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Related Concept Videos

Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

309
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...
310
Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

572
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: Biosynthesis, Chemistry, and Preparation01:25

Insulin: Biosynthesis, Chemistry, and Preparation

678
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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Glucagon-like Receptor Agonists01:24

Glucagon-like Receptor Agonists

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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.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
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Insulin: The Receptor and Signaling Pathways01:28

Insulin: The Receptor and Signaling Pathways

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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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Isolation, Culture, and Imaging of Human Fetal Pancreatic Cell Clusters
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Future directions in insulin therapy.

Philip Home1

  • 1Translational and Clinical Research Institute, Newcastle University, UK.

Metabolism: Clinical and Experimental
|September 18, 2021
PubMed
Summary

Current insulin therapy faces challenges in precise glucose control and mealtime delivery. Future advancements may lie in islet cell transplantation, offering a promising long-term solution for diabetes management.

Area of Science:

  • Biotechnology
  • Endocrinology
  • Diabetes Mellitus Research

Background:

  • Insulin therapy has evolved significantly with technological advancements in purification, formulation, devices, and patient support.
  • Despite progress, current insulin therapy fails to achieve minute-to-minute glucose control and mimic physiological insulin release during meals.
  • Existing approaches like closed-loop systems and modified insulin formulations face fundamental limitations.

Purpose of the Study:

  • To review the historical advancements in insulin therapy.
  • To identify the persistent unmet needs in diabetes management.
  • To evaluate emerging biotechnological strategies for improved insulin delivery.

Main Methods:

  • Review of historical and current insulin therapy technologies.
Keywords:
Diabetes mellitusInsulin therapy

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  • Analysis of limitations in existing insulin delivery systems.
  • Assessment of potential future therapeutic approaches, including cell-based therapies.

    • Main Results:

    • Despite innovations, precise glucose regulation and mealtime insulin mimicry remain elusive.
    • Oral insulin, insulin-mimetic tablets, and glucose-responsive insulin face significant developmental hurdles.
    • Gene therapy shows limited potential for feedback-controlled insulin delivery.

    Conclusions:

    • Islet cell transplantation and stem cell-derived beta-cells represent the most promising long-term strategy for overcoming current insulin therapy limitations.
    • These cell-based approaches, while complex, offer the potential for physiological insulin replacement.
    • Significant biotechnological development is required for these advanced therapies to mature and become clinically viable.