Insulin, a hormone produced by the pancreas, acts to maintain blood glucose levels within normal limits (60–120 mg/dL).This is accomplished by the release of small amounts of insulin into the bloodstream through out the day in response to changes in blood glucose levels. Insulin is essential for the utilization of glucose in
cellular metabolism and for the proper metabolism of protein and fat.Diabetes mellitus is a complicated, chronic disordercharacterized by either insufficient insulin production
by the beta cells of the pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated
blood glucose levels, or hyperglycemia. As a result of the disease, individuals with diabetes are at greater risk
for a number of disorders, including myocardial infarction,cerebrovascular accident (stroke), blindness, kidney
disease, and lower limb amputations. Insulin and the oral antidiabetic drugs, along with diet and exercise, are the cornerstones of treatment for diabetes mellitus. They are used to prevent episodes of hypoglycemia and to normalize carbohydrate metabolism.
There are two major types of diabetes mellitus:
• Type 1—Insulin-dependent diabetes mellitus
(IDDM). Former names of this type of diabetes
mellitus include juvenile diabetes, juvenile-onset diabetes, and brittle diabetes.
• Type 2—Noninsulin-dependent diabetes mellitus
(NIDDM). Former names of this type of diabetes
mellitus include maturity-onset diabetes, adultonset diabetes, and stable diabetes.Those with type 1 diabetes mellitus produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes usually has a rapid onset, occurs before the age of 20 years, produces more severe symptoms than type 2 diabetes, and is more difficult to control.
Major symptoms of type 1
diabetes include hyperglycemia, polydipsia (increased thirst), polyphagia (increased appetite),
polyuria (increased urination), and weight loss. Treatment of type 1 diabetes is particularly difficult
to control because of the lack of insulin production by the pancreas. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home glucose testing several times a day, and multiple daily insulin injections.Type 2 diabetes mellitus affects about 90% to 95% of individuals with diabetes. Those with type 2 diabetes mellitus either have a decreased production of insulin by the beta cells of the pancreas or a decreased sensitivity of the cells to insulin, making the cells insulin resistant. Although type 2 diabetes mellitus may occur at any age, the disorder occurs most often after the age of 40 years. The onset of type 2 diabetes isusually insidious, symptoms are less severe than in type 1 diabetes mellitus, and because it tends to be morestable, it is easier to control than type 1 diabetes. Risk factors for type 2 diabetes include:
• Obesity
• Older age
• Family history of diabetes
• History of gestational diabetes (diabetes that develops during pregnancy but disappears when pregnancy is over)
• Impaired glucose tolerance
• Minimal or no physical activity
• Race/ethnicity (African Americans, Hispanic/Latino
Americans, American Indians, and some Asian Americans)Obesity is thought to contribute to type 2 diabetes by placing additional stress on the pancreas, which makes it less able to respond and produce adequate insulin to meet the body’s metabolic needs.
Many individuals with type 2 diabetes are able to control the disorder with diet, exercise, and oral antidiabetic drugs. However, about 40% of those with type 2 diabetes do not have a good response to the oral antidiabetic drugs and require the addition of insulin to control the diabetes
How To Work
Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. Insulin also stimulates the synthesis of glycogen by the liver. In addition, insulin promotes protein synthesis and helps the body store fat by preventing its break down for energy.
Onset, Peak, and Duration of Action
Onset, peak, and duration are three properties of insulin that are of clinical importance.
• Onset—when insulin first begins to act in the body
• Peak—when the insulin is exerting maximum
action
• Duration—the length of time the insulin remains in effect
To meet the needs of those with diabetes mellitus,various insulin preparations have been developed to delay the onset and prolong the duration of action of insulin. When insulin is combined with protamine (a protein), the absorption of insulin from the injection site is slowed and the duration of action is prolonged.
The addition of zinc also modifies the onset and duration of action of insulin. Insulin preparations are
classified as rapid-acting, intermediate-acting, or long-acting.
Indication To Uses
Insulin is necessary for controlling type 1 diabetes mellitus that is caused by a marked decrease
in the amount of insulin produced by the pancreas. Insulin is also used to control the more severe and complicated forms of type 2 diabetes mellitus. However, many patients can control type 2 diabetes with diet and exercise alone or with diet, exercise, and an oral antidiabetic drug .Insulin may also be used in the treatment of severe diabetic ketoacidosis (DKA) or diabetic coma. Insulin is also used in combination with glucose to treat hypokalemia by producing a shift of potassium from the blood and into the cells.
Side Effects
The two major adverse reactions seen with insulin administration are hypoglycemia
(low blood glucose or sugar) and hyperglycemia (elevated blood glucose or sugar)
Contraindicated
Insulin is contraindicated in patients with hypersensitivity to any ingredient of the product
(eg, beef or pork) and when the patient is hypoglycemic
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Unknown - Thursday 11 August 2011
