LP 3 MG IV Eng, Insulintherapy

8/13/2019 LP 3 MG IV Eng, Insulintherapy

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Insulin therapy



The Discovery of Insulin

• 1916- Nicolae Paulescu isolated the insulin

• 1921- N Paulescu published his papers

•

1923- Frederick Grant Banting and John James RickardMacleod were awarded the Nobel prize for the discovery of

insulin

• 1958- Frederick Sanger determined the primary structure of

insulin, awarded the Nobel Prize in Chemistry

• 1969-Dorothy Crowfoot Hodgkin determined the spatial

conformation of the molecule by X-ray diffraction

http://en.wikipedia.org/wiki/Frederick_Banting

http://en.wikipedia.org/wiki/John_James_Rickard_Macleod


http://en.wikipedia.org/wiki/Nobel_prize

http://en.wikipedia.org/wiki/Frederick_Sanger

http://en.wikipedia.org/wiki/Primary_structure

http://en.wikipedia.org/wiki/Nobel_Prize_in_Chemistry

http://en.wikipedia.org/wiki/Dorothy_Crowfoot_Hodgkin

http://en.wikipedia.org/wiki/Dorothy_Crowfoot_Hodgkin

http://en.wikipedia.org/wiki/Nobel_Prize_in_Chemistry

http://en.wikipedia.org/wiki/Primary_structure

http://en.wikipedia.org/wiki/Frederick_Sanger

http://en.wikipedia.org/wiki/Nobel_prize



http://en.wikipedia.org/wiki/Frederick_Banting



Endocrine pancreas

• Islets of Langerhans- 2% of pancreatic mass

– β cells: insulin, C peptide, amilyn

– α cells: glucagon, GLP-1, GLP-2, glicentin

– δ cells: somatostatin

– PP cells: pancreatic polypeptide



Insulin structure

• Small protein - molecular weight = 5800

Daltons

• Two chains held together by 2 disulfide bonds

– A chain, acid, 21 aa

– B chain, basal, 30 aa



Biosynthesis of insulin

• Preproinsulin – Proinsulin – Insulin + C Peptide

(connecting peptide)



Control of insulin secretion

• Stimuli that promote insulin secretion:

– Primarily: elevated blood glucose concentrations

– Neural stimuli: sight and taste of food

– Amino acids and fatty acids

• Two phases of insulin secretion:

– First- phase : 2’ after nutrient ingestion (10-15’)

– Second phase - sustained until normoglycemia is restored



Physiologic Effects of Insulin

• facilitates entry of glucose into muscle, adipose and several

other tissues (facilitated diffusion – glucose transportors

GLUT; 8 types)

• stimulates the liver to store glucose in the form of glycogen;

inhibits gluconeogenesis;

• promotes synthesis of fatty acids in the liver; inhibits

breakdown of fat in adipose tissue

• Stimulates protein synthesis; anabolic effect (stimulates the

uptake of amino acids)



When to start insulintherapy

• Type 1 diabetes mellitus

• Gestational diabetes

• Type 2 diabetes mellitus

–

Oral medication failed to control blood glucose level – Acute decompensation : sever illness or major surgery

– Pegnancy or breastfeeding

– Hepatic and renal failure

– Allergies to oral medications



Types of insulin

• Basal – slow absorbtion and long action

– Intermediate acting insulin

– Long acting insulin

• Prandial

– Rapid acting

– Short acting

• Combined insulin



Types of insulin

Insulin type/action

(appearance)

Brand names

(generic name in brackets)Dosing Schedule

•Rapid-acting analogue (clear)

•Onset: 10-15 minutes

•Peak: 60-90 minutes

•Duration: 3-5 hours

Apidra® (insulin glulisine)

Humalog® (insulin lispro)

NovoRapid® (insulin aspart)

Usually taken right before eating, or to lower high

blood glucose

•Short-acting(clear)

•Onset: 30 minutes

•Peak: 2-3 hours

•Duration: 6.5 hours

Humulin®-R

Actrapid

Insuman Rapid

Taken about 30 minutes before eating, or to lower

high blood glucose

•Intermediate-acting (cloudy)

•Onset: 1-3 hours

•Peak: 5-8 hours

•Duration: up to 18 hours

Humulin®-N

Novolin®ge NPH

Often taken at bedtime, or twice a day (morning

and bedtime)

•Long-acting analogue (clear and

colourless)•Onset: 90 minutes

•Peak: none

•Duration: up to 24 hours (Lantus 24 hours,

Levemir 16-24 hours)

Lantus® (insulin glargine)

Levemir® (insulin detemir)Usually taken once or twice a day

Premixed(cloudy)

A single vial or cartridge contains a fixed ratio of

insulin (the numbers refer to the percent of rapid-

or fast-acting insulin to the percent of

intermediate-acting insulin)

•PREMIXED REGULAR INSULIN -

NPHHumulin® (30/70)

• Novolin®ge (30/70, 40/60, 50/50)

•

PREMIXED INSULIN ANALOGUES

•Humalog® Mix25 and Mix50

• NovoMix 30

Depends on the combination

Adapted from the Canadian Diabetes Association 2008

Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canda



Insulin therapy regimens

• Basal regimen( once/twice daily )

• Basal-plus

•

Basal bolus• Twice daily

• Continuous subcutaneous insulin infusion



Normal insulin profile



Insulin therapy regimens



Modes of administration

• Subcutaneous

• Intravenous

•

Intramuscular• Inhalation

• Intraperitoneal



Insulin Delivery Devices

• Insulin syringes

• vials

• Insulin Pens

– (cartridges, prefilled pens

• Insulin Pump



Insulin injection site



Side effects

• Hypoglycemia

• Weight gain

•

Lipodystrophy• Allergic reaction

• Edema

LP 3 MG IV Eng, Insulintherapy

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