Insulin therapy plasma levels

Goals for self-monitored blood glucose levels while on insulin therapy are a preprandial plasma glucose level between 80 and 110 mg/dL, and a 2-hour postprandial plasma glucose level less than 155 mg/dL. 

The fundamental treatment for DKA includes aggressive intravenous hydration and insulin therapy and maintenance of potassium and other electrolyte levels. Fluid and insulin therapy is based on the patient s individual needs and requires frequent reevaluation and modification. Close attention has to be given to hydration and renal status, the sodium and potassium levels, and the rate of correction of plasma glucose and plasma osmolality. Fluid therapy generally begins with normal saline. Regular human insulin should be used for intravenous therapy with a usual starting dose of about 0.1 IU/kg/h. 

Concomitant use with anticoagulants may increase plasma levels of both drugs and, after continued therapy, may reduce the plasma levels of anticoagulant effects. Use with chloramphenicol, guanethidine, insulin, monoamine oxidase inhibitors, probenecid, salicylates, or sulfonamides may enhance the hypoglycemic effect by displacing tolazamide from its protein-binding sites. 

First-line therapy includes nutritional and exercise interventions for all women, and caloric restrictions for obese women. If nutritional intervention fails to achieve fasting plasma glucose levels less than or equal to 105 mg/dL, 1-hour post-prandial plasma glucose concentrations less than or equal to 155 mg/dL, or 2-hour postprandial levels less than or equal to 130 mg/dL, then therapy with recombinant human insulin should be instituted glyburide may be considered after 11 weeks of gestation. 

Diabetes mellitus, combination therapy PO With insulin Initially, 15-30 mg once a day. Initially, continue current insulin dosage then decrease insulin dosage by 10% to 25% if hypoglycemia occurs or plasma glucose level decreases to less than 100 mg/dl. Maximum 45 mg/day. With sulfonylureas Initially, 15-30 mg/day. Decrease sulfonylurea dosage if hypoglycemia occurs. With metformin Initially, 15-30 mg/day. As monotherapy Monotherapy is not to be used if patient is well controlled with diet and exercise alone. Initially, 15-30 mg/day. May increase dosage in increments until 45 mg/day is reached. 

In islets, A-4166 causes a steep rise in insulin release followed by a slow sustained rise to twice the basal level. The insulinotropic effect is not glucose-dependent and takes place in the absence of glucose [191, 192]. The in vivo pharmacodynamic profile (rapid and short-term action) appears to result from a rapid plasma appearance and disappearance of the compound rather than an intrinsic feature of the mechanism [191]. A-4166 may be useful as therapy for NIDDM patients with secondary failure to sulphonylureas [190]. 

In Type-I diabetes, which is due to the loss of insulin-producing cells as a consequence of autoimmune disorders, substitution of insulin is the most important measure. However, merely to inject one daily dose is not an adequate therapy. Here, the objective is to mimic the daily variations in plasma insulin which are closely related to food intake. One such attempt which has improved microvascular complications is intensified insulino-therapy through multiple daily injections of insulin. Another approach is to develop techniques of islet transplantation and using a bioartificial pancreas. In the case of islet transplantation, tissues will not only respond to changes in blood glucose levels but also to hormones of the entero-insular axis. 

In spite of the short half life and diverse actions, it has been used in a number of interesting clinical experiments which have attempted to ascertain its utility as an adjunct to the therapy of diabetes. Somatostatin in combination with insulin (at doses which did prevent postprandial hyperglycemia or hyperglucagonemia) com- pletely prevented plasma glucose levels from rising after a meal. 

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