Insulin, monitoring

The concept of immunoassay was first described in 1945 when Landsteiner suggested that antibodies could bind selectively to small molecules (haptens) when they were conjugated to a larger carrier molecule. This hapten-specific concept was explored by Yalow and Berson in the late 1950s, and resulted in an immunoassay that was applied to insulin monitoring in humans. This pioneering work set the stage for the rapid advancement of immunochemical methods for clinical use. 

PHENYTOIN ANTIDIABETIC DRUGS- METFORMIN, SULPHONYLUREAS 1 hypoglycaemic efficacy Hydantoins are considered to 1 release of insulin Monitor capillary blood glucose closely higher doses of antidiabetic drugs needed... 

Diabetes mellitus (insulin, monitoring equipment, supplies) Stye (hordeolum)... 

The U.S. market for dmgs to control blood glucose totals about 1 x 10 , equally divided between insulin and all other antidiabetic dmgs (33). Insulin sales ate expected to grow by about 10% annually, whereas the antidiabetic dmg market as a whole is expected to shrink by about 3%. The blood glucose monitoring market totals about 7.5 x 10 in the United States and is expected to grow at a rate of 10% annually. 

Antidiabetic Drugs other than Insulin. Table 4 Main exclusions, adverse events and precautionary monitoring required for clinical use of oral anti-diabetic drugs... 

The hydantoins may affect the blood glucose levels. In some patients these drugs have an inhibitory effect on the release of insulin in the body, causing hyperglycemia The nurse closely monitors blood glucose levels, particularly in patients with diabetes. The nurse reports any abnormalities to the primary health care provider. 

Hyperglycemia is the most common metabolic complication. A too rapid infuson of amino add-carbohydrate mixtures may result in hyperglycemia, glycosuria, mental confuson, and loss of consciousness Blood glucose levels may be obtained every 4 to 6 hours to monitor for hyperglycemia and guide the dosage of dextrose and insulin (if required). To minimize these complications the primary health care provider may decrease the rate of administration, reduce the dextrose concentration, or administer insulin. 

Insulin, a small protein of molecular mass 6000 daltons, is composed of two chains designated A and B. There are no reduced cysteine residues in insulin, but it contains three essential disulfide bonds two that crosslink the A and B chains, and one internal to the A chain to stabilize the overall tertiary stmcture. These disulfide bonds are cleaved in the presence of excess AuX4, leaving A and B chains that have cysteine residues that have become oxidized to sulfonic adds [119]. With smaller amounts of AuX4, a single disulfide bond will be attacked to form sulfinic acid [119]. The reaction is second order for AuCU while AuBr4 reacts too quickly for accurate monitoring. 

Frequent monitoring of blood glucose levels and adjustments of insulin are required to avoid hypoglycemia... 

Monitor electrocardiogram continuously in patients with cardiac abnormalities until serum potassium levels drop below 5 mEq/L (5 mmol/L) or cardiac abnormalities resolve. Evaluate serum potassium and glucose levels within 1 hour in patients who receive insulin and dextrose therapy. Evaluate serum potassium levels within 2 to 4 hours after treatment with SPS or diuretics. Repeat doses of diuretics or SPS if necessary until serum potassium levels fall below 5 mEq/L (5 mmol/L). Monitor blood pressure and serum potassium levels in 1 week in patients who receive fludrocortisone. 

Thereafter, the preceding parameters and other nutritional parameters should be monitored routinely or as indicated (Table 97-8). Random capillary blood glucose concentrations also should be monitored every 6 to 8 hours when initiating PN, and regular insulin should be administered to control glucose as needed (either by intermittent administration per sliding scale or as a continuous infusion). 

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