Insulin Therapy Revised
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Transcript of Insulin Therapy Revised
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INSULIN THERAPY
Olagunju Timilehin
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OUTLINE
IntroductionTypes of insulin
Indications for insulin therapyPrinciples of insulin therapy
ComplicationsMonitoring glycaemic control
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INTODUCTION
The beta islet cells of the pancreasproduce insulin
Insulin is an anabolic hormone that
functions primarily in facilitatingglucose uptake by cells
It has effects on the: liver, skeletal
muscles and fat cells
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METABOLIC ACTIONS OF INSULIN
Increase (anabolic) Decrease
Carbohydrate metabolism gluconeogenesis
Glucose transport glycogenolysis
Glycogenesis
glycolysis
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METABOLIC ACTION OF INSULIN
Insulinincrease(anabolic) Insulin decrease
Lipid metabolism
Triglyceride synthesis lipolysis
Fatty acid synthesis ketogenesis
Protein metabolism
Protein synthesis Protein degradation
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INDICATIONS FOR INSULIN THERAPY
Type 1 diabetes mellitus Pregnant or breastfeeding diabetic
women
Special conditions in type 2 DM(transient use): surgery, infection,stressful conditions)
Inadequate control in type 2 DM onoral antidiabetic drugs
Diabetic emergencies: DKA, HONK
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TYPES OF INSULIN
Based on the source:Porcine(pigs),bovine (sheep), recombinantDNA insulin (humans)
Based on the duration of action:rapidacting, short acting, intermediateacting, long acting.
Based on route of administration:injectable or inhaled.
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Type Onset-hrs
Peak-hrs Duration-hrs
Rapid: lispro 24 or more
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EXAMPLES OF INJECTABLE INSULIN
Rapid acting insulin: lispro and aspart,very fast onset of action, more rapidlyremoved from circulation.
Short-acting insulin: regular/soluble,suitable for multiple dose regimen, forintravenous infusion in labour and duringdiabetic emergencies.
disadv: enters circ too slowly and effectpersists long after meal, predisposing tohypoglycaemia.
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Intermediate acting insulin:NPH(neutral protamine hagedorn)and lente. Protamine/zinc is added to
human/aml insulin to aid formation ofinsulin crystals which dissolve slowly.They are premixed with soluble insulin
to form stable mixtures30%soluble+70%NPH
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Long-acting insulin: ultralente,glargine, determir.
Insulin glargine: decreased solubility at
physiologic pH which prolongs itsaction.
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MODES OF ADMINISTRATION
Syringes: plastic, pen Infusion pumps (CSII) continous subcutaneous
insulin injection.Adv: basal overnight infusion can be programmed
to fit each patients need
Disadv: nuisance of being attached to a pump,skin infection, risk of ketoacidosis if insulin flow isbroken.
Inhalation:
only short acting insulin can be given via thisroute.only 10% of administered insulin reaches thecirculation.
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PRINCIPLES OF INSULIN THERAPY
Normal: there is a baseline insulinsecretion and insulin secretion due to araised plasma glucose level
Insulin therapy is aimed at mimicking this. Total dose of insulin require per day:
0.5 1.0/kg/day
Common regimen used: twice dailyinjection of an intermediate and short-acting insulin before breakfast and after
dinner.
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2/3 AM: 2/3 of intermediate actinginsulin
1/3 of short acting insulin
1/3AM: 2/3 of intermediate actinginsulin
1/3 of short acting insulin
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PRINCIPLES OF INSULIN THERAPY
Insulin injection:Use a sharp needle
Inject subcutaneously
Children and young adults- 31G, 6mmOlder adults- 30G, 8mm
Insert needle to its full length
Sites: abdomen> arm> thighChange site of insulin regularly
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COMPLICATIONS
Hypoglycaemia: commonestSymptoms develop -
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