Insulin administration injection

Managing the Complications of Diabetes. Diabetes is more than just a disorder of elevated glucose it is a systemic disease that affects many organ systems. In addition to the metabolic problems there are numerous neurological, circulatory, and renal complications, even when the blood glucose level is properly controlled. The main reason is the unnatural administration of insulin by injection, instead of the constant secretion by the pancreas in response to changing blood glucose levels. Diabetics have a predisposition of atherosclerosis, with an increased risk for heart attacks and stroke. 

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

One of the main drivers for the development of new pulmonary drug delivery systems has been the potential for noninvasive systemic delivery of protein and peptide compounds. The systemic delivery of macromolecules via the airways would overcome the inconvenience and cost associated with current methods of administration (injection), and appears likely given the large surface area of the airways and the thin pulmonary epithelium. Most research has concentrated on pulmonary delivery of insulin for the treatment of diabetes. Recently, one insulin product has completed phase three studies and is now undergoing review by European regulatory agencies for marketing approval. 

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... 

Since the first introduction of insulin to treat diabetic patients in 1923, much effort has been made to seek alternative convenient and painless routes for insulin administration instead of daily injections. In this respect the pulmonary route has received the most attention, and substantial evidence has shown inhaled insulin to be an effective, well-tolerated, noninvasive alternative route [53-56]. Insulin therapy is required for patients with type 1 diabetes. Although some patients with type 2 diabetes can control their disease with oral antidiabetics, many will eventually also require insulin. Thus, inhaled insulin shows promise for type 2 diabetic patients [54, 56]. There are two principal inhalation systems for insulin, namely aqueous solution and dry powder. The dry powder form (Exubera ) has been approved by FDA and the European Medicines Agency (EMEA) in January 2006. 

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. 

In some cases, cell surface expression of certain species can be induced for example, interleukin-1 has been shown to induce the biosynthesis and cell surface expression of procoagulant activity in human vascular endothelial cells [197]. Such materials may also be exploitable as candidates for bioadhesion studies. Millions of lives of patients with diabetes have been saved since the introduction of insulin therapy. However, several daily injections of insulin are required to maximize glucose control in diabetic patients. Insulin is administered by subcutaneous injection, but this route of administration has a slow onset and subsequent prolonged duration of action. These limitations show up more when higher doses of insulin are injected, which results in a long duration of action and forces the patients to consume additional amounts of food to limit the risk of hypoglycemia [198]. 

This chapter deals first with the therapeutic use of insulin and its analogues in TIDM as well as different ways of insulin administration, that is, by conventional intensified insulin therapy with multiple injections (MDl), pump treatment (CSII) and inhalation (INHI). 

Insulin antibodies have been separated by paper electrophoresis from the blood of insulin-treated patients. These antibodies act on insulin labeled with iodine 131, and a cross reaction occurs between the antibodies and insulin obtained from humans, pork, and beef. Insulin antibodies appear in the blood after bovine or foreign insulin administration. The amount of antibody is proportional to the amount of insulin injected. The antibody insulinic complex has little insulinlike activity. Insulin antibody develops in those patients who receive large doses of insulin, and it is therefore impossible to judge whether the insulin resistance results from antibody formation or from the appearance of agents with autoimmune activity. 

Williamson studied the effect of glucagon on animals treated with anti-insulin serum (AIS). He found that whereas the effects of glucagon were of short duration in normal animals, they were of long duration in animals injected with AIS. Insulin administration restores the effect of glucagon to a transient one. 

A number of external or internal pumps have been developed as insulin infusion pumps, or an artificial pancreas, which gives a more precise control over the body s insulin level. These devices normally inject the insulin solution directly into the patient s blood. Many of these "artificial pancreas devices are able to vary the rate of insulin administration, and much progress has been made to couple these pumps with a microprocessor controlled glucose sensor which would closely approximate normal pancreatic activity. Most of these infusion pumps utilize poly-(dimethylsiloxane). 0,41... 

Administration of insulin—sites to be used rotation of injection sites (see Home Care Checklist Rotating Insulin Injection Sites) angle of injection administration at die time of day prescribed by the health care provider disposal of die needle and syringe... 

The results obtained from A-II injected animals (Figure 15) confirmed that the peak arterial pressure response is a reliable indirect indicator of A-II absorption (27,25). On this basis it is very unlikely that oral administration of A- II-impregnated resin (Figure 16) resulted in any significant absorption, even at an A-II dose which was 25X higher than the maximally effective subcutaneous dose. As in the insulin studies, the detectable response was observed about two and one-half hours after dosing. 

Somatostatin. Somatostatin is an endogenous peptide hormone involved in e.g. the control of the release of Somatomedin, Insulin and Pancreatin. Due to its biological role, Somatostatin has a very low biological stability. The half-life in the rabbit after intravenous administration has been determined to approximately 90 seconds in this investigation. After sc or im administration, the apparent half-life is somewhat longer, close to 10 minutes, probably due to the absorption of the peptide from the injection site into the systemic circulation. 

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