Insulin therapy is an essential part of diabetes management. A type 1 and type 2 diabetes patients requires insulin at some stage. As injectable therapies such as human insulin, insulin analogs, are used for the management of diabetes, several factors, including correct injection technique, are to achieve glycemic control.
How does insulin help glucose move into the cell?
Insulin helps glucose move into the cells by attaching to a special place on the cell wall called the receptor site. Once insulin is attached at the cell wall, a chemical reaction occurs that allows glucose to move into the cell. This is why insulin is said to be the key that unlocks the cell.
Pancreas produces insulin almost continuously in the body. The amount of insulin it made depended i how
Injection; injection technique ; insulin; insulin analogs; needle length ; skin fold ; lipo hypertrophy; strove ; injection sites; compliance; education .
An alarmingly rising prevalence of diabetes has been reported according to the recent 2030, the prevalence of diabetes among Indians is projected to reach 87 million.
Insulin is an anabolic hormone promoting protein synthesis, fat storage, entry of glucose into calls for energy use, and glycogen storage in muscle and liver cells. Insulin is an absolute requirement for type1 diabetes and is used to prevent long term complications of diabetes. It may be required in those with type2 diabetes if other forms of therapy do not adequately control glucose levels. It is also used in gestational diabetes for those who have inadequate glucose control on diet alone.
To provide an understanding of insulin therapy in type 1 diabetes, type 2 diabetes, gestational diabetes and diabetes secondary to another condition or medication, such as steroid – induced diabetes.
. Pathophysiology and the basis for insulin replacement regimen
- History: In 1921, the Canadian scientists Fredrick G. Banting, Charles H. Best, J.J.R. Macleod and James B. Collip discovered insulin. They extracted insulin from the islets of animal pancreas, Insulin is a peptide (small protein hormone) which lowers blood sugar. They extracted insulin from the islets of animal pancreas. Up to that time, type 1 diabetes was a virtual death sentence for patients suffering from it. A year later, in January 1922, bovine insulin was first given to humans by injection. It was still so impure that as a result of the first insulin injection patient had a 7.5 cm callus at the injection site on his left buttock.
- Nevertheless, the quality of the insulin administered at that time was far from the quality of today’s products.
- Each vial of insulin had a different effect because of differing purity. That is why Elizabeth Hughes, one of the first diabetics to be treated with insulin, often had hypoglycemic reactions. She also suffered pain and swelling at the injection site, especially when large quantities of insulin were injected.
Sources of insulin: Beginning in 1922, and in the face of great demand for the new medicine, several companies were granted licenses by the University of Toronto to manufacture insulin. In 1936, protamine, a low-weight protein, was used to develop slow-release insulin. With the availability of protamine, as well as zinc, the first slow-acting insulin was produced. Protamine zinc insulin (PZI) was insulin whose effect lasted for 24–36 h.
In 1950, yet another approach led to the presently available isophane NPH (neutral protamine Hagedorn) insulin, which is also bound to protamine. It has a maximal effect of 24 h and can be mixed with any proportion of fast-acting regular insulin.
In 1974, chromatographic purification techniques allowed the production of highly purified animal insulin.
.Differentiate between the various types of insulin
.Discuss the duration of action of different types of insulin
.Identify factors affecting insulin requirement and absorption
.Explain different insulin regimens
.Identify the appropriate type of insulin and regimen to use in different clinical situations
. Identify strategies that could Assisi the person overcome fears associated with commencing insulin therapy
.Demonstrate preparation and administration of insulin using different methods
. Discusses principle of management of an insulin pump
Describe side- effect of insulin treatment.
Pathophysiology and the basis for insulin replacement regimen:
Insulin secretion following a meal occurs in two phase – phase 1 last for about 10 minutes and is involved in suppression of the hepatic glucose production .phase 1 also facilities a phase 2 realize which last two hours and manages the rise in blood glucose produced by the carbohydrate in the meal.
A low basal secretion of insulin is present between meals that meet ongoing metabolic demands. With rising blood glucose levels, the beta calls responds in a linear fashion by secreting insulin. When beta cells are exposed to high glucose concentration over a prolonged period of time as in diabetes, there is a blunting in the Beta cells response. This is referred to as glucose toxicity.
The pathology in type 2 diabetes is that the phase 1 insulin responds is absent and phase 2 releases is delayed and insufficient. Initially there is an increased secretion of insulin to compensate for the insulin resistance but progression of the diseases the beta cents tire out and insulin secretion is decreased.
Hyperglycemia is identified as an independent risk factor for adverse outcome of numerous surgical and medical conditions. The risks of hyperglycemia comprises of increased vulnerability to infectious complications, impaired recovery of organ failure, myocardial dysfunction and neuromuscular weakness. The cardiovascular and immune systems thus emerge as two important target systems of glycemic control in the critically ill.
Sources of insulin:
Main sources of insulin are beef, pork, human (recombinant)
Bovine insulin differs from human insulin by three amino acids ( AA) and porcine insulin by only one AA . Conversion of a patients in insulin injection from animals source to human I insulin may require dosage adjustment because of the shorter duration if action and lower antigenicity.
Classification of insulin
this include bolus and basal insulin. Bolus insulin are rapidly acting analogs or short acting regular human insulin. The basal insulin are the intermittent and long acting human insulin’s and analogs. Bolus stimulate the levels of insulin seen in individuals without diabetes after ingestion of a meal . Whereas basal insulin stimulate the insulin level between meals, through the night and with fasting.
. Neutral protamine hagedron(N PH)
. Isophane insulin/
Ultralente (extended insulin zinc suspension)
.insulin analogs: detemir, glargine.
Analogs forms: aspart lispro and glulisune
Premixed insulin: premixed preparation of short and intermediate acting insulin are available in a wide range of rations. The most commonly used premixed insulin is 30/70 which contains 30% short acting and 70% intermediate acting insulin.
Indication for insulin:
Type 1 diabetes mellitus
Type 2 copy from ur slide …
Injection storage: ::
It is recommended to follow the specific storage guidelines provided by the manufacturer. Insulin should be stored in a cool and dark place. Insulin pens and vials should be refrigerated, but not frozen. If frozen, insulin should be discarded.