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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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