Glucose subcutaneous injection

If the galactose tolerance test is used, it must obviously be applied with discretion. Glucose for intravenous administration and adrenaline for subcutaneous injection should be on hand. It is probably wiser not to carry out this test on young infants who may have galactosemia. 

Systemic absorption of pulmonary-deUvered peptides and proteins has been the objective of many investigations [2]. The most successful work in this field is the development of insulin formulations for inhalation.These dosage forms might, in the near future, become a suitable alternative for the current subcutaneous injection of insulin that is used to obtain meal-time glucose control [3]. In spite of the strict requirements regarding dose variability for insulin, the pulmonary products under development seem to be as safe as the subcutaneous injections. 

Pharmaceutically, glucose is probably the most important of all regular monosaccharides. A solution of pure glucose has been recommended for use by subcutaneous injection as a restorative after severe operations, or as a nutritive in wasting diseases. It has also been used to augment the movements of the uterus. Glucose is added to nutritive enemata for rectal alimentation. Its use has also been recommended for rectal injection and by mouth in delayed chloroform poisoning. 

The effects of insulin are modified by various factors. The speed and extent of absorption of insulin depends, for example, on the site of injection (1), the depth of the subcutaneous injection, skin temperature (2), the presence of lipodystrophy, and variation in the extent of inactivation of injected insulin. The disposal of insulin depends on many factors. Exercise and hard work lower the blood glucose and thereby increase the effect of insulin. Infections and obesity reduce its effect. The timing of food intake and the composition of meals are also related to the action of insulin. A thin layer of fat, as sometimes occurs in the upper arm or in the thighs of thin men, can result in intramuscular injection, leading to faster absorption of long-acting insulins. This can reduce the absorption time by half (3). The major factors that affect the fate of injected insulin (and thereby also its risks) are listed in Table 1 (4). 

Several peptide products used in the treatment of diabetes mellitus, in addition to insulin, are currently administered by subcutaneous injection and these drugs are candidates for development of nasal formulations. Glucagon-like peptide-1 (GLP-l)-related peptides stimulate the insulin response to glucose and diminish the release of glucagon after a meal. These effects diminish the excessive postprandial increase in glucose observed after a meal in persons with type 2 diabetes mellitus. GLP-1-related peptides must be administered by subcutaneous injection before meals in order to be effective. This requirement for injection before each meal is likely to impact the utilization of these products by persons with type 2 diabetes. Exendin-4 is a GLP-1-related peptide with a molecular mass of 4.2 kDa. The development of a GLP-1-related peptide nasal formulation containing an absorption enhancer would allow patients to scll-administer one of these drugs just before a meal without the need for a subcutaneous injection. 

Dose reproducibility Several human studies comparing aerosol insulin administration to subcutaneously administered insulin showed that the variability in glucose response from a liquid nebulizer that utilized the standing cloud concept was equivalent or better than that seen with insulin injection. Inhale Therapeutics Systems, Inc. has adopted this standing cloud concept for its dry powder inhaler to achieve reproducibility of delivery of macromolecules to the systemic circulation that is equivalent to subcutaneous injections. 

Oral formulations of Momordica charantia (karela fruit, bitter melon) have hjrpoglycemic activity in non-insulin dependent diabetes meUitus (8,9), and can interfere with conventional treatment with diet and chlorpropamide (10). In 15 patients aged 52-65 years a soft extract of M. charantia plus half doses of metformin or glibenclamide or both in combination caused hjrpoglycemia greater than that caused by full doses during treatment for 7 days (11). Subcutaneous injection of a principle obtained from the fruit may lower blood glucose concentrations in juvenile diabetes. 

The effects of insulin are modified by various factors. The speed and extent of absorption of insulin depends, for example, on the site of injection (1), the depth of the subcutaneous injection, skin temperature (2), the presence of lipodystrophy, and variation in the extent of inactivation of injected insulin. The disposal of insulin depends on many factors. Exercise and hard work lower the blood glucose and thereby increase the effect of... 

On the other hand, acetyl groups of hyaluronate in the higher animals may not undergo exchange. This is indicated by the equivalent, biological half-lives of radioactive hyaluronate formed by subcutaneous injection into rabbits either of acetate-l-C or of uniformly labeled D-glucose. Thus,... 

Studies in eight insulin-dependent diabetic men indicated that a sauna accelerated insulin absorption from the subcutaneous injection site and that, 2 h after the sauna, mean blood glucose concentration was significantly lower than on the control day (Dandona etal., 1978 Cuppers et al., 1980 Koivisto, 1980b). Hypoglycaemia and seizures were observed in one patient after the use of a sunbed (Husband and Gill, 1984). 

Schiffrin A, Belmonte M. Multiple daily self-glucose monitoring its essential role in long-term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections. Diabetes Care 1982 5 479-84. 

---