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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Insulin Formulations: Types and Delivery01:27

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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Glucose Homeostasis: Pancreatic Islets and Insulin Secretion01:27

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The pancreatic islets comprising only 1%-2% of the volume are highly vascularized and innervated mini-organs. They contain five endocrine cell types, including β cells that secrete insulin, which is synthesized as a single polypeptide chain, preproinsulin, processed to proinsulin, and finally to insulin and C-peptide. This process is complex and regulated, involving the Golgi complex, the endoplasmic reticulum, and the secretory granules of the β cell.
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Insulin: Biosynthesis, Chemistry, and Preparation01:25

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The endoplasmic reticulum (ER) of pancreatic β-cells synthesizes preproinsulin, which consists of a signal peptide, A and B chains, and a C-peptide. Preproinsulin is then cleaved and folded into proinsulin, which translocates to the Golgi apparatus for sorting and packaging into secretory granules. In these granules, enzymatic clipping generates insulin and C-peptide.
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Insulin pump therapy: a meta-analysis.

Jill Weissberg-Benchell1, Jeanne Antisdel-Lomaglio, Roopa Seshadri

  • 1Children's Memorial Hospital, Chicago, Illinois, USA. jwbenchell@childrensmemorial.org

Diabetes Care
|March 29, 2003
PubMed
Summary
This summary is machine-generated.

Continuous subcutaneous insulin infusion (CSII) therapy significantly improves glycemic control in patients with diabetes. While generally safe, further research is needed on its psychosocial effects and rare risks like diabetic ketoacidosis (DKA).

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Continuous subcutaneous insulin infusion (CSII) is an advanced insulin delivery method.
  • Understanding its metabolic and psychosocial effects is crucial for patient care.

Purpose of the Study:

  • To perform a meta-analysis on the metabolic and psychosocial impact of CSII therapy.
  • To evaluate CSII's effectiveness and safety in adults, adolescents, and children.

Main Methods:

  • Meta-analysis of 52 studies involving 1,547 patients.
  • Collected data on study design, patient demographics, and CSII therapy duration.
  • Analyzed glycohemoglobin, blood glucose, insulin dosages, and body weight using meta-analytic procedures.
  • Descriptively reviewed pump complications and psychosocial functioning.

Main Results:

  • CSII therapy significantly improves glycemic control, indicated by lower glycohemoglobin and blood glucose levels.
  • A descriptive review indicated fewer hypoglycemic episodes with CSII.
  • An increased frequency of diabetic ketoacidosis (DKA) was noted in studies published before 1993.

Conclusions:

  • CSII therapy demonstrates superior glycemic control compared to conventional insulin therapies.
  • CSII does not appear to be associated with significant adverse outcomes.
  • Further research is recommended to explore the psychosocial impact and relative risks of CSII therapy.