at 180 minutes). No significant increase in glucagon or cortisol was noted with equivalent amounts of subcutaneous or intramuscular insulin injection. Our studies suggest that, in normal lean subjects, insulin injection by the intramuscular route provides a faster absorption of insulin with a concomitant greater drop in plasma glucose than does injection by the subcutaneous route. Continue reading >>

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Hormone secreted by pancreatic beta-cells of the islets of Langerhans and essential for the metabolism and homeostasis of carbohydrate, fat, and protein. Insulin glargine is a once-daily basal insulin analog without pronounced peaks. BASAGLAR, Lantus, Lantus SoloStar, Toujeo SoloStar BASAGLAR/Lantus/Lantus SoloStar/Toujeo SoloStar Subcutaneous Inj Sol: 1mL, 100U, 300U For the treatment of type 1 diabetes mellitus and type 2 diabetes mellitus. For the treatment of type 1 diabetes mellitus. Subcutaneous dosage (100 units/mL, i.e., Lantus, Basaglar) Initially, administer one-third of the total daily insulin requirements/dose subcutaneously once daily. Titrate dosage to achieve blood glucose control and A1C goals in conjunction with a short-acting insulin. Give the dose at the same time every day, at any time. Administration in the morning may avoid nocturnal hypoglycemia. When transferring from once daily NPH insulin, the dose is usually not changed. However, when transferring from twice-daily NPH insulin to insulin glargine, the total daily dose of NPH insulin (or other twice daily basal insulin) should be reduced by 20% and administered as single dose once daily. When transferring from once-daily Toujeo to once-daily Lantus or Basaglar, the recommended initial Lantus or Basaglar dose is 80% of the Toujeo dose that is being discontinued. Thereafter, the dosage of insulin glargine should be adjusted to response. Children and Adolescents 6 years and older Insulin requirements are highly variable and must be individualized based on patient-specific factors and type of insulin regimen. During partial remission phase, total combined daily insulin requirement is often less than 0.5 units/kg/day. Prepubertal children (outside the partial remission phase) usually require 0.7 to Continue reading >>

The Route Of Insulin Administration In The Management Of Diabetes Mellitus

The Route Of Insulin Administration In The Management Of Diabetes Mellitus

By utilizing I131-labeled lente insulin, data from the study presented here suggest that the rates of clearance of insulin which may be expected when insulin is injected in the thigh differ from those which may be expected when it is injected into the upper arm. Such variability was not observed in relation to the tissue of injection. Similar rates of clearance were found following injections in both subcutaneous and intramuscular tissues. The interest of precise diabetic control would appear to be best served by consistently injecting insulin into the same anatomic region (e.g., the thigh), but by varying the sites within the region. Utilization of intramuscular tissue sites for injection provides a reasonable alternative to subcutaneous injections and could have application in the treatment and prevention of lipodystrophic complications. Continue reading >>

Insulin Delivery Methods: Past, Present And Future

Insulin Delivery Methods: Past, Present And Future

1 Department of Pharmacology, GMERS Medial College, Gandhinagar, Gujarat, India 2 Brain Research and Intervention Center, University of Illinois, Chicago, USA 3 Barbara Davis Center for Diabetes, University of Colorado, Denver, USA Correspondence Address: Dr. Rima B Shah Department of Pharmacology, GMERS Medical College, Gnadhinagar - 382 012, Gujarat India Viral N Shah Barbara Davis Center for Diabetes, 1775 Aurora Ct, MS A140, Colorado USA Source of Support: None, Conflict of Interest: None DOI: 10.4103/2230-973X.176456 Many patients with advanced type 2 diabetes mellitus (T2DM) and all patients with T1DM require insulin to keep blood glucose levels in the target range. The most common route of insulin administration is subcutaneous insulin injections. There are many ways to deliver insulin subcutaneously such as vials and syringes, insulin pens, and insulin pumps. Though subcutaneous insulin delivery is the standard route of insulin administration, it is associated with injection pain, needle phobia, lipodystrophy, noncompliance and peripheral hyperinsulinemia. Therefore, the need exists for delivering insulin in a minimally invasive or noninvasive and in most physiological way. Inhaled insulin was the first approved noninvasive and alternative way to deliver insulin, but it has been withdrawn from the market. Technologies are being explored to make the noninvasive delivery of insulin possible. Some of the routes of insulin administration that are under investigation are oral, buccal, nasal, peritoneal and transdermal. This review article focuses on the past, present and future of various insulin delivery techniques. This article has focused on different possible routes of insulin administration with its advantages and limitation and possible scope for the new drug d Continue reading >>

Route And Rate Of Insulin Administration In Diabetic Ketoacidosis

Route And Rate Of Insulin Administration In Diabetic Ketoacidosis

DOI: This article does not have an abstract to display. Continue reading >>

Insulin Administration

Insulin Administration

Insulin is a protein formed by two cross-linked peptide chains. Insulin is secreted in pulses by the pancreas and reaches the liver via the portal circulation. Some 80% of the insulin reaching the liver is cleared from the circulation, which means that insulin attains much higher concentrations in the liver than in the peripheral circulation. Insulin has a short plasma half-life (3-4 minutes), and choice of the route and timing of insulin administration is a major determinant of metabolic control. Conventional insulin injections are given into the thigh, abdomen or outer side of the buttock. Standard needles range from 0.8 - 1.6 cm in length, are used with a syringe or pen device and deliver insulin into the subcutaneous fat. Too long a needle or poor injection technique can result in injection into a muscle, which is painful and results in more rapid absorption of insulin. Many alternative routes of administration have been tested, but none can match direct injection or infusion. Subcutaneous insulin injection or infusion share the disadvantages of delivery into the systemic rather than portal circulation, and rates of appearance in the blood stream which are delayed and rendered somewhat erratic by the process of absorption from subcutaneous tissues. Characteristics of an ideal insulin administration system Nature has placed the pancreatic beta cell inside a digestive gland and astride an arterial supply that continuously samples the rate of nutrient absorption from the gut. It responds instantaneously to these blood-borne signals by releasing insulin in synchronised pulses, a pattern of secretion that maximises its effect on liver cells. Furthermore, it matches this insulin secretion with reciprocal suppression or release of its partner hormone pancreatic glucagon, t Continue reading >>

Non-invasive Routes For Insulin Administration: Current State And Perspectives

Non-invasive Routes For Insulin Administration: Current State And Perspectives

Diabetes mellitus is a chronic disease that usually requires multiple insulin injections to achieve adequate glycaemic control. This represents a major cause of reduced compliance to treatment. Consequently, other routes for insulin administration have been explored. During recent years, much progress in the development of inhaled insulin has been made. Inhaled insulin has shown favourable properties, such as a rapid onset of action, improved bioavailability and good tolerability; thereby providing satisfaction and ease of administration. However, long-term safety of inhaled insulin needs to be assessed, and the cost would be higher than injectable insulin. Nasal, oral and transdermal insulins are undergoing early phases of pharmacological development. The purpose of this review is to describe the latest developments in the area of non-invasive routes for insulin delivery. Continue reading >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex Make sure you have the type (beef and pork, pork, or human) and the strength of insulin that your doctor ordered for you. You may find that keeping an insulin label with you is helpful when buying insulin supplies. The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin. Insulin doses are measured and injected with specially marked insulin syringes. The appropriate syringe is chosen based on your insulin dose to make measuring the dose easy to read. This helps you measure your dose accurately. These syringes come in three sizes: 3/10 cubic centimeters (cc) measuring up to 30 USP Units of insulin, ½ cc measuring up to 50 USP Units of insulin, and 1 cc measuring up to 100 USP Units of insulin. It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body. There are several important steps that will help you successfully prepare your insulin injection. To draw the insulin up into the syringe correctly, you need to follow these steps: Wash your hands with soap and water. If your insulin contains zinc or isophane (normally cloudy), be sure that it is completely mixed. Mix the insulin by slowly rolling the bottle between your hands or gently tipping the bottle over a few times. Never shake the bottle vigorously (hard). Do not use the insulin if it looks lumpy or grainy, seems unusually thick, sticks to the bottle, or seems to be even a little discolored. Do not use the insulin if it contains crystals or if the bottle looks frosted. Regular insulin (short-acting) should be used only if it is clear and colorless. Remove the colored protective cap on the bottle. Do not Continue reading >>

Alternative Routes Of Administration As An Approach To Improve Insulin Therapy: Update On Dermal, Oral, Nasal And Pulmonary Insulin Delivery

Alternative Routes Of Administration As An Approach To Improve Insulin Therapy: Update On Dermal, Oral, Nasal And Pulmonary Insulin Delivery

Abstract: For the past 75 years subcutaneous injections have been the only route of delivery of insulin therapy to diabetic patients. During this time, numerous attempts have been made to explore alternative routes for systemic insulin administration. However, thus far, no feasible other way of non-invasive insulin delivery has been developed. Dermal insulin application does not result in a reproducible and sufficient transfer of insulin across the highly efficient skin barrier. The dream of an insulin tablet has also not become a reality, the main problem being digestion and a lack of a specific peptide carrier system in the gut. Nasal insulin application was considered for a number of years as a potential method, because of the rapid absorption of insulin across the nasal mucosa. However, relative bioavailability was low and required use of absorption enhancers and more importantly, the metabolic effect lasted too short to be of clinical usefulness. To date the most promising alternative route of insulin administration, is the pulmonary delivery of insulin by inhalation which will likely lead to a practically usable system within the next few years. For maximal rate of absorption insulin must be applied deep into the lung, i.e., into the alveoli. A considerable number of inhalers (in combination with appropriate insulin formulations), which are ask to generate insulin particles with an appropriate size for pulmonary delivery, are currently in the clinical phase of development. The pharmacodynamic effects of insulin formulations administered via the lung are comparable to, or even faster than, those of s.c. injected regular insulin or rapid-acting insulin analogues. The relative biopotency of inhaled insulin in most cases is approximately 10percent, i.e., the dose of i Continue reading >>

Insulin Injection Sites: Where And How To Inject

Insulin Injection Sites: Where And How To Inject

Insulin is a hormone that helps cells use glucose (sugar) for energy. It works as a “key,” allowing the sugar to go from the blood and into the cell. In type 1 diabetes, the body doesn’t make insulin. In type 2 diabetes, the body doesn’t use insulin correctly, which can lead to the pancreas not being able to produce enough — or any, depending on the progression of the disease —insulin to meet your body’s needs. Diabetes is normally managed with diet and exercise, with medications, including insulin, added as needed. If you have type 1 diabetes, insulin is required for life. This may seem difficult at first, but you can learn to successfully administer insulin with the support of your healthcare team, determination, and a little practice. There are different ways to take insulin, including syringes, insulin pens, insulin pumps, and jet injectors. Your doctor will help you decide which technique is best for you. Syringes remain a common method of insulin delivery. They’re the least expensive option, and most insurance companies cover them. Syringes Syringes vary by the amount of insulin they hold and the size of the needle. They’re made of plastic and should be discarded after one use. Traditionally, needles used in insulin therapy were 12.7 millimeters (mm) in length. Recent research shows that smaller 8 mm, 6 mm, and 4 mm needles are just as effective, regardless of body mass. This means insulin injection is less painful than it was in the past. Insulin is injected subcutaneously, which means into the fat layer under the skin. In this type of injection, a short needle is used to inject insulin into the fatty layer between the skin and the muscle. Insulin should be injected into the fatty tissue just below your skin. If you inject the insulin deeper int Continue reading >>

Insulin Administration: Present Strategies And Future Directions For A Noninvasive (possibly More Physiological) Delivery

Insulin Administration: Present Strategies And Future Directions For A Noninvasive (possibly More Physiological) Delivery

Authors Matteucci E, Giampietro O, Covolan V, Giustarini D, Fanti P, Rossi R Accepted for publication 12 February 2015 Checked for plagiarism Yes Peer reviewer comments 3 Editor who approved publication: Professor Shu-Feng Zhou 1Department of Clinical and Experimental Medicine, 2Department of Chemistry and Industrial Chemistry, University of Pisa, 3Department of Life Sciences, Laboratory of Pharmacology and Toxicology, University of Siena, Siena, Italy; 4Division of Nephrology, University of Texas Health Science Center San Antonio, South Texas Veteran Health Care System, San Antonio, Texas, USA Abstract: Insulin is a life-saving medication for people with type 1 diabetes, but traditional insulin replacement therapy is based on multiple daily subcutaneous injections or continuous subcutaneous pump-regulated infusion. Nonphysiologic delivery of subcutaneous insulin implies a rapid and sustained increase in systemic insulin levels due to the loss of concentration gradient between portal and systemic circulations. In fact, the liver degrades about half of the endogenous insulin secreted by the pancreas into the venous portal system. The reverse insulin distribution has short- and long-term effects on glucose metabolism. Thus, researchers have explored less-invasive administration routes based on innovative pharmaceutical formulations, which preserve hormone stability and ensure the therapeutic effectiveness. This review examines some of the recent proposals from clinical and material chemistry point of view, giving particular attention to patients’ (and diabetologists’) ideal requirements that organic chemistry could meet. Keywords: type 1 diabetes mellitus, drug formulations, drug administration routes, insulin, portal system, nanoparticles, biodegradable polymers Pati Continue reading >>

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