Insulin therapy administration

Intensive insulin therapy, the administration of insulin three or more times daily to maintain preprandial blood glucose levels between 70 and 120 g/dL and postprandial blood glucose levels less than 180 g/dL, has been shown to decrease the incidence of proteinuria and albuminuria in patients with diabetes, both with and without documented nephropathy. The development and progression of nephropathy is also delayed in patients with type 1 DM receiving intensive insulin therapy. Continued benefits of intensive insulin therapy have been demonstrated up to 8 years after the study.16... 

Combination insulin therapy Concurrent administration of insulin and an oral... 

The standard mode of insulin therapy has traditionally been by subcutaneous injection using disposable needles/syringes. However, other routes of administration, including continuous subcutaneous insulin infusion pumps and inhalation of finely powdered aerosolized insulin, are currently being explored. 

Pramlintide is approved for concurrent mealtime administration in individuals with type 1 diabetes who have poor glucose control after eating despite optimal insulin therapy. The addition of pramlintide leads to a significant reduction in early postprandial glucose excursions mealtime insulin doses usually have to be reduced to prevent hypoglycemia. 

Responses to hormonal manipulations and fasting. Activities responded in a parallel fashion to glucocorticoid administration (93-96, 113), alloxan diabetes and insulin therapy (41, 113, 117), growth hormone treatment (118), and acute and prolonged fasting (90, 98, 118, 121). 

When acarbose is combined with insulin, the greatest effects are seen with regimens that involve only once- or twice-daily administration. The alpha-glucosidase inhibitors seem to be less effective when they are combined with intensive insulin therapy (35). In combination with insulin or oral hypoglycemic drugs the frequency of hypoglycemic episodes can increase sucrose or higher carbohydrates are reported to be less effective, which can be understood from the mechanism of action. 

Taira M, Takasu N, Komiya I, Taira T, Tanaka H. Voglibose administration before the evening meal improves nocturnal hypoglycemia in insulin-dependent diabetic patients with intensive insulin therapy. Metabolism... 

Heinemann L, Pfutzner A, Heise T. Alternative routes of administration as an approach to improve insulin therapy update on dermal, oral, nasal and pulmonary insulin delivery. Curr Pharm Des 2001 7(14) 1327-51. 

Herz M, Arora V, Sun B, Ferguson SC, Bolli GB, Frier BM. Basal-bolus insulin therapy in Type 1 diabetes comparative study of pre-meal administration of a fixed mixture of insulin lispro (50%) and neutral protamine lispro (50%) with human soluble insulin. Diabet Med 2002 19(ll) 917-23. 

Patients on long-term insulin therapy are usually trained to administer their own medication. In order to safely use insulin, it is important to provide adequate (refrigerated) storage of the preparation, to maintain sterile syringes, to accurately measure the dose and fill the syringe, and to use a proper injection technique. Patients should rotate the sites of administration (abdomen, upper thighs, upper arms, back, and buttocks) to avoid local damage from repeated injection. 

Hypoglycemia is a primary complication of insulin therapy and may result from either an excess of insulin or a lack of glucose, or both. Severe hypoglycemia may cause headache, confusion, double vision, drowsiness, and convulsions. The treatment of this hypoglycemia may include the administration of glucose or glucagon. 

The standard mode of insulin therapy is subcutaneous injection using conventional disposable needles and syringes. During the last 3 decades, much effort has gone into exploration of other means of administration. 

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. 

It has been observed (D6) Aat addition of vitamin Be to insulin therapy allowed the employment of lower doses of insuhn and, in one subject, the total cessation of insulin administration. Finally, Oka and Leppanen (04) studied the tryptophan metabolism in 10 patients with diabetes mellitus and in 12 control subjects by determining the urinary excretion of 5-hydroxyindoleacetic acid, kynurfenine, and anthranilic, 3-hydroxyanthranilic, and xanthurenic acids before and after a load of 2 g L-tryptophan. The authors noted a markedly increased excretion of... 

Type 1 diabetes is characterized by a near-absolute insulin deficiency at diagnosis or soon thereafter. The beta cells of the pancreas are no longer able to secrete insulin due to autoimmune destruction. Therefore, people with type 1 diabetes require exogenous administration of insulin for survival. People with type 2 diabetes may require insulin therapy when diet, exercise, and the oral agents are no longer enough to provide adequate glucose control. 

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]. 

Quellhorst E. Insulin therapy during peritoneal dialysis pros and cons of various forms of administration. J Am Soc Nephrol 2002 13(Suppl 1) S92-S96. 

Unlike the safety question surrounding pesticides, with their more complex chemistry and toxicology, the primary argument for the absolute safety of BST can be understood by anyone who has a friend or relative suffering from diabetes requiring insulin therapy. Today, insulin is manufactured as a recombinant peptide hormone similar in many respects to BST. Yet it is still primarily delivered the way it was decades ago, by hypodermic needles, since insulin cannot be absorbed after oral administration. Even if high levels of BST were found in milk (which they are not), it is impossible for humans, or for that matter even the cow itself, to orally absorb BST or peptides of any kind into the bloodstream and experience any biological effects. 

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). 

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