Insulin replacement

Because CF-related diabetes (CFRD) results from insulin insufficiency, exogenous insulin replacement is required. 

Insulin Preparations. Since diabetes mellitus is a defect of one or more of insulin production, secretion, or action, the administration of insulin replacement as a treatment for diabetes in the 1920s was a landmark discovery. Historically, most commercial insulin came from either bovine or porcine sources. Beef insulin differs from human insulin by three amino acid substitutions pork insulin differs by only one residue. For many years, standard insulin preparations were 70% beef and 30% porcine. However, the biosynthesis of human insulin has now displaced the animal insulins, especially bovine insulin which was more antigenic. Mass production of human insulin by recombinant DNA methods is achieved by inserting the human proinsulin gene into either E. coli or yeast and treating the resulting proinsulin to yield the human insulin molecule. Insulin preparations may be divided into four major types ... 

For persons with type 1 diabetes, insulin replacement therapy is necessary to sustain life. Pharmacologic insulin is administered by injection into the subcutaneous tissue using a manual injection device or an insulin pump that continuously infuses insulin under the skin. Interruption of the insulin replacement therapy can be life-threatening and can result in diabetic ketoacidosis or death. Diabetic ketoacidosis is caused by insufficient or absent insulin and results from excess release of fatty acids and subsequent formation of toxic levels of ketoacids. 

Individuals with type 2 diabetes may not require insulin to survive, but 30% or more will benefit from insulin therapy to control blood glucose. It is likely that 10-20% of individuals in whom type 2 diabetes was initially diagnosed actually have both type 1 and type 2 or a slowly progressing type 1 called latent autoimmune diabetes of adults (LADA), and they will ultimately require full insulin replacement. Although persons with type 2 diabetes ordinarily... 

Programming is done through a hand-held unit that communicates wirelessly with the pump. CSII delivery is regarded as the most physiologic method of insulin replacement. 

Zinman B, Ross S, Campos RV, Strack TThe Canadian Lispro Study Group. Effectiveness of human ultralente versus NPH insulin in providing basal insulin replacement for an insulin lispro multiple daily injection regimen. A doubleblind randomized prospective trial. Diabetes Care 1999 22(4) 603-8. 

Rolla A. The pathophysiological basis for intensive insulin replacement. IntJ Obes Relat Metab Disord. 2004 28(suppl 2) S3-S7. 

The onset and duration of action of NPH insulin are similar to those of lente insulin (Figure 41-5) it is usually mixed with regular, lispro, or aspart insulin and given two to four times daily for insulin replacement in patients with type 1 diabetes. The dose regulates the action profile, specifically, small doses have lower, earlier peaks and a short duration of action with the converse true for large doses. 

Progress in insulin replacement strategies utilizing gene therapy... 

While insulin replacement will be the primarily aspect of long-term management of this patient, the acute problem is the diabetic keto-... 

Type 1 diabetes is treated with insulin replacement therapy, usually by insulin injection or insulin pump, along with attention to dietary management and careful monitoring of blood glucose levels. Today most insulin is produced using genetic recombination techniques insulin analogues are a form of modified insulin with different onset-of-action times or duration-of-action times. 

Seizure activity should be initially treated with benzodiazepines. If benzodiazepines are not effective, phenytoin and barbiturates can be administered. Insulin replacement may be necessary to correct hyperglycemia. 

Insulin replacement therapy is the only efficacious treatment for type 1 diabetes and is also useful for treatment of type 2 diabetes when... 

Diabetic Sequelae - While the development of insulin replacement therapy has greatly prolonged the diabetic s lifespan, it has not had a major impact in the prevention of the myriad of sequelae associated with longstanding diabetes. Kidney, retina, peripheral nerve, lens and the cardiovascular system all suffer dysfunctions secondary to diabetes. The multisystem nature of this disease has made difficult the development of a unifying hypothesis to explain these sequelae. 

Used for insulin replacement therapy in diabetic patients... 

This chapter focuses on the recent successes achieved during development of the Oralin RapidMist Diabetes Management System in various clinical trials, and its future potential as meal insulin (replacement of subcutaneous injections) in patients with type 1 and type 2 diabetes. 

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