Clinical Utility Of Insulin And Insulin Analogs
Go to: Introduction Diabetes mellitus is characterized by elevated blood glucose levels as a result of insulin deficiency and/or increased hepatic glucose production. The International Diabetes Foundation declared that 371 million people currently have diabetes with a worldwide prevalence of 8.3%.1,2 In addition, 4.6 million deaths (8.2% globally) were attributed to diabetes in 2011.3 According to the most recent CDC reports, diabetes is the third most common disease and the seventh leading cause of death in North America. Intriguingly, half of the patients with diabetes are not even aware they have the disease. There are two main forms of diabetes.4 The most common form in humans is type-2 diabetes (T2DM), which accounts for approximately 90% of all diabetes cases. T2DM generally starts with the loss of insulin sensitivity, but the disease eventually leads to impaired β cell function. At least 50% of T2DM patients will require insulin treatment during the disease course. Type-1 diabetes (T1DM) is the less common form (10%) and is characterized by autoimmune destruction of pancreatic islet β cells resulting in insulin deficiency.5 The molecular pathogenesis of T1DM is not well defined; however, it is generally accepted that environmental and/or genetic factors may predispose individuals to T1DM.6 Because of the complete lack of insulin, treatment with exogenous insulin is the mainstay of treatment in patients with T1DM. While hyperglycemia is a common denominator in both T1DM and T2DM, the clinical features and pathophysiology vary greatly between the two diseases.7 Since prolonged exposure to hyperglycemia can cause vascular complications leading to multiple organ failure, proper control of blood glucose is vital to avert diabetes and limit the development of chronic Continue reading >>
Insulin Therapy
Why do I need to take insulin? When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems. All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible so you’ll stay healthy. Insulin can’t be taken by mouth. It is usually taken with injections (shots). It can also be taken with an insulin pen or an insulin pump. How often will I need to take insulin? You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day. Do I need to monitor my blood sugar level? Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You can read the results yourself or insert the strip into a machine called an electronic glucose meter. The results will tell you whether or not your blood sugar is in a healthy range. Your doctor will give you additional information about monitoring your blood sugar. When should I take insulin? You and your doctor should discuss when and how you Continue reading >>
Insulin-toronto | Definition Of Insulin-toronto By Medical Dictionary
Insulin-Toronto | definition of Insulin-Toronto by Medical dictionary Related to Insulin-Toronto: Novolin ge NPH 1. the major fuel-regulating hormone of the body, a double-chain protein formed from proinsulin in the beta cells of the islets of Langerhans in the pancreas . Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis. Secretion of insulin is a response of the beta cells to a stimulus; the primary stimulus is glucose, and others are amino acids and hormones such as secretin, pancreozymin , and gastrin . These chemicals play an important role in maintaining normal blood glucose levels by triggering insulin release after a meal. After insulin is released from the beta cells, it enters the blood stream and is transported to cells throughout the body. The cell membranes have insulin receptors to which the hormone becomes bonded or fixed. An interaction between the insulin and its receptors leads to biochemical processes that include (1) the transport of glucose, amino acids, and certain ions across the membrane and into the cell body; (2) the storage of glycogen in liver and muscle cells; (3) the synthesis of triglycerides and storage of fat; (4) the synthesis of protein, RNA, and DNA, and (5) inhibition of gluconeogenesis, degradation of glycogen and protein, and lipolysis. Although insulin increases the transport of glucose across the cell membrane of most cells, in the brain glucose enters the cells by simple diffusion through the blood--brain barrier. 2. a preparation of the hormone, first discovered in 1921, used in treatment of diabetes mellitus ; it may be bovine or porcine in origin (prepared from the pancreas of the animals) or a recombinant human type, althou Continue reading >>
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 >>
Humulin R
HUMULIN®R (regular insulin human) Injection, USP (rDNA Origin) 100 Units per ML (U-100) DESCRIPTION Humulin® R U-100 is a polypeptide hormone structurally identical to human insulin synthesized through rDNA technology in a special non-disease-producing laboratory strain of Escherichia coli bacteria. Humulin R (insulin human recombinant) U-100 has the empirical formula C257H383N65O77S6 and a molecular weight of 5808. Humulin R (insulin human recombinant) U-100 is a sterile, clear, aqueous, and colorless solution that contains human insulin (rDNA origin) 100 units/mL, glycerin 16 mg/mL and metacresol 2.5 mg/mL, endogenous zinc (approximately 0.015 mg/100 units) and water for injection. The pH is 7.0 to 7.8. Sodiumhydroxide and/or hydrochloric acid may be added during manufacture to adjust the pH. Adequate insulin dosage permits patients with diabetes to effectively utilize carbohydrates, proteins and fats. Regardless of dose strength, insulin enables carbohydrate metabolism to occur and thus to prevent the production of ketone bodies by the liver. Some patients develop severe insulin resistance such that daily doses of several hundred units of insulin or more are required. Continue reading >>
Pharmacology Chapter 52
Type of insulin: Humalog (Lispro), aspart, exubera. Type of insulin: Humulin N (NPH), Lente. Onset of action is 2 to 4 hours. How often is Long-acting insulin Lantus (Insulin Glargine) An interaction between insulin and thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking have what effect? Low sugar levels. Side effects: Headache, dizziness, confusion, slurred speech Nervousness, anxiety, agitation Tremors, uncoordination, sweating, tachycardia, seizures High sugar levels. Side effects: Extreme thirst, dry mucous membranes Poor skin turgor, polyuria, fruity breath Fatigue, tachycardia, Kussmaul respirations. Keep in refrigerator. Remove from refrigerator 30 minutes before injection. Avoid storing insulin in direct sunlight or at high temperatures. Criteria for use of oral antidiabetic drugs include what? onset of diabetes mellitus at age 40 years or older, diagnosis of diabetes for less than 5 years, fasting blood glucose equal to or less than 200 mg/dl, fewer than 40 units of insulin required per day, Stimulates beta cells to secrete insulin, alters sensitivity of peripheral insulin receptors. Control hyperglycemia in type 2 diabetes Liver or kidney dysfunction, elderly, malnourished, adrenal or pituitary insufficiency. What is an adverse effect of Glipizide (Glucotrol)? Reduces absorption of glucose from small intestine. It does not produce hypoglycemia nor hyperglycemia. What is caused by an interaction between Metfotmin and Tends to create alteration in the client's liver function tests. Hyperglycemic hormone secreted by alpha cells of the islets of Langerhans in the pancreas A client is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instruction should the nurse include in the teaching of insulin admini Continue reading >>
Insulin Actions Times And Peak Times
A good way to improve your glucose levels is to track the peaks and drops in your glucose , so you can figure out why they happened and how to correct them. Once you identify glucose patterns (they ARE there!), you also want to understand when each of your insulins is active and when they typically stop lowering your glucose. This helps you adjust your doses or food intake to stop unwanted ups and downs in your readings. The table below shows the start, peak, and end times for various insulins with some explanations and typical uses for each. When Does My Insulin Peak and How Long Does It Last? designed to peak, covers meals and lowers high BGs Humalog , Novolog and Apidra insulins currently give the best coverage for meals and help keep the glucose lower afterward. Their glucose lowering activity starts to work about 20 minutes after they are taken, with a gradual rise in activity over the next 1.75 to 2.25 hours. Their activity gradually falls over the next 3 hours with about 5 to 6 hours of activity being common with these insulins.Although insulin action times are often quoted as 3-5 hours, the actual duration of insulin action is typically 5 hours or more. See our article Duration of Insulin Action for more information on this important topic. In general, "rapid" insulins are still too slow for many common meals where the glucose peaks within an hour and digestion is complete within 2-3 hours. The best kept secret on stopping post meal spiking is to eake the injection or bolus earlier before the meal and to eat slower low glycemic carbs. Regular insulin still carries its original name of "fast insulin" but its slower action often works better for people who take Symlin or for those who have gastroparesis (delayed digestion). It is also a great choice for those who Continue reading >>
Insulin Therapy And Hypoglycemia
Hypoglycemia impedes safe achievement of optimal glycemia. The benefits of nearly normal glycemia in reducing microvascular diabetes complications are clear, although the benefits and risk-to-benefit ratio for macrovascular disease is contentious and complex. Overall achievement of excellent glycemia seems beneficial to cardiovascular risk when implemented early in the course of both type 1 and type 2 diabetes. Despite strong evidence of likely benefit, those trying to decrease the risk of micro-vascular complications through intensive glycemic control inevitably face a 3-fold increased risk of severe hypoglycemia, often without warning symptoms and potentially with severe consequences, especially to heart and brain. This is especially true for those with type 1 diabetes mellitus (DM) but also for insulin-deficient patients with type 2 DM (Fig. 1). Studies of glycemic control and diabetes complications before ACCORD (Action to Control Cardiovascular Risk in Diabetes),1 ADVANCE (Action in Diabetes to Prevent Vascular Disease),2 and VADT (Veterans Administration Diabetes Trial)3 indicate that severe hypoglycemia is less common with tight glycemic control in type 2 (see Fig. 1, left) when compared with type 1 DM (see Fig. 1, right). Studies of type 1, such as the DCCT (Diabetes Control and Complications Trial), show that severe insulin reactions occur up to severalfold more than 60 per 100 patient-years and have a threefold increased risk relative to those of control groups with less intensive glucose control. Studies of type 2 diabetes, by contrast, found a risk of severe hypoglycemia with tight glycemic control that was substantially less. It is noteworthy, however, that some studies found an overlap in frequency indicating that some type 2 DM4–12 patients have a risk Continue reading >>
Overdose Of Oral Antidiabetic Medications And Insulin
Overdose of Oral Antidiabetic Medications and Insulin Authors: Diana Strasburger, MD, RDMS, Attending Physician, Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL. Janna H. Villano, MD, Resident Physician, Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL. Peer Reviewer: Gina Piazza, DO, Associate Professor of Emergency Medicine, Georgia Health Sciences University, Augusta, GA. — Sandra M. Schneider, MD, Editor Treating the hypoglycemia and metabolic derangements caused by antidiabetic medications, especially in massive overdose, are dynamic as new agents are introduced. Emergency physicians should know potential pitfalls in order to effectively and safely manage these patients, avoiding rebound hypoglycemia and premature discharge without appropriate monitoring. This article will review the clinical presentation and management of toxicity from commercially available antidiabetic agents in the United States, including oral hypoglycemic agents such as sulfonylureas and oral antihyperglycemic agents such as biguanides, as well as novel antidiabetic agents and insulin. Introduction Diabetes mellitus (DM) is an ever-increasing epidemic facing the current health care system. Its prevalence is increasing worldwide from an estimated 30 million in 1985 to 150 million in 2000, 171 million in 2007, and an anticipated 366 million in 2030.1,2 Medications used to treat diabetes are diverse, and often patients use multiple classes of medications to obtain euglycemia. Oral preparations can be divided into two categories based on their pharmacodynamics and effect or lack of an effect on insulin: hypoglycemic agents such as sulfonylureas and meglitinides; and antihyperglycemic agents such as biguanides, alpha-glucosidase inhibi Continue reading >>
Diabetes Medication
There are different types of medications available for diabetes mellitus with each having their own mechanism of action and side effects. The best drug should be chosen by a doctor assessing the condition of the patient – please note all these are prescription medicines and need to be taken properly, under medical-supervision and with correct dosage and at the right timings. You must, at all times, follow instructions from your doctor. Never self-medicate. Basically, anti-diabetic drugs can be categorized into two classes: A. Oral anti-diabetic drugs: This includes the following classes: Insulin secretagogues: sulphonylureas and non-sulphonylureas(Glinides/Meglitinide) Biguanides Thiazolidinediones a-glucosidase inhibitors Di-peptydyl Peptidase-4 (DPP-4) inhibitors/gliptins Sodium-glucose co-transporter 2 (SGLT2) inhibitors B. Injectable anti-diabetic drugs: Insulin preparations Glucagon-like peptide 1 (GLP1) agonists According to A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes, a tier system is used to prescribe medicines depending on how validated (tested) the medication is. The tier is divided into steps depending on the stage of diabetes and how the patient responds to the lifestyle changes and medicines. Tier 1: This includes the best established, most-effective and most cost effective therapeutic strategies to control blood sugar. This is also the most preferred strategy for patients with type 2 diabetes. The tier is divided into 3 steps. Step 1: These are prescribed at when someone is diagnosed with type 2 diabetes. Apart from a lifestyle change, a mild medication that is well tested, has low and less severe side-effects and is cheap is prescribed. Step 2: A second medication is added when step 1 Continue reading >>
Insulin Regular - Medcircle
Diabetes mellitus: SubQ: Note: Insulin requirements vary dramatically between patients and therapy requires dosage adjustments with careful medical supervision. Specific formulations may require distinct administration procedures; please see individual agents. Note: Multiple daily doses or continuous subcutaneous infusions guided by blood glucose monitoring are the standard of diabetes care. Combinations of insulin formulations are commonly used. The daily doses presented below are expressed as the total units/kg/day of all insulin formulations combined. Initial total insulin dose: 0.2 to 0.6 units/kg/day in divided doses. Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. A rapid-acting insulin may be the only insulin formulation used initially. Usual maintenance range: 0.5 to 1 units/kg/day in divided doses. An estimate of anticipated needs may be based on body weight and/or activity factors as follows: Pubescent Children and Adolescents: During puberty, requirements may substantially increase to >1 unit/kg/day and in some cases up to 2 units/kg/day (IDF/ISPAD 2011). Division of daily insulin requirement (conventional therapy): Generally, 50% to 75% of the total daily dose (TDD) is given as an intermediate- or long-acting form of insulin (in 1 to 2 daily injections). The remaining portion of the TDD is then divided and administered before or at mealtimes (depending on the formulation) as a rapid-acting (eg, insulin aspart) or short-acting form of insulin. Some patients may benefit from the use of CSII which delivers rapid-acting insulin (insulin aspart) as a continuous infusion throughout the day and as boluses at mealtimes via an external pump device. Division of daily insulin requirement (intensive t Continue reading >>
Insulin Therapy - An Overview | Sciencedirect Topics
Regular insulin is a crystalline zinc insulin preparation, the effect of which appears within 30 minutes of subcutaneous injection. Mark A. Atkinson*, in Williams Textbook of Endocrinology (Thirteenth Edition) , 2016 Regular insulin consists of zinc-insulin crystals dissolved in a clear fluid. After subcutaneous injection, regular insulin tends to dissociate from its normal hexameric form, first into dimers and then into monomers; only the monomeric and dimeric forms can pass through the endothelium into the circulation to any appreciable degree.309 This feature determines the pharmacokinetic profile of regular insulin. The resulting relative delay in onset and duration of action of regular insulin limits its effectiveness in controlling postprandial glucose and results in dose-dependent pharmacokinetics, with a prolonged onset, peak, and duration of action with higher doses. Thundiparambil Azeez Sonia, Chandra P. Sharma, in Oral Delivery of Insulin , 2014 Capsulin is an oral insulin formulation developed by a UK-based company named Diabetology. The dry powder mixture, which contains insulin, stabilizer and solubilizer, is packaged in an enteric-coated capsule (with 150U) that protects the insulin from gastric degradation. The capsule is declared to pass intact through the stomach to the small intestine. The coating dissolves in the jejunum in an area with neutral pH, and the capsule content is subsequently released. The excipients (an aromatic alcohol and a solubilization aid) are supposed to enhance insulin absorption through the intestinal mucosal layer. Diabetology has performed some early clinicalexperimental proof-of-concept studies in healthy subjects and patients with type 1 diabetes, and more recently a phase IIa randomized, open, crossover study in 16 patient Continue reading >>
Short-acting Insulins
Rapid-Acting Analogues Short-Acting Insulins Intermediate-Acting Insulins Long-Acting Insulins Combination Insulins Onset: 30 minutes Peak: 2.5 - 5 hours Duration: 4 - 12 hours Solution: Clear Comments: Best if administered 30 minutes before a meal. Mixing NPH: If Regular insulin is mixed with NPH human insulin, the Regular insulin should be drawn into the syringe first. Aspart - Novolog ®: Compatible - but NO support clinically for such a mixture. Draw up Novolog first before drawing up Regular Insulin. Lispro - Humalog ®: Compatible - but NO support clinically for such a mixture. Draw up Humalog first before drawing up Regular Insulin. Mixtures should not be administered intravenously. When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin. CLINICAL PHARMACOLOGY Insulin is a polypeptide hormone that controls the storage and metabolism of carbohydrates, proteins, and fats. This activity occurs primarily in the liver, in muscle, and in adipose tissues after binding of the insulin molecules to receptor sites on cellular plasma membranes. Insulin promotes uptake of carbohydrates, proteins, and fats in most tissues. Also, insulin influences carbohydrate, protein, and fat metabolism by stimulating protein and free fatty acid synthesis, and by inhibiting release of free fatty acid from adipose cells. Insulin increases active glucose transport through muscle and adipose cellular membranes, and promotes conversion of intracellular glucose and free fatty acid to the appropriate storage forms (glycogen and triglyceride, respectively). Although the liver does not require active glucose transport, insulin increases hepatic gl Continue reading >>
What Insulin Preparations Could Potentially Cause A Hypoglycemic Reaction Within One Hour?
What insulin preparations could potentially cause a hypoglycemic reaction within one hour? What insulin preparations could potentially cause a hypoglycemic reaction within one hour? Would you like to merge this question into it? already exists as an alternate of this question. Would you like to make it the primary and merge this question into it? Answers.com is making the world better one answer at a time. Lidocaine is used for more than numbing. Because of lidocaine's direct effect on heart muscle cells it is used to help control the rhythm of the heart. So lidocaine can absolutely cause an adverse reaction. That is why close monitoring of patients who are being given lidocaine to treat an irregular heart rhythm is necessary. For general local numbing procedures lidocaine is practically harmless. If it was risky, believe me, there'd be a heart monitor in every dentist's office. can lidocaine cause chemical inblance? in 1998, my son had some dental work he had a seizure in the Dentist chair after that he start hearing and seeing things could this be from the Lidocaine? Adverse reaction can occur following use of Parcaine. This is an anesthetic used as drops to numb the eye prior to certain exams. It may be prevented by manually closing tear ducts to prevent drops from reaching general circulation. {As you would do to prevent Timoptic drops from having a systemic beta blocker effect.) One such reaction can be bradycardia (30-40 bpm) for prolonged time ( hours). No BP or EKG documented. You can have adverse reactions with practically anything you put in your body, either by mouth, injections, or any other routes. I had 2 adverse reactions to lidocaine. The first, a doctor administered lidocaine and I had a severe reaction. I fainted and then started vomiting and was very Continue reading >>
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Course Content - #35322: Diabetes Pharmacology - Netce
Diabetes is a serious and growing problem in the United States. Behavior change, diet, and exercise are first in the line of treatment for this chronic disease. However, diabetes is a progressive disease, and these techniques will only work for a small portion of patients. Oral medications will eventually be necessarily incorporated into treatment plans in order to preserve control of the disease at an optimal level, and injectable medications are started in the second tier of therapy when glucose levels are significantly greater than the goal range. Healthcare professionals are required to sustain a fundamental understanding of diabetes medication classes, including action, maximal safe dosing, and side effects, when caring for their patients. Oral medications for diabetes impact individuals to differing degrees and maintain various safe practice recommendations. Furthermore, although insulin and other injectable medications are beneficial, patient acceptance of injectable medications continues to be a significant barrier to achieving optimal blood glucose control. The emotional stressors can be a substantial barrier to success for individuals and their significant others and/or caregivers. These emotional interferences include needle fears and phobias, ignorance, and time constraints. Patients' responses to the medications, laboratory results for safe, efficacious dosing, and drug effects must all be monitored. This course is designed for nurses in any practice setting with a desire to familiarize themselves with the medications used in the treatment of type 2 diabetes. In support of improving patient care, NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and th Continue reading >>
