ref harrison

1. INSULIN IN MANAGEMENT
OF DIABETES MELLITUS

2. OVERVIEW OF DIABETES MELLITUS
• DM Is a group of metabolic d/o sharing phenotype of
“hyperglycemia’’ caused by complex interaction of genetics
&environment.
• FACTORS CONTRIBUTING TO HYPERGLYCEMIA-↓Insulin secretion
-↓glucose utilization
-↑glucose production

6. REGULATION OF GLUCOSE HOMEOSTASIS
• It is a balance b/w energy
intake from ingested
food,hepatic glucose
production(gluconeogenesis)
&peripheral tissue uptake
&utilization
• Regulated by
insulin(mainly),neural
input,metabolic signals,other
hormones-glucagon

7. History,Biosynthesis,Structure of Insulin
• Insulin discovered by Banting & Best in 1921
• Structure proposed by Sanger in 1956

8. Insulin Secretion

9. Insulin Action

10. Insulin Preparations

11. Insulin regimen in type I DM
• GOAL
Target-basal insulin,insulin replacement for meals appropriate for carb intake

12. MDI,MCI,CSII

13. Insulin in type 2 DM
Initial therapy in lean individuals/one with severe weight loss,one
with underlying hepatic/renal disease,hospitalized
individuals,acutely ill patients
In pt with long standing dm type2
Single dose of long acting insulin(0.2-0.4u/kg/day)evening/just b4
bed time
In combination with oral hypoglycemics

14. Reactions to insulin
Hypoglycemia
Lipodystrophy
Allergy
Edema

15. Drug interactions
b blockers-prolong hypoglycemia by inhibiting compensatory
response by b2 receptors
-mask hypoglycemic warning signs
palpitation,tremor,anxiety
Thiazides,furosemides,corticosteroids,oral contraceptives reduce
insulin effectiveness
Acute alchohol ingestion precipitate hypoglycemia by depleting
hepatic glycogen

16. THANK YOU