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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.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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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.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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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.
Damage or functional impairment of β-cells inhibits insulin production, leading to diabetes. Diabetes treatment...
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Diabetes Mellitus: Overview and Type I Subtype01:22

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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Glucose Homeostasis: Pancreatic Islets and Insulin Secretion01:27

Glucose Homeostasis: Pancreatic Islets and Insulin Secretion

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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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Related Experiment Video

Updated: Mar 22, 2026

Improving IV Insulin Administration in a Community Hospital
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[Insulin therapy: as late as possible].

Stephan Jacob

    Deutsche Medizinische Wochenschrift (1946)
    |April 15, 2016
    PubMed
    Summary

    Early insulin is not always necessary for glycemic control. Lifestyle changes and new medications can improve blood sugar management, reduce weight gain, and prevent hypoglycemia, challenging traditional treatment approaches.

    Area of Science:

    • Endocrinology
    • Metabolic Disorders
    • Diabetes Research

    Context:

    • Historically, progressive beta cell loss necessitated early insulin supplementation for diabetes management.
    • Limited non-insulin treatment options previously guided clinical practice towards early insulin initiation.

    Purpose:

    • To evaluate the necessity of early insulin supplementation in diabetes management.
    • To explore alternative strategies for maintaining glycemic control.
    • To assess the impact of lifestyle modifications and novel medications on diabetes outcomes.

    Summary:

    • Current data suggest beta cell dysfunction, not just loss, is key in diabetes progression.
    • Effective lifestyle management and new medications can achieve good glycemic control without early insulin.

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  • These approaches also offer benefits in weight management and significantly reduce hypoglycemia risk.

    • Impact:

    • Challenges the paradigm of early insulin use in diabetes treatment.
    • Highlights the potential of non-insulin therapies and lifestyle interventions.
    • Suggests a shift towards personalized diabetes management strategies focusing on beta cell function preservation.