Diabetes mellitus (DM)

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par Suthakaran Arumugam

produced by Mostafa alaa-college of medicin-university of Kerbala

Diabetes mellitus (D.M)

SYNTHETIC AMYLIN ANALOG

Pramlintide

it is an amylin analog that delays gastric emptying, decreases postprandial glucagon secretion, and improves satiety. Pramlintide is administered by subcutaneous injection and should be injected immediately prior to meals. It cannot be mixed with insulin.

Adverse effects: hypoglycemia, nausea, anorexia, and vomiting.

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.

INSULIN PREPARATIONS:

Insulin combinations

: such as 70-percent NPH insulin plus 30-percent regular insulin, 50 percent of each of these, and 75-percent NPL(neutral protamine lispro) insulin plus 25-percent insulin lispro

C.Long-acting insulin preparations:

2.Insulin detemir

has a fatty-acid side chain. This addition enhances association to albumin. Slow dissociation from albumin results in long-acting properties.

1.Insulin glargine

it precipitates at the injection leading to prolongation of its action. It is slower in onset than NPH insulin and has a flat, prolonged hypoglycemic effect with no peak. It must be given subcutaneously

B.Intermediate-acting insulin

Neutral protamine Hagedorn (NPH or called insulin isophane) insulin is a suspension of crystalline zinc insulin combined with polypeptide protamine (to delayed insulin absorption). NPH insulin has an onset of approximately 2–5 hours and duration of 4–12 hours

It should only be given subcutaneously (never IV) and is useful in treating all forms of diabetes except diabetic ketoacidosis and emergency hyperglycemia

A.Rapid-acting (with very fast onset and short duration insulin lispro, insulin aspart, and insulin glulisine.) and short-acting (with rapid onset regular insulin) insulin preparations

Regular insulin is short-acting, soluble, crystalline zinc insulin which rapidly lowers blood glucose. Its effect appears within 30 minutes and peaks between 2 and 3 hours after subcutaneous injection and generally lasts 5–8 hours

Insulin lispro differs from regular insulin in that lysine and proline at positions 28 and 29 in the B chain are reversed. This results in more rapid absorption after subcutaneous injection than is seen with regular insulin. The rapid-acting insulins permit more physiologic prandial insulin replacement because their rapid onset and early peak action more closely mimic normal endogenous prandial insulin secretion

Adverse reactions:

4-Development of resistance.

3-Allergic reactions.

2-Weight gain, lipodystrophy.

1-Hypoglycemia

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.

Insulin administration

4-Continuous subcutaneous insulin infusion (insulin pump).

3-Regular insulin is injected intravenously in hyperglycemic emergency.

2-Subcutaneous

1-orally not given because will degraded

Action of insulin

4-Intracellular accumulation of potassium and phosphate

which is linked to glucose transport in some tissues.

3-Effect on adipose tissue

Increased triglyceride storage, induction of Lipoprotein lipase.

2-Effect on muscle

Increased protein synthesis, Increases amino acid transport

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

note about insulin

value

normal = 5–15 U/mL

peak rise to 60–90 U/mL

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.

Diabetes mellitus management involves various insulin administration methods, including subcutaneous injections, continuous subcutaneous insulin infusion via pumps, and intravenous injections for hyperglycemic emergencies.