Insulin therapy
- 1. INSULINTHERAPY Presented by : Meraj Fatima PharmD Sultan ul Uloom College of Pharmacy Hyderabad Guided by : Dr S.P. Srinivas Nayak, Assistant professor, SUCP, HYD
- 2. INSULIN • Polypeptide hormone. • Produced by Beta-cells of islets of Langerhans in pancreas. • Profound effects on carbohydrate, fat & protein metabolism and to some extent an water & electrolyte balance.
- 3. Action of Insulin ■ Integrated action on carbohydrate, protein and fat metabolism. ■ Dominant effect on glucose homoeostasis predominantly exerted in 3 tissues 1. Liver 2. Skeletal muscle 3. Fat In Liver • Inhibition of glycogenolysis & gluconeogenesis. • Stimulation of glycogenesis & storage. In skeletal muscle & adipocytes • Stimulation of glucose uptake, utilization & storage. • Increases glucose transport. • Activation/inactivation of enzymes responsible for storage & metabolism of glucose.
- 4. Insulin deficiency results in : o Elevated plasma glucose hyperglycemia o Elevated plasma lipid - hyertriglyceridemia o Altered protein metabolism - metabolic Immune defects
- 5. INSULIN SECRETION Normally secreted as basal (between meals and night time) ; bolus – meal related peaks (1st and 2nd phase)
- 6. TYPES OF INSULIN ■ Rapid-acting insulin (Analogs) ■ Short-acting Humulin (Regular) ■ Intermediate-acting insulin (NPH) ■ Premixed insulin ■ Long-acting insulin
- 11. COMMON INSULIN REGIMENS Split Mix Regimens Two injections per day Twice daily regimens • Intermediate acting insulin(NPH)and short acting (regular) insulin • 2/3 of insulin - morning(ratio 1:2) • 1/3 of insulin - evening before breakfast & before bedtime Proportion/dosage of insulins titrated based on BG profile Drawback Mixing insulins is tedious and problematic Inaccuracy of dose Not preferred -more problems for patients
- 12. MULTIPLE INJECTION REGIMEN • Short acting- before meal • Intermediate or long acting -once or twice daily Advantage: Allows greater freedom with regard to meal timing More variable day to day physical activity
- 13. BASAL INSULIN o Usually given at night. o Proportion dosage of insulin titrated based on FBG. Drawback o Expensive. o Fasting blood glucose is primary targeted. o May be with sensitizer and or secretagogue. BASAL BOLUS INSULIN o Basal insulin at night and one rapid acting insulin immediately before each major meal (3 times). o Basal insulin is titrated following FBG o Rapid acting insulin is titrated by post meal BGs Drawback o Expensive o 4 times needle prick a day
- 15. Continuous subcutaneous insulin infusion (CSII) • Very effective insulin regimen for type 1 DM • Sophisticated device • requires education of the patient and frequent interactions with diabetes management team Advantages: • programmed dose. • basal infusion rates altered during exercise. • different doses of insulin can be matched based on meals. Disadvantages: • Infection. • Hyperglycemia. • Decrease potassium level.
- 16. INSULIN DEVICES Insulin syringes-10ml insulin vials 30 unit -0.3 ml,50 unit-0.5 ml, 100 unit-1ml Need - 8mm to 13mm Use each syringe only once. Insulin pen-insulin catridge-3ml-300 units fits into the device. Disposable, reusable Insulin pumps-reservoir of insulin-infusion set worn outside the body-abdomen Only short or rapid acting insulin are used-mimics physiological pattern Inhaled insulin
- 18. SITES OF INSULIN INJECTION
- 19. Side effects of insulin therapy • Hypoglycemia (predominantly seen in type 1 patients) • Weight gain • Peripheral edema (salt and water retention in short term) • Insulin antibodies (with animal insulin) • Local allergy • Lipohypertrophy or lipoatrophy at site of injection
- 20. THANKYOU