Insulin Lecture Notes PDF

# Basrah University of Science And Technology ## Academic year 2024-2025 ### 2nd stage ### Pharmacology ## Lecture - VI ### Hormones By Dr. Aamer A. AL-Chaab Anesthesia Dep. Ref. Lippincott Illustrated Reviews Pharmacology 7th edition # Hormones - Is a class of signaling molecules in multicellu...

# Basrah University of Science And Technology ## Academic year 2024-2025 ### 2nd stage ### Pharmacology ## Lecture - VI ### Hormones By Dr. Aamer A. AL-Chaab Anesthesia Dep. Ref. Lippincott Illustrated Reviews Pharmacology 7th edition # Hormones - Is a class of signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physiology and behavior. - Hormone secretion occurs in response to specific biochemical signals and is often subject to negative feedback regulation. - Hormones secreted by - Endocrine glands = Secretes hormones directly into the bloodstream. - Exocrine glands = Secretes its hormones indirectly using ducts. - Paracrine glands = Diffuse through the interstitial spaces to nearby target tissue. # Types | No. | Types | Derived from | Example | |---|:---|:---|:---:| | 1 | Protein/peptide | Made up of amino acid | Insulin, Oxytocin | | 2 | Amino Acid Derivatives | Derived from amino acids (tyrosine) | Thyroxin, Melatonin | | 3 | Steroids | Derived from cholesterol | Estradiol, Testosterone, Cortisol | | 4 | Eicosanoids | Derived from lipids such as arachidonic acid, lipoxins produced by cyclooxygenases and lipoxygenases | Prostaglandin, Thromboxane | | 5 | Gases | | Nitric Oxide | # 1. Insulin - Polypeptide hormone (A-Chain = 21a.a. + B-Chain = 30a.a. + C-Chain). - Secreted by the β cells of the pancreas # Production: Human insulin is produced by rDNA technology. - Modification of the amino acid sequence of human insulin produces insulin with different pharmacokinetic properties - Onset - Duration # Administration - SC = Subcutaneous, IV = Intravenous [Emergency ] - Inhalation - Continuous subcutaneous insulin infusion (insulin pump) # Insulin Preparations ## I- Rapid-acting and short-acting insulin: - Regular insulin, insulin Lispro, insulin Aspart, insulin Glulisine, and inhaled insulin. - Modification of the amino acid sequence of regular insulin produces analogs that are more rapid absorption, a quicker onset, and a shorter duration of action after subcutaneous injection. - Are administered to mimic the prandial (mealtime) release of insulin and to control postprandial glucose. - Regular insulin should be injected subcutaneously 30 minutes before a meal, whereas rapid-acting insulin are administered in the 15 minutes preceding a meal or within 15 to 20 minutes after starting a meal. - Regular insulin is most commonly used when the IV route is needed. | Generic | Brand | Conc. | |---|---|---| | Aspart | Novolog | U-100 | | Aspart | Fiasp | U-100 | | Lispro | Humalog | U-100 | | Lispro | Humalog | U-200 | | Lispro | Admelog | U-100 | | Glulisine | Apidra | U-100 | ## II- Intermediate-acting insulin - Neutral protamine Hagedorn (NPH) insulin is an intermediate-acting insulin formed by the addition of zinc and protamine to regular insulin. [insulin isophane]. - The combination with protamine forms a complex that is less soluble, resulting in delayed absorption and a longer duration of action. - NPH insulin is used for basal (fasting) control in type 1 or 2 diabetes and is usually given along with rapid- or short-acting insulin for mealtime control. - NPH insulin should be given only subcutaneously (never IV) & it should not be used when rapid glucose lowering is needed (for example, diabetic ketoacidosis) ## III- Long-acting insulin preparations - The isoelectric point of insulin glargine is lower than that of human insulin, leading to formation of a precipitate at the injection site that releases insulin over an extended period. - Insulin detemir has a fatty acid side chain that enhances association to albumin. Slow dissociation from albumin results in long-acting properties similar to those of insulin glargine. - Insulin degludec remains in solution at physiologic pH, with a slow release over an extended period. It has the longest half-life of the long-acting insulin. ## IV- Insulin combinations - Various premixed combinations of human insulins, such as 70% NPH insulin plus 30% regular insulin or 50% of each of these, are also available. - Uses of premixed combinations decreases the number of daily injections. # TABLE 19-3 Pharmacokinetics of Various Insulins Administered Subcutaneously | Type of Insulin | Onset | Peak (hours) | Duration (hours) | Maximum Duration (hours) | Appearance | |---|---|---|---|---|---| | **Rapid-acting** | | | | | | | Aspart | 15-30 min | 1-2 | 3-5 | 5-6 | Clear | | Lispro | 15-30 min | 1-2 | 3-4 | 4-6 | Clear | | Glulisine | 15-30 min | 1-2 | 3-4 | 5-6 | Clear | | **Short-acting** | | | | | | | Regular | 30-60 min | 2-3 | 3-6 | 6-8 | Clear | | **Intermediate-acting** | | | | | | | NPH | 2-4 hours | 4-6 | 8-12 | 14-18 | Cloudy | | **Long-acting** | | | | | | | Detemir | 2 hours | 6-9 | 14-24 | 24 | Clear | | Glargine | 4-5 hours | - | 22-24 | 24 | Clear | NPH, neutral protamine Hagedorn. # Standard treatment versus intensive treatment - Standard insulin therapy involves twice daily injections. - Intensive treatment utilizes three or more injections daily with frequent monitoring of blood glucose levels. - The ADA recommends a target mean blood glucose level of 154 mg/dL or less (HbA1c ≤ 7%) for most patients, and intensive treatment is more likely to achieve this goal. - The frequency of hypoglycemic episodes, coma, and seizures is higher with intensive insulin regimens. - Patients on intensive therapy show a significant reduction in microvascular complications of diabetes such as retinopathy, nephropathy, and neuropathy compared to patients receiving standard care. # Adverse effects - Hypoglycemia is the most serious and common adverse reaction to insulin. - weight gain, local injection site reactions, lipodystrophy. - Diabetics with renal insufficiency may require a decrease in insulin dose. - Due to the potential for bronchospasm with inhaled insulin, patients with asthma, chronic obstructive pulmonary disease, and smokers should not use this formulation. # Thank You The image shows titles and text for a presentation on hormones. Several pictures of insulin pens and vials are shown. The titles and text are written in a black and white style, while the background has an orange color. The document is full of handwritten annotations, likely made by the speaker during the presentation.