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Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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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.
Short-acting insulins are divided into...
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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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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.
Insulin and C-peptide are...
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Glucagon-like Receptor Agonists01:24

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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
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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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Insulin pumps: Beyond basal-bolus.

Richard Millstein1, Nancy Mora Becerra2, Jay H Shubrook3

  • 1Department of Endocrinology, University of Colorado, Denver, CO, USA.

Cleveland Clinic Journal of Medicine
|December 15, 2015
PubMed
Summary

Insulin pumps offer advanced diabetes management, improving insulin dosing accuracy and flexibility. They are a preferred treatment for type 1 and type 2 diabetes patients requiring basal-bolus insulin therapy.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Insulin pumps represent a significant advancement in diabetes care.
  • They offer improved accuracy, flexibility, and safety for insulin delivery.
  • Basal-bolus insulin therapy is crucial for many individuals with diabetes.

Purpose of the Study:

  • To review the fundamental principles of insulin pump operation.
  • To identify patient populations who benefit from insulin pump therapy.
  • To outline management strategies for inpatients and outpatients using insulin pumps.

Main Methods:

  • Literature review on insulin pump technology and clinical application.
  • Analysis of benefits, safety, and efficacy data for insulin pump users.
  • Examination of inpatient and outpatient management protocols.

Main Results:

  • Insulin pumps enhance the ease and precision of insulin dosing.
  • They provide significant flexibility, safety, and efficacy for basal-bolus therapy.
  • Preferred treatment for type 1 diabetes and many type 2 diabetes patients.

Conclusions:

  • Insulin pump therapy is a cornerstone of modern diabetes management.
  • Understanding pump function and management is key for healthcare providers.
  • This review provides essential information for optimizing insulin pump use in diverse patient settings.