Meal times

James HM, Milbum ME, Blair JA. 1985. Effects of meals and meal times on uptake of lead from the gastrointestinal tract of humans. Human Toxicol 4 401-407. 

Figure 2.5 A plot of oxygen uptake after two meals in young adult males. The vertical bars indicate the meal times. The measurements were carried out after physical activity which exaggerates the effect of the meal. The meal was high in carbohydrate.

Systemic absorption of pulmonary-deUvered peptides and proteins has been the objective of many investigations [2]. The most successful work in this field is the development of insulin formulations for inhalation.These dosage forms might, in the near future, become a suitable alternative for the current subcutaneous injection of insulin that is used to obtain meal-time glucose control [3]. In spite of the strict requirements regarding dose variability for insulin, the pulmonary products under development seem to be as safe as the subcutaneous injections. 

INSULIN LISPRO Insulin lispro is intended for subcutaneous administration. When used as a meal-time insulin, give insulin lispro within 15 minutes before or immediately after a meal. 

Although many cells in the body express the insulin receptor, its most important targets are skeletal muscle fibres, hepatocytes and adipocytes, where it often antagonizes the effects of glucagon (Table 8.1). The most potent known stimulus of pancreatic insulin release is an increase in blood glucose levels, often occurring after meal times. Insulin orchestrates a suitable metabolic response to the absorption of glucose and other nutrients in a number of ways ... 

FIGURE 23-39 Variations in ghrelin and insulin relative to meal times, (a) Plasma levels of ghrelin rise sharply just before the normal time for meals (7 a.m. breakfast, 12 noon lunch, 5 30 p.m. dinner) and drop precipitously just after meals, paralleling the subjective feelings of hunger, (b) Insulin levels rise immediately after each meal, in response to the increase in blood glucose concentration. 

Pramlintide 30 micrograms was given to 16 patients using insulin pumps as an injection at meal times (6). Mealtime insulin was reduced by 17%. Serum fructosa-mine improved. Nausea was the most common adverse effect. There was no hypoglycemia. 

August 18. For the past week, we have been living on C-rations— naturally I in particular take a dim view of such behavior— and the view becomes even dimmer when I realize that we have to live on C-rations again next week. Dickinson also suflFers with us and gets off some choice remarks at meal times. [NDRC group photograph taken at this time. Figure 5.5.]... 

In many NIDDM patients once daily intermediate- or long-acting insulin may be adequate to render them asymptomatic, avoid the risk of nocturnal hypoglycaemic episodes (Bilous and Alberti, 1990) and produce basal normoglycaemia. A combination of intermediate-acting insulin and sulphonylureas is possible, the patients own B-cells providing the meal-time spikes. Alternatively one or two injections of a mixture of short- and intermediate-acting insulin daily is sufficient for metabolic control. In elderly... 

If patients have a number of tablets or capsules to take in a day it may help them to remember to take their medication if the times are linked to daily events such as meal times or brushing teeth, etc. 

Assure medication compliance by reviewing medication calendar. Once the patients are stable, they are more apt to develop their own regimens. These regimens may allow medications to be dosed too close together or too close to meal times, skip certain medications deemed unnecessary by the patient, and/or add certain medications (i.e., natural herbs, vitamins). 

Examples include, choice of antihypertensive agent to he used while on cyclosporine or tacrolimus, timing medication ingestion around meal times. After identifying medications that are detrimental to the bone marrow, offer options for treatment that have no effect or minimal effect on the bone marrow. 

Blood sampling strategies may need to be selected in relation to meal times to describe enterohepatic recycling. 

InsuHn Hspro (sold under the trade names Humalog and Liprolog) exemplifies engineered short-acting insuHn products. This product displays an amino acid sequence identical to native human insuHn, with the exception that the natural pro-Hne-lysine sequence characteristics of positions 28 and 29 of the insuHn B chain have been reversed. The sequence inversion leads to local conformational changes, eHminating hydrophobic interactions critical to dimer stabiHzation. As a result, de-oligomerization occurs rapidly upon injection and the product can be administered at meal times rather than 30 min before. The different forms and formulations of insuHn are shown on the supplementary CD-ROM. 

The aim of this proofofconcept study was to introduce Oralin as meal insulin in place of meal-time insulin injections in the treatment of type 2 diabetes, and to... 

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