2. INTRODUCTION
Insulin is a hormone that is important
for metabolism and utilization of energy from the
ingested nutrients - especially glucose.
Insulin is produced in the islets of Langerhans in
the pancreas. The name insulin comes from the
Latin ''insula'' for "island" from the cells that produce
the hormone in the pancreas.
Insulin's structure varies slightly between species of
animal. Both porcine (from pigs) and bovine (from
cows) insulin are similar to human insulin but
porcine insulin resembles human insulin more
closely.
3. Dr. Nicolae Paulescu , Romanian scientist invented
Insulin in 1916.
On January 11, 1922 Leonard Thomson a 14 year
old boy who was dyeing of Diabetes , was given the
first experimental dose of insulin and his life saved.
In 1923 , Banting and Macleod were awarded the
noble prize for their work on discovering insulin.
4. WHAT DOES INSULIN DO ?
It causes the cells in the liver, muscle, and fat tissue to take up
glucose from blood and convert it to glycogen that can be
stored in the liver and muscles.
Insulin also prevents the utilization of fat as an energy source.
In absence of insulin or in conditions where insulin is low
glucose is not taken up by body cells, and the body begins to
use fat as an energy source.
Insulin also controls other body systems and regulates the
amino acid uptake by body cells.
It has several other anabolic effects throughout the body as
well.
5.
6. INDICATIONS OF INSULIN THERAPY
At onset :
Fasting > 250 mg /dl
Post prandial > 300mg/dl
HbA1c > 9.0%
OHA Failure
Fasting >150mg/dl
Random or Post prandial > 200mg/dl
HbA1c >8.5%
Co-morbid conditions
Severe systemic infection or sepsis
Acute Myocardial Infarction / Unstable Angina
Diabetic Ketoacidosis/Hyperosmolar state
Diabetic Kidney Disease
Pre - gestational / Gestational Diabetes
11. INSULIN DOSING REGIMENS
Degree of glycaemic control.
Severity of underlying insulin deficiency.
Patient’s lifestyle.
His/Her ability to adjust the insulin dose.(SMBG)
12. TYPE OF INSULIN FOR INSULIN INITIATION
Insulin initiation could be done with premixed
insulins which control effectively both fasting and
post prandial hyperglycemia.
Premixed formulations are generally available as
30/70, 25/75 or 50,50 combinations of rapid acting
and intermediate acting insulins.
The gold standard for insulin regimen is basal bolus
therapy combining one or two doses of basal
insulins and three doses of rapid acting insulins to
cover the post prandial peaks following three major
meals.
14. SIDE EFFECTS OF INSULIN THERAPY
Hypoglycaemia (<63mg/dl)
Weight gain
Peripheral oedema( salt and water retention)
Insulin antibodies
Local allergy ( rare )
Lipodystrophy at injection sites.
15. CONCLUSION
There is evidence demonstrating that fasting plasma
glucose(FPG) should be the key focus in initial
management of patients with poor glycaemic
control,while postprandial glycaemia should be targeted
in patients with lower HbA1c.
Controlling glycaemia is an important part of this
integrated multifactorial approach and maintaining
glycaemic levels as close to the non-diabetic range as
possible and is essential in preventing microvascular as
well as macrovascular complications.
The gold standard for insulin regimen is basal bolus
therapy combining one or two doses of insulins and
three doses of rapid acting insulins to cover the
postprandial peaks following three rapid meals.
