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Related Concept Videos

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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Insulin Formulations: Types and Delivery01:27

Insulin Formulations: Types and Delivery

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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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Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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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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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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Oral Hypoglycemic Agents: Glinides01:06

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Improving IV Insulin Administration in a Community Hospital
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Is Insulin Therapy Safe?

Philip Home1, Baruch Itzhak2

  • 1Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; and.

American Journal of Therapeutics
|October 1, 2019
PubMed
Summary

Insulin therapy offers health benefits, but long-term safety concerns like arterial disease or cancer are not supported by current evidence. Severe hypoglycemia may be reduced by insulin analogues, improving tolerability.

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Area of Science:

  • Endocrinology and Metabolism
  • Pharmacology
  • Diabetology

Background:

  • Insulin therapy, used for nearly a century, still faces safety concerns.
  • Specific worries include arterial proliferation, retinopathy, tumor growth, pregnancy risks, and hypoglycemia-induced cardiac events.
  • Immunological aspects have been minimally studied since the 1970s.

Purpose of the Study:

  • To review the available literature on the safety of insulin therapy.
  • To address uncertainties regarding potential long-term adverse effects of insulin, particularly insulin analogues.
  • To evaluate risks associated with hypoglycemia and specific insulin preparations.

Main Methods:

  • A literature review was conducted, focusing on specific safety concerns.
  • Informed literature searching was supplemented by manual review of published articles, especially those on insulin analogues.
  • Analysis included clinical outcome trials and meta-analyses.

Main Results:

  • Safety data for pregnancy are limited but show no increased maternal or fetal risk.
  • Clinical trials do not suggest insulin promotes arterial disease.
  • Concerns about insulin glargine promoting growth were unfounded; studies on retinopathy and malignancy showed no signals of concern.
  • Severe hypoglycemia may be fatal in type 1 diabetes, but its reduction in type 2 diabetes did not prevent arterial events.
  • Insulin analogues can reduce hypoglycemia and improve tolerability.

Conclusions:

  • Despite health benefits, robust evidence for long-term harm from insulin therapy is lacking.
  • Current data suggest insulin therapy is generally safe, with specific concerns largely unsubstantiated.
  • Further research into the mechanisms of severe hypoglycemia and its cardiac effects is warranted.