Insulin Therapy PDF

Insulin therapy A.PROF. SABAH A A CONSULTANT ENDOCRINOLOGIST  Insulin is injected subcutaneously into the anterior abdominal wall, upper arms, outer thighs. Once absorbed into the blood, insulin has a half-life of just a few minutes. Excretion is hepatic and renal, so insulin levels are el...

Insulin therapy A.PROF. SABAH A A CONSULTANT ENDOCRINOLOGIST  Insulin is injected subcutaneously into the anterior abdominal wall, upper arms, outer thighs. Once absorbed into the blood, insulin has a half-life of just a few minutes. Excretion is hepatic and renal, so insulin levels are elevated in hepatic or renal failure. Insulin delivered by re-usable syringe has largely been replaced by that delivered by pen injectors containing sufficient insulin for multiple dosing. Insulin analogues have largely replaced soluble and isophane insulins, especially for type 1 diabetes, because they allow more flexibility and convenience. Site of insulin injection 3 Calibration of Insulin dose, syringes 4 Insulin pens Metallic pens Disposable pens 5  Types of insulin Type of insulin Onset Duration Rapid acting(analogue) Lispro 10-15 min 2-4 hr Analogue Aspart Short acting Regular 30 min 3-6 hr intermediate acting Isophan(NPH) 2-4 hr 12-18 hr Lente Long acting(analogue) Glargine,Detemir Peakless 24 hr (Basal) Degludec Analogue Premixed L/R (70/30) and (50/50) 6 Indications for insulin therapy.. Indications of insulin therapy: ✓Type 1 DM. ✓Type 2 DM with acute stressful condition. ✓Type 2 DM who failed to respond to oral hypoglycemic agents(OH). ✓Gestational DM not respond to approvable pills. 8  The complications of insulin therapy include Hypoglycaemia. Weight gain. Peripheral oedema (insulin treatment causes salt and water retention in the short term). insulin antibodies (animal insulins). Local allergy (rare). Lipodystrophy at injection sites. 9 Dawn phenomenon A common problem is fasting hyperglycaemia (the ‘dawn phenomenon’) caused by the release of counter-regulatory hormones during the night, which increases insulin requirement before wakening. Q.What Is The Somogyi phenomenon? 10 Standard insulin regimens 1. Once daily regimen. 2. Twice daily regimen. 3. Basal- plus regimen. 4. Basal-bolus insulin regimen. 5. Continuous subcutaneous infusion using insulin pump. 11 Once daily regimen. o This regimen is used for type 2 diabetics who failed to response to OH. o One dose of basal insulin given before breakfast or at bed time. o Can be used in combination with OH. 12 Twice daily regimen ❑This regimen used by most patients with type 1 DM. ❑Two doses of premixed insulin given before breakfast and before dinner. ❑2/3 of total dose given before breakfast and 1/3 of total dose given before dinner Dose of insulin is variable, need professional physician, however approximately between 0.4-1.2U/kg. 13 Basal-plus 1 regimen oThis regimen is used for control of blood sugar in type 2. with single large meal daily ingestion. oSingle dose basal insulin at bed time, plus 1 doses of short acting (prandial) insulin before main meal to control blood sugar. oBasal-plus 2. oBasal-plus 3(basal-bolus). 14 Basal-bolus I. These are popular, with short-acting insulin before each meal, plus intermediate- or long-acting insulin injected once or twice daily (basal-bolus regimen). II. This regimen allows greater freedom of meal timing and more variable day-to-day physical activity. III. It is preferable for type1 and suitable for type2. 15 Insulin pump Continuous subcutaneous infusion using insulin pump. 16 Transplantation I. Whole pancreas transplantation presents problems relating to - exocrine pancreatic secretions and.. - long-term immunosuppression is necessary. At present, the procedure is usually undertaken only in patients with end-stage renal failure who require a combined pancreas/kidney transplantation and in whom diabetes control is particularly difficult, e.g. because of recurrent hypoglycaemia. 17 II. Transplantation of isolated pancreatic islets ❑Usually into the liver via the portal vein WHICH has been achieved safely in an increasing number of centres around the world. ❑ Progress is being made towards meeting the needs of supply, purification and storage of islets, ❑But the problems of transplant rejection, and of destruction by the patient’s autoantibodies against β cells, remain. 18 Thank you MY PAINTING DURING COVID ERA 19