Insulin and Its Types in Diabetes Management

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Questions and Answers

What is the main reason for the preference of insulin analogues over traditional insulins in type 1 diabetes?

Insulin analogues provide more flexibility and convenience in dosage timing.

List two complications associated with insulin therapy.

Hypoglycaemia and weight gain are two common complications.

Describe the dawn phenomenon in diabetes management.

The dawn phenomenon is fasting hyperglycemia resulting from overnight release of counter-regulatory hormones.

Explain the purpose of using a basal-bolus insulin regimen.

A basal-bolus regimen allows for the management of blood glucose throughout the day with rapid insulin for meals and long-acting insulin for baseline control. Signup and view all the answers

What are the two main excretion pathways for insulin in the body?

Insulin is excreted primarily by hepatic and renal mechanisms. Signup and view all the answers

What is the onset time for rapid-acting insulin analogues like Lispro?

The onset time for rapid-acting insulin analogues such as Lispro is 10-15 minutes. Signup and view all the answers

Identify a key indication for initiating insulin therapy in type 2 diabetes.

Insulin therapy is indicated for type 2 diabetes patients who fail to respond to oral hypoglycemic agents. Signup and view all the answers

What is the Somogyi phenomenon?

The Somogyi phenomenon refers to rebound hyperglycemia due to excessive insulin leading to hypoglycemia during the night. Signup and view all the answers

What is the primary use of the once daily insulin regimen?

It is used for type 2 diabetics who have not responded to oral hypoglycemics. Signup and view all the answers

In the twice daily insulin regimen for type 1 DM, how is the total daily dose distributed?

2/3 of the total dose is given before breakfast and 1/3 before dinner. Signup and view all the answers

Describe the basal-plus 1 insulin regimen.

It includes a single dose of basal insulin at bedtime and one dose of short-acting insulin before a main meal. Signup and view all the answers

What are the advantages of the basal-bolus insulin regimen?

It allows greater freedom in meal timing and accommodates varying daily physical activity. Signup and view all the answers

What challenges are associated with whole pancreas transplantation?

Challenges include issues with exocrine secretions and the need for long-term immunosuppression. Signup and view all the answers

What is the procedure for transplantation of isolated pancreatic islets?

Isolated pancreatic islets are usually transplanted into the liver via the portal vein. Signup and view all the answers

What is the main purpose of using an insulin pump?

It provides continuous subcutaneous insulin infusion. Signup and view all the answers

What is the insulin dosage range typically required by patients?

Insulin dosage typically ranges from 0.4 to 1.2 units per kilogram of body weight. Signup and view all the answers

Study Notes

Insulin

Insulin is injected subcutaneously into the anterior abdominal wall, upper arms, and outer thighs.
Insulin has a half-life of a few minutes and is excreted via the liver and kidneys.
Insulin levels are elevated in cases of hepatic or renal failure.
Insulin pens have largely replaced syringes.
Insulin analogues are preferred over soluble and isophane insulins, particularly for type 1 diabetes.
Insulin analogues offer greater flexibility and convenience.

Insulin Types

Rapid acting (analogue): Lispro or Aspart. Onset is 10-15 minutes and duration is 2-4 hours.
Short acting: Regular. Onset is 30 minutes and duration is 3-6 hours.
Intermediate acting: Isophane (NPH) or Lente. Onset is 2-4 hours and duration is 12-18 hours.
Long acting (analogue): Glargine, Detemir, or Degludec (Basal). Peakless and duration is 24 hours.
Premixed: L/R (70/30) and (50/50).

Insulin Therapy Indications

Type 1 Diabetes Mellitus (DM).
- Type 2 DM with acute stressful conditions.
- Type 2 DM not responding to oral hypoglycemic agents (OH).
- Gestational DM not responding to approved pills.

Complications of Insulin Therapy

Hypoglycemia.
Weight gain.
Peripheral edema.
Insulin antibodies (animal insulins).
Local allergy (rare).
Lipodystrophy at injection sites.

Dawn Phenomenon

A common issue where fasting hyperglycemia occurs during the night.
This is due to the release of counter-regulatory hormones, increasing insulin requirements before waking.

Somogyi Phenomenon

The Somogyi phenomenon is not directly mentioned in the text. However, it is a related concept, which can occur when there is a blood sugar drop during the night, leading to a release of counter-regulatory hormones, resulting in rebound hyperglycemia in the morning.

Standard Insulin Regimens

Once daily regimen: For type 2 diabetics not responding to OH. Single dose of basal insulin before breakfast or bedtime. May be used in combination with OH.
Twice daily regimen: Used by most type 1 diabetics. Two doses of premixed insulin before breakfast and dinner (2/3 total dose before breakfast, 1/3 before dinner).
Basal-plus regimen: For blood sugar control in type 2 diabetics with single large meals per day. Single dose of basal insulin bedtime plus short acting (prandial) insulin before the main meal.
Basal-bolus regimen: Short-acting insulin before each meal plus intermediate or long-acting insulin once or twice daily.
Continuous subcutaneous infusion using insulin pump: Another method of insulin delivery.

Pancreas Transplantation

Whole pancreas transplantation is challenging due to exocrine pancreatic secretions and the need for long-term immunosuppression.
Typically performed in patients with end-stage renal failure requiring a combined pancreas/kidney transplant, especially when diabetes control is difficult.

Isolated Pancreatic Islet Transplantation

Usually transplanted into the liver via the portal vein.
Increasingly being done safely in various medical centers.
Ongoing research focuses on the supply, purification, and storage of islets.
Challenges remain relating to transplant rejection and destruction by the patient's autoantibodies against β cells.

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Description

This quiz covers the fundamentals of insulin therapy, including its administration, types, and indications for use in diabetes management. Explore the various forms of insulin, their onset, duration, and preferred applications for type 1 diabetes. Understand the advancements in insulin delivery methods for better patient outcomes.