Insulin administration

Example of Insulin Administration Using a Sliding Scale... 

Insulin aspart is given immediately before a meal (widiin 5 to 10 minutes of beginning a meal). Insulin lispro is given 15 minutes before a meal or immediately after a meal. Insulin aspart and lispro make insulin administration more convenient for many patients who find taking a drug 30 to 60 minutes before meals bothersome hi addition, insulin lispro (Humalog) appears to lower die blood sugar level 1 to 2 hours after meals... 

B. may be more intense than reactions seen with insulin administration... 

Availability. Some 170 million people suffer from diabetes worldwide, a figure projected to double by 2030. Insulin administration is essential to the survival of those with type-1 (insulin-dependent) diabetes, and is required to control the progression of a minority of those with (the more common) insulin-independent type-2 diabetes. The annual insulin requirement has surpassed 5000 kg and continues to grow, prompting concern of an insulin shortfall from slaughterhouse sources. 

Hypoglycaemia remains the most frequent complication of insulin administration to diabetics. It usually occurs due to (a) administration of an excessive amount of insulin (b) administration of insulin prior to a mealtime, but with subsequent omission of the meal or (c) due to increased physical activity. In severe cases this can lead to loss of consciousness, and even death. Although it may be treated by oral or i.v. administration of glucose, insulin-induced hypoglycaemia is sometimes treated by administration of glucagon. 

Medical nutrition therapy is recommended for all patients. For individuals with type 1 DM, the focus is on regulating insulin administration with a balanced diet to achieve and maintain a healthy body weight. A meal plan that is moderate in carbohydrates and low in saturated fat, with a focus on balanced meals is recommended. In addition, patients with type 2 DM often require caloric restriction to promote weight loss. Bedtime and between-meal snacks are not usually needed if pharmacologic management is appropriate. 

Toxicity problems (due to impurities) associated with prolonged repeat insulin administration soon put this treatment in jeopardy. However, a biochemist, James Collip, devised an improved purification scheme entailing insulin crystalUzation, which overcame such toxicity. 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

Type II diabetics are less prone to develop ketone bodies or diabetic ketoacidosis but may develop hyperosmolar coma, a condition characterized by severe hyperglycemia and dehydration. Both diabetic ketoacidosis and hyperosmolar coma are medical emergencies that require prompt insulin administration and intravenous fluids. 

R. Quintana, and D.A. Shapiro, Insulin administration via the Aero Dose (TM) inhaler Comparison to subcutaneously injected insulin. Diabetes, 2000. 49 ... 

Insulin administration Decrease in both normal and diabetic (7, 41, 99, 113)... 

In 1500 patients in intensive care, there was hypoglycemia (4 mmol/1 and less) in 5.2% of the intensively treated group and 0.8% of those who received conventional therapy (93). It has been reported that 11% of drug errors are from insulin administration errors and it has been recommended that frequent checks be made of infusion systems (93). 

Intermittent insulin administration seems to favor the development of allergic reactions to insulin (SEDA-6, 369). 

The American Diabetes Association has published revised guidelines on insulin administration, including storage of insulin, use and reuse of needles, alternatives to syringes, injection techniques, and patient management... 

ADA Clinical Practice Recommendations. Insulin administration. Diabetes Care 2003 26 Suppl LS121-4. 

Kaar ML, Maenpaa J, Knip M. Insulin administration via a subcutaneous catheter. Effects on absorption. Diabetes Care 1993 16(10) 1412-3. 

FIGURE 2.5 Hypoglycemic effect of insulin administered orally to normal rats by means of coated soft capsules containing an absorption-enhancing formulation (8 IU porcine insulin, 4 mg sodium laurate (Ci2) and 16 mg cetyl alcohol) two capsules RSI (open stars) 2 capsules RS2 (open circles) 2 capsules RS2 + 1 capsule surfactant post-insulin administration (open square) insulin i.p. 4 IU (close circles) 2 placebo capsules (no insulin) (close stars). Each point is the mean SD of five animals for insulin administration and of four animals for controls. RSI and RS2 are capsules coated with various mixtures of Eudragits RS, S, and L. (From Touitou, E. and Rubinstein, A., Int. J. Pharm., 30, 95, 1986. With permission from Elsevier.)... 

Nasal administration of formulations containing insulin plus 0.125% TDM concurrently at time 0 caused a rapid and significant increase in plasma insulin levels and a corresponding decrease in blood glucose levels (described above). When an interval of 2 h elapsed between TDM addition and insulin administration, a significant attenuation was noted in the maximal increase in plasma insulin, as well as in the maximal reduction in blood glucose levels [10]. The experimental protocol described above was then used to assess the amount of insulin absorbed when the interval between TDM administration and insulin administration was... 

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