Diabetes mellitus (D.M)

Definition

NORMAL INSULIN

insulin work

Insulin stimulants

sugars

amino acids (e.g., leucine, arginine)

hormones

glucagon-like polypeptide-1 (GLP-1)

glucose-dependent insulinotropic polypeptide (GIP)

glucagon

cholecystokinin

vagal activity

Inhibitory signals

somatostatin

hronically elevated glucose and fatty acid

note about insulin

The half-life of circulating insulin is 3–5 minutes

pharmacokinetiks

The liver (60%) and kidney (35–40%) are the two main organs that remove insulin from the circulation but this ratio is reversed if insulin is given exogenously.

value

normal = 5–15 U/mL peak rise to 60–90 U/mL

Action of insulin

1-On the liver

: Inhibits glycogenolysis, Inhibits conversion of fatty acids and amino acids to keto acids, Promotes glucose storage as glycogen and Increases triglyceride synthesis and very-low-density lipoprotein formation

2-Effect on muscle

Increased protein synthesis, Increases amino acid transport

3-Effect on adipose tissue

Increased triglyceride storage, induction of Lipoprotein lipase.

4-Intracellular accumulation of potassium and phosphate

which is linked to glucose transport in some tissues.

Insulin administration

1-orally not given because will degraded

2-Subcutaneous

3-Regular insulin is injected intravenously in hyperglycemic emergency.

4-Continuous subcutaneous insulin infusion (insulin pump).

Sources of insulin

Human insulin is produced by recombinant DNA technology using special strains of Escherichia coli or yeast. Insulin is inactivated by insulin-degrading enzyme (also called insulin protease), which is found mainly in the liver and kidney.

Adverse reactions:

1-Hypoglycemia

2-Weight gain, lipodystrophy.

3-Allergic reactions.

4-Development of resistance.

INSULIN PREPARATIONS:

Intensive regimens

involving multiple daily injections (MDI) use long-acting insulin analogs to provide basal or background coverage, and rapid-acting insulin analogs to meet the mealtime requirements. The most sophisticated insulin regimen delivers rapid-acting insulin analogs through a continuous subcutaneous insulin infusion device.