Basics of insulin and GLP1

1. INJECTABLE THERAPY IN
DIABETES MELLITUS
MANAGEMENT
Dr Pranab Kumar Sahana

2. TYPES
 Insulin
 GLP1 R agonist/Analogue

3. INSULIN STRUCTURE: 51 AMINO ACIDS POLY
PEPTIDE

4. INDICATION OF INSULIN
 Type 1 Diabetes Mellitus: Always
 Type2 Diabetes Mellitus: OAD failure, surgery, acute illness
 Gestational Diabetes Mellitus: Always
 Pancreatic Diabetes
 Steroid induced Diabetes Mellitus

5. INSULIN CLASSIFICATION AND TIME OF
ADMINISTRATION
 Short acting Insulin: Regular Insulin – before
meal (15-30 minutes)
 Rapid acting Insulin: Lispro, Aspart,Glulisine-
before meal (5 minutes/immediately after meal)
 Intermediate acting Insulin: Isophane Insulin
(NPH) before or after –once or twice daily
 Long acting Insulin: Glargine –U100, Degludec,
Detemir, Glargine U300 - before or after meal-
usally once daily
 Premixed Insulin(30/70,25/75,50/50)- before
meal (15-30 minutes)

6. TIME ACTION PROFILE OF INSULINS

7. PREMIXED INSULIN
Brand name COMPOSITION
Human Insulin 30/70 Human Mixtard 30/70 30% Regular Insulin,70
% NPH
BIPHASIC
ASPART30/70
Novomix 30/70 30% Aspart,70%
Protaminated Aspart
BIPHASIC LISPRO
30/70
Humalog Mix 30/70 30% Lispro,70%
Protaminated Lispro
Coformulation of Aspart
and Degludec
Ryzodeg 30% Aspsart
,70%Degludec

8. PHARMACOKINETIS OF DIFFERENT INSULINS

13. U40 INSULIN SYRINGE
 U40 syringe
 0-40 marks
 RED cap and RED markings
 1 MARK= 1 unit of Insulin
 It is only for U40 vial
 U40 vial= 40 units of insulin /ml

14. U100 INSULIN SYRINGE
 U100 SYRINGE
 0-100 MARKS
 ORANGE CAP and black markings
 1 MARK= 2 units OF Insulin
 It is only for U100 vial
 U100 vial= 100 units of insulin /ml

15. INSULIN INJECTION SITES :
ABDOMEN,THIGH,ARM,BUTTOCK

16. INSULIN INJECTION TECHNIQUE WITH SYRINGE
FROM VIAL
 Wash your hand
 Check and prepare insulin vial and syringe
 Pull air into the syringe
 Push air into the vial
 Draw up the insulin into the syringe
 Check the syringe for air bubble
 Remove the syringe from the vial
 Select the site
 Push the needle into the skin
 Push the plunger to inject the insulin
 Wait for 5 seconds
 Pull the needle out from the skin
 Release the skin lift

19. INSULIN REGIMENS
BASAL ONLY OAD+BASAL
BASALPLUS 1 PRANDIAL+BASAL
PREMIXED OD/BID/TID
BASL BOLUS 3

21. LIPATROPHY AND HYPERTROPHY (INSULIN
INDUCED)


23. GLP1 ANALOGUE- CLASSIFICATION
Agent Half life
Exenatide Twice daily 2.4 hours
Lixisenatide Once daily 3 hours
Liraglutide Once daily 13 hours
Dulaglutide Once weekly 4 days
Albiglutide Once weekly 5-8 days
Exenatide Once weekly 14 days

24. MECHANISM OF ACTION OF
GLP1 ANALOGUE

25. BENEFITS OF GLP1 ANALOGUE
 Glucose lowering effects
 Non hypoglycemic
 Weight loss

26. INDICATION OF GLP1 ANALOGUE
 Type 2 DM
 Obesity

27. ADVERSE EFFECTS OF GLP1 ANALOGUE
Acute pancreatitis and Medullary thyroid cancer – rare but
serious