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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.
Short-acting insulins are divided into...
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Insulin: Dosing Regimen and Adverse Effects01:16

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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: 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: 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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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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Control systems are foundational elements in automation and engineering. They are broadly categorized into open-loop and closed-loop systems. These classifications hinge on the presence or absence of feedback mechanisms, significantly influencing the system's performance, complexity, and application.
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Improving IV Insulin Administration in a Community Hospital
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Recent advances in closed-loop insulin delivery.

Julia Ware1, Roman Hovorka1

  • 1Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom; Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.

Metabolism: Clinical and Experimental
|December 10, 2021
PubMed
Summary
This summary is machine-generated.

Automated insulin delivery systems have revolutionized type 1 diabetes management. This review covers current and emerging closed-loop systems, special populations, and future research directions for equitable access.

Keywords:
Artificial pancreasClosed loop insulin deliveryDiabetes technologyType 1 diabetes

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Biomedical Engineering

Background:

  • Insulin discovery over 100 years ago marked a turning point in diabetes therapy.
  • Recent advancements include glucose-responsive automated insulin delivery systems.
  • Closed-loop insulin delivery systems have rapidly evolved from research to clinical practice, with multiple commercial options available.

Purpose of the Study:

  • To review the key evidence on currently available and developing closed-loop insulin delivery systems.
  • To discuss dual-hormone and do-it-yourself (DIY) systems.
  • To examine clinical evidence in special populations and identify future research directions and barriers to adoption.

Main Methods:

  • Literature review of current and emerging closed-loop insulin delivery systems.
  • Analysis of clinical evidence in specific populations (very young children, older adults, pregnancy).
  • Discussion of dual-hormone and DIY systems.

Main Results:

  • Multiple closed-loop insulin delivery systems are now commercially available.
  • Evidence is reviewed for systems in development, dual-hormone, and DIY approaches.
  • Clinical data in special populations and future research needs are identified.

Conclusions:

  • Closed-loop insulin delivery represents a significant advancement in managing type 1 diabetes.
  • Further research and strategies are needed to address barriers and ensure equitable access to these novel therapies.
  • Future directions include optimizing systems for special populations and exploring innovative delivery methods.