Why Insulin Injections Are Given For Type 2 Diabetes Mellitus Despite Insulin Resistance?
Diabetes is progressive disease. When you first time detect high blood sugars or diabetes almost 50% of beta cells are exhausted. As the disease progresses beta cell reserve keep on decreasing ( this beta cell exhaustion is even faster if you use insulin secretagouges like sulfonylureas) and finally a stage arrives where external or exogenous insulin is required to control blood sugars( this will remain lifetime ). 2. When you give external insulin especially IV it increases insulin sensitivity. And also reverses glucotoxicity (sustained hyperglycemia puts beta cell in non secretary refractory period ). In layman term you can say External insulin reduces pressure on beta cells so they can start functioning again. Weight loss and exercise also decreases insulin resistance by increasing GLUT 4 receptor transloction to surface of muscle and fat cells increasing glucose intake by then. This also enhance when you give external insulin. Other stress conditions like illness surgery etc we use insulin to avoid any drug reactions and easy monitoring for dose adjustments. Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Clifford Whittaker given medal for living with diabetes for 80 years
- NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes
Subcutaneous Rapid-acting Insulin Analogues For Diabetic Ketoacidosis
Abstract Background Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of uncontrolled diabetes that mainly occurs in individuals with autoimmune type 1 diabetes, but it is not uncommon in some people with type 2 diabetes. The treatment of DKA is traditionally accomplished by the administration of intravenous infusion of regular insulin that is initiated in the emergency department and continued in an intensive care unit or a high-dependency unit environment. It is unclear whether people with DKA should be treated with other treatment modalities such as subcutaneous rapid-acting insulin analogues. Objectives To assess the effects of subcutaneous rapid-acting insulin analogues for the treatment of diabetic ketoacidosis. We identified eligible trials by searching MEDLINE, PubMed, EMBASE, LILACS, CINAHL, and the Cochrane Library. We searched the trials registers WHO ICTRP Search Portal and ClinicalTrials.gov. The date of last search for all databases was 27 October 2015. We also examined reference lists of included randomised controlled trials (RCTs) and systematic reviews, and contacted trial authors. Selection criteria We included trials if they were RCTs comparing subcutaneous rapid-acting insulin analogues versus standard intravenous infusion in participants with DKA of any age or sex with type 1 or type 2 diabetes, and in pregnant women. Data collection and analysis Two review authors independently extracted data, assessed studies for risk of bias, and evaluated overall study quality utilising the GRADE instrument. We assessed the statistical heterogeneity of included studies by visually inspecting forest plots and quantifying the diversity using the I² statistic. We synthesised data using random-effects model meta-analysis or descriptive analysis Continue reading >>
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 >>
Subcutaneous Rapid-acting Insulin Analogues For Diabetic Ketoacidosis
Review question What are the effects of subcutaneous rapid-acting insulin analogues compared with standard intravenous infusion of regular insulin for the treatment of diabetic ketoacidosis? Background Rapid-acting insulin analogues (artificial insulin such as insulin lispro, insulin aspart, or insulin glulisine) act more quickly than regular human insulin. In people with a specific type of life-threatening diabetic coma due to uncontrolled diabetes, called diabetic ketoacidosis, prompt administration of intravenous regular insulin is standard therapy. The rapid-acting insulin analogues, if injected subcutaneously, act faster than subcutaneously administered regular insulin. The need for a continuous intravenous infusion, an intervention that usually requires admission to an intensive care unit, can thereby be avoided. This means that subcutaneously given insulin analogues for diabetic ketoacidosis might be applied in the emergency department and a general medicine ward. Study characteristics We found five randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) with a total of 201 participants. Most trials did not report on type of diabetes. Younger diabetic participants and children were underrepresented in our included trials (one trial only). Participants in four trials received treatment with insulin lispro, and one trial with 45 participants investigated insulin aspart. The average follow-up as measured by mean hospital stay ranged between two and seven days. The study authors termed the diabetic ketoacidosis being treated with insulin analogues or regular insulin as mild or moderate. This evidence is up to date as of October 2015. Key results Our results are most relevant for adults with mild or modera Continue reading >>
Matched Glucose Responses To Insulin Administered Subcutaneously And Intravenously
Summary A new technique of programmed intra-venous insulin infusion at a series of decreasing rates has been used to imitate the magnitude and time course of biological responses obtained by the subcutaneous route. Groups of normal rats prepared with indwelling venous cannulae were injected subcutaneously with soluble porcine insulin, 0.4U/kg. The pattern of the resulting hypoglycaemic response was subsequently matched by a 2-hour intravenous insulin infusion at rates decreasing stepwise from 0.3 to 0.05 U kg-1h-1. The total amount of insulin infused intravenously was only 50% of that required subcutaneously. In addition, subcutaneous or intravenous infusions of insulin at 0.05 U kg-1h-1 were given to two groups of rats from the same batch. When both infusions were continued until plateau responses were reached, a significantly greater lowering of plasma glucose was caused by the intravenous route. These results suggest that when insulin is given subcutaneously significant inactivation of the insulin occurs at or near the injection site. Continue reading >>
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
Transitioning Safely From Intravenous To Subcutaneous Insulin
Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention. Common hospital uses for IV insulin include the perioperative setting, during the use of high-risk medications (such as corticosteroids), or during crises such as diabetic ketoacidosis (DKA) [1,2]. Other conditions such as hyperglycemic hyperosmolar state (HHS) and trauma frequently require IV insulin, as well as specific hospital units such as the cardiothoracic intensive care unit [3,4]. The correlation between hyperglycemia and poor inpatient outcomes has been well described in the literature [5,6]. The treatment of hyperglycemia using an IV Continue reading >>
Insulin Lispro (intravenous Route, Subcutaneous Route)
Description and Brand Names Drug information provided by: Micromedex US Brand Name Humalog Lispro-PFC Descriptions Insulin lispro is a fast-acting type of insulin. Insulin is one of many hormones that help the body turn the food we eat into energy. This is done by using the glucose (sugar) in the blood as quick energy. Also, insulin helps us store energy that we can use later. When you have diabetes mellitus, your body cannot make enough or does not use insulin properly. So, you must take additional insulin to regulate your blood sugar and keep your body healthy. This is very important as too much sugar in your blood can be harmful to your health. Insulin lispro starts to work faster than some other types of insulin, and its effects do not last as long. It should act more like the insulin your body would normally produce. Because the effects of insulin lispro are short-acting, your doctor may also prescribe a longer-acting insulin for you to use. This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Suspension Copyright © 2017 Truven Health Analytics Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Continue reading >>
7.3 Intradermal And Subcutaneous Injections
Intradermal injections (ID) are injections administered into the dermis, just below the epidermis. The ID injection route has the longest absorption time of all parenteral routes. These types of injections are used for sensitivity tests, such as TB (see Figure 7.13), allergy, and local anesthesia tests. The advantage of these tests is that the body reaction is easy to visualize, and the degree of reaction can be assessed. The most common sites used are the inner surface of the forearm and the upper back, under the scapula. Choose an injection site that is free from lesions, rashes, moles, or scars, which may alter the visual inspection of the test results (Lynn, 2011). Equipment used for ID injections is a tuberculin syringe calibrated in tenths and hundredths of a millilitre, and a 1/4 to 1/2 in., 26 or 27 gauge needle. The dosage of an ID injection is usually under 0.5 ml. The angle of administration for an ID injection is 5 to 15 degrees. Once the ID injection is completed, a bleb (small blister) should appear under the skin. Checklist 56 outlines the steps to administer an intradermal injection. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Do not aspirate. It is not necessary to aspirate because the dermis is relatively without vessels. Always take steps to eliminate interruptions and distractions during medication preparation. If the patient expresses concerns about the medication or procedure, stop and explore the concerns. Re-verify order with physician if appropriate. Steps Additional Information 1. Prepare medication or solution as per agency policy. Ensure all medication is properly identified. Check physician orders, Parenteral Drug Therapy Manual (PDTM), and MAR to validate medication order and guidelines for admin Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- New diabetes treatment could eliminate need for insulin injections
- Smart Insulin Patch Could Replace Painful Injections for Diabetes
Structural Biochemistry/subcutaneous
A subcutaneous injection (SC, SQ, SubQ) is a method of drug administration in which the drug is injected into hypodermis, the fatty tissue layer directly beneath the dermis and epidermis. Because there is limited blood flow to the hypodermis, subcutaneous injection is usually used when slow absorption of medication is preferred.[1] Drugs that are administered using this method must be soluble and potent in small concentrations. Common medications used with this procedure include heparin, insulin, growth hormones, and vaccines against MMR and varicella. With subcutaneous injection, the drug is usually administered through loose interstitial tissues of the upper arm, the anterior surface of the thigh, the lower portion of the abdomen, or the lower back. When injecting, the skin is pinched up to prevent injection into muscle. It is recommended to use the same site for routine injections. The shot is given at a straight 90 degree angle if at least 2 inches of skin can be grasped. Otherwise, it is given at a 45 degree angle.[2] Factors that may increase absorption rate are heat, massaging, co-administers vasodilators, or hyaluronidase at the site of injection. Epinephrine may decrease the absorption rate due to decreased blood flow. Continue reading >>
Subcutaneous Or Intramuscular Insulin Injections.
Abstract To find out whether diabetic children may inject their insulin intramuscularly rather than subcutaneously, a random sample of 32 patients aged 4.3-17.9 (median 11.3) years was studied. Distance from skin to muscle fascia was measured by ultrasonography at standard injection sites on the outer arm, anterior and lateral thigh, abdomen, buttock, and calf. Distances were greater in girls (n = 15) than in boys (n = 17). Whereas in most boys the distances were less than the length of the needle (12.5 mm) at all sites except the buttock, in most girls, the distances were greater than 12.5 mm except over the calf. Over the fascial plane just lateral to the rectus muscle the distance from skin to peritoneum was less than 12.5 mm in 14 of the 17 boys and one of the 15 girls. Twenty five of the 32 children injected at an angle of 90 degrees, and 24 children raised a skinfold before injecting. By raising a skinfold over the anterior thigh, the distance from skin to muscle fascia was increased by 19% (range 0-38%). We conclude that most boys and some girls who use the perpendicular injection technique may often inject insulin into muscle, and perhaps on occasions into the peritoneal cavity. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (773K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- New diabetes treatment could eliminate need for insulin injections
- Smart Insulin Patch Could Replace Painful Injections for Diabetes
Subcutaneous Injections
Subcutaneous Sites: Indications for Subcutaneous Injections: The onset of action for subcutaneous ( SC, SQ) injections is usually slower than for intramuscular (IM) injections (heparin is absorbed as quickly when given SC). The medications given SC are isotonic, nonirritating, and water-soluble; examples are epinephrine, insulin, heparin. The dosage that can be given SC is less than 1 ml. Equipment: The amount of adipose tissue determines the needle length and angle of insertion. Use what is needed to deliver the medication into the subcutaneous tissue. In general, a 25g, 5/8 inch needle is inserted at a 45-90 degree angle. The needle-length should be 1/2 of the depth of the skinfold. A rule of thumb is that if the skinfold depth is 2 inches, inject using a 90 degree angle; if the depth is 1 inch, inject using a 45 degree angle. Subcutaneous Compared to Intramuscular Injection: Subcutaneous Tissue: Continue reading >>
How To Give A Subcutaneous Injection
Reader Approved Three Parts:Preparing for a Subcutaneous InjectionDrawing a Dose of MedicationGiving a Subcutaneous InjectionCommunity Q&A A subcutaneous injection is an injection administered into the fatty area just under the skin (as opposed to an intravenous injection, which is administered directly into the bloodstream). Because they give a slower, more gradual release than intravenous injections, subcutaneous injections are frequently used as a way to administer both vaccines and medications (for instance, type I diabetics often use this type of injection to administer insulin.). Prescriptions for medications requiring subcutaneous injections are usually accompanied by detailed instructions on the correct way to give the injection. The instructions in this article are intended to be used only as a guideline - contact a medical professional before you give any injections at home. Read on below the jump for detailed instructions. 1 Gather your supplies. Performing a subcutaneous injection properly requires more than just a needle, syringe, and medicine. Before proceeding, make sure you have the following: A sterile dose of your medication or vaccine (usually in a small, labeled vial) A suitable syringe with a sterile needle tip. Depending on the size of your patient and the amount of medication to be administered, you may choose to use one of the following configurations or another safe, sterile means of injection: A 0.5, 1, or 2 cc syringe with a 27-gauge needle A 3 cc luer lock syringe (for large doses) A pre-filled, disposable syringe A sterile gauze pad (usually 2 x 2 inch) A sterile adhesive bandage (note - make sure the patient is not allergic to the adhesive, as can lead to irritation near the wound) A clean towel 2 Ensure you have the correct medication and Continue reading >>
The Pharmaceutics And Compounding Laboratory
The subcutaneous (SC, SQ) route is one of the most versatile routes of administration in that it can be used for both short term and very long term therapies. The injection of a drug or the implantation of a device beneath the surface of the skin is made in the loose interstitial tissues of the upper arm, the anterior surface of the thigh, or the lower portion of the abdomen. The upper back also can be used as a site of subcutaneous administration. The site of injection is usually rotated when injections are frequently given. The maximum amount of medication that can be subcutaneously injected is about 2 ml. Needles are generally 3/8 to 1 inch in length and 24 to 27 gauge. Absorption of drugs from the subcutaneous tissue is influenced by the same factors that determine the rate of absorption from intramuscular sites (slowly soluble salt forms, suspensions versus solutions, differences in particle size, viscosity of the injection vehicle, etc.); however, the vascularity in the subcutaneous tissue is less than that of muscle tissue, and therefore absorption may be slower than after intramuscular administration. But absorption after subcutaneous administration is generally more rapid and predictable than after oral administration. There are several ways to change the absorption rate: use heat or massage the site to increase the absorption rates of many drugs. co-administer vasodilators or hyaluronidase to increase absorption rates of some drugs. Conversely, epinephrine decreases blood flow which can decrease the absorption rate. Many different solution and suspension formulations are given subcutaneously. Heparin, enoxaparin, and insulin are the most important drugs routinely administered by this route. Drugs that are administered by the route must be soluble and potent in Continue reading >>
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Why Is Insulin Absorbed Quickly/quickest When Injected Into The Abdomen?
TID 50 years: Note: the following is not to be taken as medical advice or opinion\ I was attending the Diabetes clinic at Royal Prince Alfred Hospital when in 1979 one of the doctors there did some research on insulin absorption. He found that insulin injected into the subcutaneous tissue of the abdomen in diabetics was more quickly absorbed than from other common subcutaneous sites. It was also noted, as I think was known at the time, that vigorous exercising of an area around a subcutaneous site such as the thigh could increase insulin absorption from that site. I have not seen any explanation given as to why insulin is absorbed more quickly from the abdominal subcutaneous tissue. Continue reading >>
Injecting Insulin
Tweet Injecting insulin is an essential part of the daily regime for many diabetics. Although insulin that can be inhaled is now available and approved, the reality is that most type 1 diabetics (and type 2 diabetics who require insulin) will have to continue injecting insulin until it is more common. Does injecting insulin hurt? Needle technology for insulin injection has become much better in recent years, meaning that the injection process, although not pain-free, does not hurt as much as it used to. Many patients still find injecting insulin to manage their diabetes an unpleasant process, however. Is injecting insulin and having diabetes going to change my life? Unfortunately, having diabetes does lead to lifestyle complications. For insulin therapy to be effective, it is necessary to make certain lifestyle changes. These should include: eating healthily exercising regularly testing blood glucose regularly and following a strict insulin regimen Although adhering to all these changes does influence your daily routine, the benefits for diabetics are enormous. Into what part of my body should I inject insulin to best help my diabetes? The abdomen is the most common site for injecting insulin. For some people, this site is not suitable, and other sites must be used. These include the upper arms, the upper buttocks and the outside of the thigh. All of these sites are most effective because they have a layer of fat to absorb the insulin better. This process directly injects insulin into the subcutaneous tissue. These areas also have fewer nerve endings, meaning that they are the least painful areas in which to inject. Should I switch the site where I inject insulin? Your healthcare team should be able to help you to decided the best places to inject insulin, when you shou Continue reading >>
- Man Accused Of Injecting Illegal Drugs At Bus Stop Wants To Raise Greater Awareness Of Diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Calculating Insulin Dose
