Insulin therapy

Insulin therapy for management of type 1 and 2 Diabetes mellitus

1. INSULIN THERAPY Presented b y : Meraj Fatima PharmD Sultan u l Uloom C ollege of P harmacy Hyderabad Guided by : Dr S.P. Srinivas Nayak, Assistant professor, SUCP, HYD

2. INSULIN Polypeptide hormone. Produced by Beta-cells of islets of Langerhans in pancreas. Profound effects on carbohydrate, fat & protein metabolism and to some extent an water & electrolyte balance.

3. Action of Insulin Integrated action on carbohydrate, protein and fat metabolism. Dominant effect on glucose homoeostasis predominantly exerted in 3 tissues Liver Skeletal muscle Fat In Liver Inhibition of glycogenolysis & gluconeogenesis. Stimulation of glycogenesis & storage. In skeletal muscle & adipocytes Stimulation of glucose uptake, utilization & storage. Increases glucose transport. Activation/inactivation of enzymes responsible for storage & metabolism of glucose.

4. Insulin deficiency results in : Elevated plasma glucose hyperglycemia Elevated plasma lipid - hyertriglyceridemia Altered protein metabolism - metabolic Immune defects

5. INSULIN SECRETION Normally secreted as basal (between meals and night time) ; bolus – meal related peaks (1 st and 2 nd phase)

6. TYPES OF INSULIN Rapid-acting insulin ( Analogs ) Short-acting Humulin (Regular) Intermediate-acting insulin (NPH) Premixed insulin Long-acting insulin

7. TYPES OF INSULIN

8. COMMON INSULIN REGIMENS Split Mix Regimens Two injections per day Twice daily regimens • Intermediate acting insulin(NPH)and short acting (regular) insulin • 2/3 of insulin - morning(ratio 1:2) • 1/3 of insulin - evening before breakfast & before bedtime Proportion/dosage of insulins titrated based on BG profile Drawback Mixing insulins is tedious and problematic Inaccuracy of dose Not preferred -more problems for patients

9. MULTIPLE INJECTION REGIMEN Short acting- before meal Intermediate or long acting -once or twice daily Advantage: Allows greater freedom with regard to meal timing More variable day to day physical activity

10. BASAL INSULIN Usually given at night. Proportion dosage of insulin titrated based on FBG. Drawback Expensive. Fasting blood glucose is primary targeted. May be with sensitizer and or secretagogue. BASAL BOLUS INSULIN Basal insulin at night and one rapid acting insulin immediately before each major meal (3 times). Basal insulin is titrated following FBG Rapid acting insulin is titrated by post meal BGs Drawback Expensive 4 times needle prick a day

11. Continuous subcutaneous insulin infusion (CSII) Very effective insulin regimen for type 1 DM Sophisticated device requires education of the patient and frequent interactions with diabetes management team Advantages: programmed dose. basal infusion rates altered during exercise. different doses of insulin can be matched based on meals. Disadvantages: Infection. Hyperglycemia . Decrease potassium level.

12. INSULIN DEVICES Insulin syringes -10ml insulin vials 30 unit -0.3 ml,50 unit-0.5 ml, 100 unit-1ml Need - 8mm to 13mm Use each syringe only once. Insulin pen -insulin catridge-3ml-300 units fits into the device. Disposable, reusable Insulin pumps -reservoir of insulin-infusion set worn outside the body-abdomen Only short or rapid acting insulin are used-mimics physiological pattern Inhaled insulin

13. SITES OF INSULIN INJECTION

14. Side effects of insulin therapy Hypoglycemia (predominantly seen in type 1 patients) Weight gain Peripheral edema (salt and water retention in short term) Insulin antibodies (with animal insulin) Local allergy Lipohypertrophy or lipoatrophy at site of injection

15. Thank you