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Related Concept Videos

Glucagon-like Receptor Agonists01:24

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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-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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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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Hypoglycemia and Glucagon01:15

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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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Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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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.
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Insulin Edema Associated With Glargine.

Jessica Wood1, Varun Samji1, Francesco S Celi2

  • 1Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, VA 23298, USA.

JCEM Case Reports
|December 20, 2023
PubMed
Summary
This summary is machine-generated.

Insulin edema, a rare complication of insulin therapy, can cause significant fluid retention. Switching insulin types, as seen in a type 1 diabetes case, effectively resolved leg swelling and weight gain.

Keywords:
edemaglargineinsulintype 2 diabetes mellitus

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Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Insulin edema is a rare complication of insulin therapy, affecting patients with type 1 and type 2 diabetes mellitus.
  • It typically manifests after initiating or intensifying insulin treatment, particularly in newly diagnosed or poorly controlled cases.

Observation:

  • A 20-year-old male with new-onset type 1 diabetes mellitus presented with hyperglycemia (824 mg/dL) and significant weight loss.
  • Following initiation of insulin glargine and lispro, he developed bilateral leg edema and rapid weight gain (25 lbs in 10 days).

Findings:

  • After excluding other causes of edema, insulin edema was diagnosed.
  • Switching from insulin glargine to insulin degludec resulted in complete resolution of edema within 3 days.

Implications:

  • This case highlights insulin edema as a diagnosis of exclusion, potentially linked to insulin's effects on renal sodium handling, vasodilation, or vascular permeability.
  • Clinicians should consider insulin edema in patients presenting with unexplained edema during insulin therapy and consider alternative insulin formulations.