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Related Concept Videos

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.
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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-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 secretory vesicles release insulin to stimulate blood glucose uptake and regulate carbohydrate metabolism. When the blood glucose levels increase, glucose enters the pancreatic β-islet cells through glucose transporters. Once inside, glucose is metabolized through glycolysis, the citric acid cycle, and the electron transport chain, producing ATP. This increase in ATP concentration closes ATP-sensitive potassium channels, leading to depolarization of the membrane and the opening of...
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Insulin: The Receptor and Signaling Pathways01:28

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Insulin action is mediated through a receptor tyrosine kinase, akin to the IGF-1 receptor. The number of receptors per cell varies significantly, from 40 on erythrocytes to 300,000 on adipocytes and hepatocytes. The insulin receptor consists of linked α/β subunit dimers, forming a heterotetramer glycoprotein with two extracellular α subunits and two β subunits spanning the membrane. The α subunits inhibit the inherent tyrosine kinase activity of the β subunits, but...
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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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Improving IV Insulin Administration in a Community Hospital
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Open source automated insulin delivery: addressing the challenge.

Nick Oliver1, Monika Reddy1, Claire Marriott2

  • 11Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.

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|December 17, 2019
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Do-it-yourself automated insulin delivery systems show promise for type 1 diabetes management. Further research and regulatory frameworks are needed to address challenges and ensure safe, equitable access to these glucose control technologies.

Keywords:
Translational researchType 1 diabetes

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Area of Science:

  • Biomedical Engineering
  • Endocrinology
  • Health Informatics

Background:

  • Do-it-yourself (DIY) automated insulin delivery (AID) systems are increasingly used by individuals with type 1 diabetes (T1D).
  • These systems integrate commercially available continuous glucose sensors (CGM) and insulin pumps with open-source software.
  • Growing evidence suggests potential for positive glucose control outcomes with DIY AID systems.

Purpose of the Study:

  • To discuss the challenges and obstacles hindering the wider implementation of DIY AID systems.
  • To outline necessary steps for a coordinated approach to improve access to these technologies.
  • To address the needs of healthcare professionals, device manufacturers, and regulators regarding DIY AID systems.

Main Methods:

  • Literature review and discussion of existing data on DIY AID systems.
  • Analysis of challenges including data, education, policy, technology, and medicolegal aspects.
  • Identification of next steps for a structured implementation strategy.

Main Results:

  • DIY AID systems offer feasible glucose control benefits for T1D management.
  • Significant legal, governance, and risk framework gaps exist for these unregulated devices.
  • Key obstacles include data management, user education, policy development, technological integration, and medicolegal considerations.

Conclusions:

  • Wider implementation of DIY AID systems requires addressing multifaceted challenges.
  • A coordinated approach is essential to reduce access variations and optimize glucose self-management.
  • Defining legal and regulatory frameworks is crucial for the safe and effective use of DIY AID technologies.