There are several types of insulin that differ in their onset of action, peak time, and duration. Rapid-acting insulin starts working within 15 minutes and has a duration of 3-4 hours. Regular or short-acting insulin starts within 30 minutes and lasts 6 hours. Intermediate-acting insulin starts within 2-4 hours and lasts 12 hours. Long-acting insulin starts within 2-4 hours and lasts up to 24 hours. Premixed insulin starts working within 15-30 minutes and lasts 12-16 hours. Inhaled insulin starts within 10 minutes and lasts 3 hours. The document also discusses the properties and uses of different insulin analogs and human insulins.
The document summarizes insulin therapy for diabetes mellitus. It describes the cells in the pancreas that secrete insulin and other hormones. It details the discovery and purification of insulin in the 1920s which revolutionized treatment of diabetes. The document discusses different insulin formulations including short-acting and long-acting types. It explains factors that affect insulin absorption and common dosing regimens for insulin therapy.
Diazepam is an antianxiety agent that works by potentiating the effects of the inhibitory neurotransmitter GABA in the central nervous system. It can be used orally or parenterally to treat anxiety, muscle relaxation, seizures, alcohol withdrawal, and other conditions. Common side effects include drowsiness, dizziness, and lethargy. Nurses are responsible for monitoring patients receiving diazepam for changes in vital signs and level of consciousness, instructing patients on proper administration and side effects, and ensuring patient safety during and after administration.
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
This document discusses various classes of oral hypoglycemic drugs used to treat type 2 diabetes mellitus. It describes sulfonylureas, the first class developed which work by stimulating insulin release from the pancreas. First and second generation sulfonylureas are outlined, noting their mechanisms, effects, and interactions. Meglitinides are discussed as having a similar insulin-releasing action to sulfonylureas but with a more rapid onset and shorter duration. Biguanides like metformin are covered, explaining how they lower blood glucose through decreasing hepatic glucose production and increasing glucose uptake in tissues. Thiazolidinediones are also mentioned as sensitizing tissues to insulin.
The document summarizes the history and types of insulin. It describes the key discoveries in insulin's development, including the identification of the islets of Langerhans in 1869, the discovery that removing the pancreas causes diabetes in 1889, and the isolation of insulin from the pancreas by Banting and Best in 1922. It also discusses the different types of human and analog insulins, including rapid-acting, long-acting, premixed, and biosimilar insulins. The document emphasizes that insulin comes in various preparations that can be tailored to individual patient needs.
The document discusses insulin, its synthesis and secretion, mechanisms of action, and effects on metabolism. It also covers oral hypoglycemic agents and their mechanisms. Insulin is synthesized in the pancreas as proinsulin and processed into insulin and C-peptide. Insulin regulates glucose and lipid metabolism through effects on liver, muscle and adipose tissue. Insulin resistance and deficiency lead to hyperglycemia and other metabolic abnormalities.
The document summarizes insulin therapy for diabetes mellitus. It describes the cells in the pancreas that secrete insulin and other hormones. It details the discovery and purification of insulin in the 1920s which revolutionized treatment of diabetes. The document discusses different insulin formulations including short-acting and long-acting types. It explains factors that affect insulin absorption and common dosing regimens for insulin therapy.
Diazepam is an antianxiety agent that works by potentiating the effects of the inhibitory neurotransmitter GABA in the central nervous system. It can be used orally or parenterally to treat anxiety, muscle relaxation, seizures, alcohol withdrawal, and other conditions. Common side effects include drowsiness, dizziness, and lethargy. Nurses are responsible for monitoring patients receiving diazepam for changes in vital signs and level of consciousness, instructing patients on proper administration and side effects, and ensuring patient safety during and after administration.
This document discusses basics of insulin therapy including:
- The discovery of insulin in the 1920s and types of insulin including basal, mealtime, premixed, and newer combinations.
- Insulin action profiles, indications for insulin use, administration techniques using vials, syringes and pens, and common insulin regimens for type 2 diabetes including once or twice daily basal insulin +/- mealtime insulin or premixed insulin.
- Proper storage, mixing, and injection of insulin as well as recommended sites for injection are also reviewed.
This document discusses various classes of oral hypoglycemic drugs used to treat type 2 diabetes mellitus. It describes sulfonylureas, the first class developed which work by stimulating insulin release from the pancreas. First and second generation sulfonylureas are outlined, noting their mechanisms, effects, and interactions. Meglitinides are discussed as having a similar insulin-releasing action to sulfonylureas but with a more rapid onset and shorter duration. Biguanides like metformin are covered, explaining how they lower blood glucose through decreasing hepatic glucose production and increasing glucose uptake in tissues. Thiazolidinediones are also mentioned as sensitizing tissues to insulin.
The document summarizes the history and types of insulin. It describes the key discoveries in insulin's development, including the identification of the islets of Langerhans in 1869, the discovery that removing the pancreas causes diabetes in 1889, and the isolation of insulin from the pancreas by Banting and Best in 1922. It also discusses the different types of human and analog insulins, including rapid-acting, long-acting, premixed, and biosimilar insulins. The document emphasizes that insulin comes in various preparations that can be tailored to individual patient needs.
The document discusses insulin, its synthesis and secretion, mechanisms of action, and effects on metabolism. It also covers oral hypoglycemic agents and their mechanisms. Insulin is synthesized in the pancreas as proinsulin and processed into insulin and C-peptide. Insulin regulates glucose and lipid metabolism through effects on liver, muscle and adipose tissue. Insulin resistance and deficiency lead to hyperglycemia and other metabolic abnormalities.
This document discusses insulin analogues, which are genetically engineered versions of human insulin that have altered pharmacokinetic properties. It describes the classification of insulin analogues as either short-acting like lispro, aspart, and glulisine, or long-acting like glargine, detemir, and degludec. Insulin analogues were developed to overcome limitations of standard insulins like regular and NPH insulins in order to better mimic the body's natural insulin secretion and reduce risks of hypoglycemia. While analogues provide benefits like improved glucose control and flexibility, their higher cost is a drawback.
Insulin analogues are genetically engineered versions of human insulin that are designed to more closely mimic the body's natural insulin secretion. Short-acting analogues like lispro and aspart have a faster onset of action than regular insulin, allowing for more flexibility in dosing around meals. Long-acting analogues like glargine and degludec aim to provide a steady basal insulin level throughout the day without peaks, reducing the risk of nocturnal hypoglycemia. While insulin analogues provide benefits over regular insulin in terms of better glycemic control and reduced side effects, their higher cost is still a limitation to their use.
Noradrenaline acts as a neurotransmitter between sympathetic postganglionic nerves and the organs they innervate. When an action potential reaches the nerve terminal, noradrenaline is released into the synaptic cleft and binds to alpha adrenoreceptors on nearby cells. This causes vasoconstriction and increases both systolic and diastolic blood pressure, raising mean arterial pressure. Noradrenaline interacts with various other drugs and medications and can cause side effects like anxiety, dizziness, and tremors. It should be used cautiously in patients with certain medical conditions.
1. Insulin therapy is needed for all patients with type 1 diabetes and many with type 2 diabetes as their beta cell function declines.
2. Insulin can be initiated if diet and exercise fail to control blood sugar, and oral medications are not achieving target goals.
3. There are different types of insulin preparations that provide either basal insulin levels or rapid-acting insulin to cover meals. Intensive regimens separate these types of insulin to better mimic natural patterns.
Insulin therapy in Diabetes Mellitus discusses various types of insulin, newer insulin analogs, and insulin regimens for managing type 1 diabetes mellitus. Rapid-acting insulin analogs have advantages over regular insulin such as quicker onset of action and less risk of hypoglycemia. Long-acting insulin analogs like glargine have advantages over NPH insulin such as a more consistent time action profile. The document discusses split-mix and basal-bolus insulin regimens and factors to consider when choosing a regimen. It also covers complications of insulin therapy, monitoring of blood glucose and HbA1c levels, and sick day management for patients with type 1 diabetes.
Naloxone is an opioid antagonist used to reverse opioid overdoses. It works by binding to opioid receptors in the brain more strongly than opioids, kicking the opioids off the receptors and restoring breathing. Naloxone can be administered intravenously, intramuscularly, subcutaneously, or intranasally. It takes effect within 2-5 minutes and lasts 30-90 minutes. Signs of opioid overdose include unconsciousness, blue lips/fingertips, slow/shallow breathing, and pinpoint pupils. Naloxone administration follows the SAVE ME steps of stimulating, providing airway/ventilation, evaluating, injecting naloxone into muscle, and re-evaluating
This document provides information on various gentamicin injection products available in Pakistan made by different pharmaceutical companies. It discusses gentamicin's mechanism of action as an aminoglycoside antibiotic that inhibits protein synthesis in bacteria. It also provides dosing, administration, contraindications and precautions for gentamicin treatment. The document then shifts to discussing cloxacillin products in Pakistan and information about cloxacillin as a penicillinase-resistant penicillin antibiotic.
Insulin has three characteristics:
Onset: is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
Peak time: is the time during which insulin is at maximum strength in terms of lowering blood glucose.
Duration: is how long insulin continues to lower blood glucose.
Insulin therapy involves various types of insulin preparations that aim to mimic the body's natural insulin secretion. Short-acting insulins like regular insulin have an onset of 30-60 minutes while rapid-acting analogs like aspart and lispro have an onset of 5-15 minutes. Intermediate-acting NPH insulin has an onset of 2 hours. Long-acting basal insulins like glargine and detemir aim to provide consistent insulin levels and have onset times of 2 hours with durations of 12-24 hours. Newer ultra-long acting insulins like degludec last over 40 hours with the goal of reducing hypoglycemia risk and glycemic variability compared to earlier insulin types.
This document provides information on insulin therapy. It discusses what insulin is, how it is secreted normally, and its actions in the body. Insulin deficiency results in hyperglycemia and other metabolic defects. The discovery of insulin by Banting and Best in 1921 revolutionized the treatment of diabetes. Insulin comes in various forms including rapid-acting, short-acting, intermediate-acting, long-acting, and premixed varieties. Common insulin regimens include split-mixed, basal, basal-plus, and basal-bolus. Early initiation of insulin in type 2 diabetes has clinical benefits beyond glycemic control. Barriers to insulin therapy include fear of hypoglycemia and the inconvenience of injection schedules. Pro
Alprazolam is a benzodiazepine used to treat anxiety disorders, panic disorder, and insomnia. It works by enhancing the effects of the inhibitory neurotransmitter GABA in the brain. Common side effects include drowsiness, dizziness, and impaired coordination. It can cause dependence and withdrawal symptoms upon discontinuation, so the dosage should be tapered under medical supervision. Nurses should monitor patients for signs of sedation and toxicity, especially when used long-term or with other CNS depressants like alcohol.
This document discusses different types of insulin, including rapid-acting, long-acting, and premixed analogs. Rapid-acting analogs like insulin lispro and insulin aspart have a faster onset and shorter duration than regular human insulin. Long-acting analogs such as insulin glargine, insulin detemir and insulin degludec are designed to provide basal insulin levels for 24 hours or more with less variability than NPH insulin. Premixed analogs contain both rapid- and long-acting components. The document also briefly mentions new methods of insulin delivery under development.
Type 1 diabetes is characterized by an absolute deficiency of insulin due to the autoimmune destruction of pancreatic beta cells. It typically presents in childhood or early adulthood with symptoms of polyuria, polydipsia, and unexplained weight loss. Treatment involves lifelong insulin replacement therapy via injections to control blood glucose levels and minimize the risk of complications. Rapid-, short-, intermediate-, and long-acting insulin formulations have different onset and duration profiles suited to individual treatment regimens. Strict glycemic control is important to reduce microvascular and macrovascular risks.
Diuretics act at different sites along the nephron to promote the excretion of sodium, chloride, and water. The main classes are carbonic anhydrase inhibitors, loop diuretics, thiazides, potassium-sparing diuretics, and osmotic diuretics. They are used to treat conditions like edema, hypertension, and liver cirrhosis. Each class has a distinct mechanism of action and side effect profile. For example, loop diuretics inhibit sodium reabsorption in the loop of Henle but can cause ototoxicity, while thiazides target the distal tubule and cause hypokalemia. The site and mechanism of the drug determines its clinical applications and adverse effects
This document discusses vasodilators and vasoconstrictors. It begins by defining vasodilators as drugs that dilate blood vessels, allowing blood to flow more easily. It then classifies vasodilators based on their site of action (arterial, venous, or mixed) and mechanism (direct or indirect acting). Examples of different classes of vasodilators are provided, along with their mechanisms, uses, administration routes, side effects, and monitoring considerations. The document provides a comprehensive overview of vasodilator drugs.
Insulin is a hormone produced in the pancreas that regulates blood sugar levels. It was discovered in 1921 and is used to treat diabetes by facilitating glucose entry into cells and inhibiting glucose production in the liver. There are various types of insulin preparations including regular, long-acting, and analogues produced through recombinant DNA technology to provide different durations of action.
This document provides an overview of antipsychotic drugs. It discusses the history of antipsychotics beginning in the late 19th century. It describes first and second generation antipsychotics and provides examples of common drugs. The document defines antipsychotics and outlines their classifications. It discusses the indications, pharmacokinetics, mechanisms of action, contraindications, and side effects of antipsychotic drugs. Finally, it provides nursing implications for managing common side effects and patient education guidelines.
Sulfonylureas are oral hypoglycemic drugs that enhance insulin secretion from the pancreas. They work by blocking ATP-sensitive potassium channels in pancreatic beta cells, which leads to insulin release. Common side effects include hypoglycemia and weight gain. Examples include glibenclamide, glipizide, and glimepiride. Choice of sulfonylurea depends on factors like duration of action, renal function, and patient age. They are generally effective treatments for type 2 diabetes but require caution in elderly patients or those with kidney/liver problems.
- Insulin is a hormone that allows glucose in the blood to enter cells, providing energy. It also helps break down fats and proteins for energy.
- There are different types of insulin that vary in how quickly they start working (onset), when they reach peak effectiveness, and how long their effects last. Fast-acting insulin works within 15 minutes, while long-acting insulin can work for up to 24 hours.
- Insulin is injected subcutaneously in areas like the abdomen, arms, thighs, and hips. Sites should be rotated and not used in the same spot for at least 2-3 weeks to prevent lumps. Proper storage and administration techniques are also important for safety and accuracy.
1. The document discusses different types of insulin, including their onset, peak, and duration of action.
2. It describes insulin treatment regimens like split-mixed, premixed, and basal-bolus approaches.
3. Guidelines are provided for starting basal insulin and advancing to a basal-bolus regimen, including dose adjustment based on blood glucose levels.
This document discusses insulin analogues, which are genetically engineered versions of human insulin that have altered pharmacokinetic properties. It describes the classification of insulin analogues as either short-acting like lispro, aspart, and glulisine, or long-acting like glargine, detemir, and degludec. Insulin analogues were developed to overcome limitations of standard insulins like regular and NPH insulins in order to better mimic the body's natural insulin secretion and reduce risks of hypoglycemia. While analogues provide benefits like improved glucose control and flexibility, their higher cost is a drawback.
Insulin analogues are genetically engineered versions of human insulin that are designed to more closely mimic the body's natural insulin secretion. Short-acting analogues like lispro and aspart have a faster onset of action than regular insulin, allowing for more flexibility in dosing around meals. Long-acting analogues like glargine and degludec aim to provide a steady basal insulin level throughout the day without peaks, reducing the risk of nocturnal hypoglycemia. While insulin analogues provide benefits over regular insulin in terms of better glycemic control and reduced side effects, their higher cost is still a limitation to their use.
Noradrenaline acts as a neurotransmitter between sympathetic postganglionic nerves and the organs they innervate. When an action potential reaches the nerve terminal, noradrenaline is released into the synaptic cleft and binds to alpha adrenoreceptors on nearby cells. This causes vasoconstriction and increases both systolic and diastolic blood pressure, raising mean arterial pressure. Noradrenaline interacts with various other drugs and medications and can cause side effects like anxiety, dizziness, and tremors. It should be used cautiously in patients with certain medical conditions.
1. Insulin therapy is needed for all patients with type 1 diabetes and many with type 2 diabetes as their beta cell function declines.
2. Insulin can be initiated if diet and exercise fail to control blood sugar, and oral medications are not achieving target goals.
3. There are different types of insulin preparations that provide either basal insulin levels or rapid-acting insulin to cover meals. Intensive regimens separate these types of insulin to better mimic natural patterns.
Insulin therapy in Diabetes Mellitus discusses various types of insulin, newer insulin analogs, and insulin regimens for managing type 1 diabetes mellitus. Rapid-acting insulin analogs have advantages over regular insulin such as quicker onset of action and less risk of hypoglycemia. Long-acting insulin analogs like glargine have advantages over NPH insulin such as a more consistent time action profile. The document discusses split-mix and basal-bolus insulin regimens and factors to consider when choosing a regimen. It also covers complications of insulin therapy, monitoring of blood glucose and HbA1c levels, and sick day management for patients with type 1 diabetes.
Naloxone is an opioid antagonist used to reverse opioid overdoses. It works by binding to opioid receptors in the brain more strongly than opioids, kicking the opioids off the receptors and restoring breathing. Naloxone can be administered intravenously, intramuscularly, subcutaneously, or intranasally. It takes effect within 2-5 minutes and lasts 30-90 minutes. Signs of opioid overdose include unconsciousness, blue lips/fingertips, slow/shallow breathing, and pinpoint pupils. Naloxone administration follows the SAVE ME steps of stimulating, providing airway/ventilation, evaluating, injecting naloxone into muscle, and re-evaluating
This document provides information on various gentamicin injection products available in Pakistan made by different pharmaceutical companies. It discusses gentamicin's mechanism of action as an aminoglycoside antibiotic that inhibits protein synthesis in bacteria. It also provides dosing, administration, contraindications and precautions for gentamicin treatment. The document then shifts to discussing cloxacillin products in Pakistan and information about cloxacillin as a penicillinase-resistant penicillin antibiotic.
Insulin has three characteristics:
Onset: is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
Peak time: is the time during which insulin is at maximum strength in terms of lowering blood glucose.
Duration: is how long insulin continues to lower blood glucose.
Insulin therapy involves various types of insulin preparations that aim to mimic the body's natural insulin secretion. Short-acting insulins like regular insulin have an onset of 30-60 minutes while rapid-acting analogs like aspart and lispro have an onset of 5-15 minutes. Intermediate-acting NPH insulin has an onset of 2 hours. Long-acting basal insulins like glargine and detemir aim to provide consistent insulin levels and have onset times of 2 hours with durations of 12-24 hours. Newer ultra-long acting insulins like degludec last over 40 hours with the goal of reducing hypoglycemia risk and glycemic variability compared to earlier insulin types.
This document provides information on insulin therapy. It discusses what insulin is, how it is secreted normally, and its actions in the body. Insulin deficiency results in hyperglycemia and other metabolic defects. The discovery of insulin by Banting and Best in 1921 revolutionized the treatment of diabetes. Insulin comes in various forms including rapid-acting, short-acting, intermediate-acting, long-acting, and premixed varieties. Common insulin regimens include split-mixed, basal, basal-plus, and basal-bolus. Early initiation of insulin in type 2 diabetes has clinical benefits beyond glycemic control. Barriers to insulin therapy include fear of hypoglycemia and the inconvenience of injection schedules. Pro
Alprazolam is a benzodiazepine used to treat anxiety disorders, panic disorder, and insomnia. It works by enhancing the effects of the inhibitory neurotransmitter GABA in the brain. Common side effects include drowsiness, dizziness, and impaired coordination. It can cause dependence and withdrawal symptoms upon discontinuation, so the dosage should be tapered under medical supervision. Nurses should monitor patients for signs of sedation and toxicity, especially when used long-term or with other CNS depressants like alcohol.
This document discusses different types of insulin, including rapid-acting, long-acting, and premixed analogs. Rapid-acting analogs like insulin lispro and insulin aspart have a faster onset and shorter duration than regular human insulin. Long-acting analogs such as insulin glargine, insulin detemir and insulin degludec are designed to provide basal insulin levels for 24 hours or more with less variability than NPH insulin. Premixed analogs contain both rapid- and long-acting components. The document also briefly mentions new methods of insulin delivery under development.
Type 1 diabetes is characterized by an absolute deficiency of insulin due to the autoimmune destruction of pancreatic beta cells. It typically presents in childhood or early adulthood with symptoms of polyuria, polydipsia, and unexplained weight loss. Treatment involves lifelong insulin replacement therapy via injections to control blood glucose levels and minimize the risk of complications. Rapid-, short-, intermediate-, and long-acting insulin formulations have different onset and duration profiles suited to individual treatment regimens. Strict glycemic control is important to reduce microvascular and macrovascular risks.
Diuretics act at different sites along the nephron to promote the excretion of sodium, chloride, and water. The main classes are carbonic anhydrase inhibitors, loop diuretics, thiazides, potassium-sparing diuretics, and osmotic diuretics. They are used to treat conditions like edema, hypertension, and liver cirrhosis. Each class has a distinct mechanism of action and side effect profile. For example, loop diuretics inhibit sodium reabsorption in the loop of Henle but can cause ototoxicity, while thiazides target the distal tubule and cause hypokalemia. The site and mechanism of the drug determines its clinical applications and adverse effects
This document discusses vasodilators and vasoconstrictors. It begins by defining vasodilators as drugs that dilate blood vessels, allowing blood to flow more easily. It then classifies vasodilators based on their site of action (arterial, venous, or mixed) and mechanism (direct or indirect acting). Examples of different classes of vasodilators are provided, along with their mechanisms, uses, administration routes, side effects, and monitoring considerations. The document provides a comprehensive overview of vasodilator drugs.
Insulin is a hormone produced in the pancreas that regulates blood sugar levels. It was discovered in 1921 and is used to treat diabetes by facilitating glucose entry into cells and inhibiting glucose production in the liver. There are various types of insulin preparations including regular, long-acting, and analogues produced through recombinant DNA technology to provide different durations of action.
This document provides an overview of antipsychotic drugs. It discusses the history of antipsychotics beginning in the late 19th century. It describes first and second generation antipsychotics and provides examples of common drugs. The document defines antipsychotics and outlines their classifications. It discusses the indications, pharmacokinetics, mechanisms of action, contraindications, and side effects of antipsychotic drugs. Finally, it provides nursing implications for managing common side effects and patient education guidelines.
Sulfonylureas are oral hypoglycemic drugs that enhance insulin secretion from the pancreas. They work by blocking ATP-sensitive potassium channels in pancreatic beta cells, which leads to insulin release. Common side effects include hypoglycemia and weight gain. Examples include glibenclamide, glipizide, and glimepiride. Choice of sulfonylurea depends on factors like duration of action, renal function, and patient age. They are generally effective treatments for type 2 diabetes but require caution in elderly patients or those with kidney/liver problems.
- Insulin is a hormone that allows glucose in the blood to enter cells, providing energy. It also helps break down fats and proteins for energy.
- There are different types of insulin that vary in how quickly they start working (onset), when they reach peak effectiveness, and how long their effects last. Fast-acting insulin works within 15 minutes, while long-acting insulin can work for up to 24 hours.
- Insulin is injected subcutaneously in areas like the abdomen, arms, thighs, and hips. Sites should be rotated and not used in the same spot for at least 2-3 weeks to prevent lumps. Proper storage and administration techniques are also important for safety and accuracy.
1. The document discusses different types of insulin, including their onset, peak, and duration of action.
2. It describes insulin treatment regimens like split-mixed, premixed, and basal-bolus approaches.
3. Guidelines are provided for starting basal insulin and advancing to a basal-bolus regimen, including dose adjustment based on blood glucose levels.
ORAL HYPOGLYCAEMIC AGENTS - PART 1.pptxNIKITA BHUTE
This document provides information about oral hypoglycemic agents used to treat diabetes. It begins with an overview of diabetes and insulin, then discusses different types of insulin including fast-acting, short-acting, intermediate-acting and long-acting insulins. The document also classifies oral hypoglycemic agents into different classes like sulfonylureas, biguanides, meglitinides, thiazolidinediones, alpha-glucosidase inhibitors, incretin agonists, SGLT2 inhibitors, DPP-4 inhibitors and miscellaneous agents. It concludes by defining oral hypoglycemic agents as medications administered orally to reduce blood glucose levels in diabetic patients.
Insulin is a hormone produced by the pancreas that helps the body use glucose for energy. It works by lowering blood sugar levels after meals. People with type 1 diabetes do not produce insulin and must take insulin injections, while some people with type 2 diabetes may require insulin if pills are not enough. There are several types of insulin that differ in how quickly they work and how long their effects last. Proper insulin storage, injection technique, and timing in relation to meals is important for managing diabetes.
Human insulin is produced by growing insulin proteins in E. coli bacteria. There are three main types of insulin based on onset, peak effect, and duration: fast-acting insulin works within 15 minutes for meals; intermediate-acting insulin lasts over 12 hours for overnight control; and long-acting insulin has a stable effect for most of the day. Insulin is usually injected subcutaneously using a disposable insulin pen, ampoules for multi-use pens, or an insulin pump.
Recent advances in insulin manufacturing and treatmentjinanAlmousawy
This document discusses recent advances in insulin manufacturing and treatment. It describes the different types of diabetes and insulin, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin. It explains insulin pens, injection techniques, recommended injection sites, and insulin pump therapy. The advantages and disadvantages of various insulin delivery methods are presented.
The document discusses insulin therapy and glucose monitoring. It provides details on the different types of insulin including rapid, short, intermediate and long acting insulins. It describes insulin administration including sites, storage, precautions and complications. It also discusses glucose monitoring methods like fasting blood glucose, oral glucose tolerance test and self monitoring of blood glucose. The normal values and nursing considerations for these tests are outlined.
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Glucose is an important source of energy for the cells that make up the muscles and tissues.
This document discusses different types of insulin, including:
- Intermediate-acting insulin which starts working 1-2 hours after injection and has a peak activity of 4-12 hours.
- Short-acting insulin which starts working 30-60 minutes after injection and has a peak activity of 2-5 hours. It is often taken three times a day before meals.
- Long-acting insulin which provides steady blood sugar levels for up to 20-24 hours and is meant to be taken once per day.
It also discusses pre-mixed insulin which contains both long- and rapid-acting insulins, replacing two injections with one but not allowing adjustment of each dose individually. Proper insulin treatment requires
This document provides an overview of anti-diabetic drugs presented by Sadia Unnisa. It begins with an introduction to diabetes mellitus and classifications of anti-diabetic drugs. The main types discussed are insulin, sulfonylureas, biguanides, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, and dipeptidyl peptidase inhibitors. For each drug class, the document covers mechanisms of action, pharmacokinetics, uses, interactions and adverse effects. Storage and delivery methods of insulin are also reviewed.
This document discusses drugs used for diabetes, including insulin and oral hypoglycemic agents. It provides details on:
- The types of insulin preparations and their mechanisms and durations of action, including rapid, short, intermediate and long-acting insulins.
- Factors affecting insulin secretion and the physiological effects of insulin.
- Classification of diabetes and treatment approaches, including standard versus intensive insulin therapy.
- Other anti-diabetic drugs like Amylin analogs, Incretin mimetics, Sulfonylureas, Meglitinides, Biguanides and Thiazolidinediones.
This document discusses diabetes mellitus and its treatment. It describes the four main types of diabetes: type 1, type 2, gestational diabetes, and other causes. It discusses the pathophysiology, clinical features, diagnosis, and management of the different types. The document also describes various insulin preparations including rapid-acting, short-acting, intermediate-acting, and long-acting insulins. It discusses oral hypoglycemic agents that increase insulin secretion like sulfonylureas.
This document discusses insulin therapy, including its pharmacodynamics, mechanisms of action, types of insulin, insulin regimens, administration techniques, side effects, and patient education. Insulin is secreted by the pancreas and lowers blood glucose levels by facilitating glucose uptake into cells. It acts on the liver, muscle, adipose tissue, and other organs. Types include rapid, short, intermediate and long-acting insulins. Patient education focuses on proper administration, storage, monitoring, hypoglycemia treatment, and lifestyle factors.
The document summarizes different types of insulin, including human insulin and newer insulin analogues. It describes the structure and production of human insulin and discusses problems with conventional insulins like regular insulin. It then provides details on various short-acting and long-acting insulin analogues like insulin lispro, insulin glargine, insulin detemir, and insulin degludec, including their structures, mechanisms of action, advantages over human insulin, dosing, and pregnancy categories. The document also briefly mentions other newer insulins under development or approval like inhaled insulin and insulin fusion proteins.
The document summarizes a randomized study comparing basal-bolus insulin therapy to sliding scale regular insulin for managing hyperglycemia in non-critically ill patients. The study found that 66% of patients treated with basal insulin glargine plus bolus insulin glulisine were within the glucose target of 140 mg/dL, compared to 38% of patients treated with sliding scale regular insulin. Basal-bolus therapy provides more effective glycemic control with no increase in hypoglycemia. The document then provides details on calculating and adjusting basal and bolus insulin doses.
Insulin is used to treat diabetes by regulating blood sugar levels. There are various types of insulin differentiated by their onset, peak time and duration of effect. Rapid-acting insulins work within 15 minutes, short-acting within 30 minutes to 1 hour, intermediate within 2-4 hours and long-acting up to 24 hours. Proper administration and storage of insulin is required to ensure safety and efficacy.
This document discusses antidiabetic drugs used to treat diabetes mellitus. It describes the two main types of diabetes and then focuses on insulin and oral hypoglycemic agents. Insulin is described in detail including its mechanism of action, types, administration, and potential complications. Oral hypoglycemic agents discussed include sulfonylureas, which stimulate insulin release, and biguanides like metformin, which lower hepatic glucose production and increase insulin sensitivity. The document provides information on the mechanisms, pharmacokinetics, uses, and adverse effects of these important antidiabetic medications.
Categories of insulin include rapid-acting, short-acting, intermediate-acting, and long-acting insulins. Rapid-acting insulins have an onset of 10-15 minutes, a peak effect at 1 hour, and a duration of 3 hours. Short-acting regular insulin has an onset of 1/2 hour to 1 hour, a peak at 2-3 hours, and a duration of 4-6 hours. Intermediate-acting NPH insulin has an onset of 2-4 hours, a peak at 6-12 hours, and a duration of 16-20 hours. Long-acting insulin glargine has no peak effect and a duration of 24 hours. Proper preparation and administration of insulin injections
This document discusses hormonal drugs and hormones, focusing on insulin and diabetes mellitus. It describes the sources and types of hormones in the body. It provides details on how insulin affects metabolism, the symptoms of insufficient insulin, and complications of diabetes. It discusses classifications of diabetes, types of insulin delivery, rules for mixing insulin drugs, and indications for insulin usage. It also summarizes traditional and intensive insulin therapy and the treatment of hyperglycemic ketoacidic coma.
This document provides vaccination schedules and guidelines for children from various health organizations. It begins by outlining the vaccination schedule for children in India from birth through age 18-19 months. It then discusses vaccination schedules from UNICEF and provides details on specific vaccines such as BCG, DTwP/DTaP, polio, hepatitis B, and others. The document discusses administration of vaccines, contraindications, side effects of the HPV vaccine, and more. It provides comprehensive information on vaccination of children.
This document provides an overview of Psychological First Aid (PFA). PFA involves caring for those in distress after a crisis event, making them feel safe and supported. It can be provided anywhere by volunteers or professionals to help address immediate needs, provide emotional support, and connect people to additional services. PFA follows the principles of looking for information, actively listening to understand needs and concerns, and linking people to information, loved ones, and other support. While most people only need basic PFA, those with severe or complex reactions may require specialized mental health services. The goal is to help people cope and feel less alone after crisis events.
The document discusses the recovery position for an unconscious person. It explains that placing an unconscious person on their side allows their tongue to fall to the side of their throat instead of blocking their airway. The recovery position turns the person three-quarters of the way to their side by flexing their knee and elbow at 90 degree angles with their neck extended, preventing complete rolling onto their side. It provides steps for placing someone in the recovery position, including bending their knees, rolling them onto their side while supporting their head and neck, and tilting their head back to ensure their airway remains clear.
Blood circulates through the body in two loops - pulmonary and systemic circulation. In pulmonary circulation, blood moves from the right side of the heart to the lungs to pick up oxygen and remove carbon dioxide, then returns to the left side of the heart. Systemic circulation then moves oxygenated blood from the left side of the heart through arteries to the entire body, where oxygen and nutrients are delivered and waste is picked up, before blood returns to the right side of the heart via veins. The circulatory system consists of the heart, arteries, veins, and capillaries to transport blood throughout the body in a continuous cycle.
Dengue is a viral infection transmitted by mosquitoes that infects around 100-400 million people annually worldwide. It is caused by the dengue virus of which there are 4 serotypes. Infection with one type provides lifelong immunity to that type but subsequent infections with other types increase the risk of severe dengue. The disease ranges from mild fever to life-threatening dengue hemorrhagic fever/dengue shock syndrome. There is no vaccine for dengue prevention currently.
PPH, or postpartum hemorrhage, is defined as blood loss of 500 ml or more within 24 hours after birth. It is a leading cause of maternal mortality globally. The most common cause is uterine atony, but trauma, retained tissue, or coagulopathy can also cause PPH. Risk factors include prior c-sections, large babies, and medical conditions. Treatment involves uterotonics, massage, compression, and in severe cases procedures like balloon tamponade or embolization. Oxytocin is the first-line treatment, while misoprostol, ergometrine, and prostaglandins are also used. Fluid resuscitation and blood transfusion may be needed
The document discusses various types of oral hypoglycemic agents (OHAs) used to treat type 2 diabetes mellitus (T2DM). It describes the classifications of OHAs including biguanides like metformin, sulphonylureas, meglitinides, thiazolidinediones, and others. For each class, it provides details on mechanisms of action, pharmacokinetics, dosing, side effects, and contraindications. Metformin and sulphonylureas have been used the longest and remain first-line treatment options, though each class has advantages and disadvantages discussed in the document.
The document discusses anaesthetic gas scavenging systems which collect excess gases from patient breathing circuits to maintain a safe operating room environment. It describes the components of effective scavenging systems including collecting waste gases, transferring them via tubing, and properly disposing of them. Both passive systems which rely on pressure flow and active systems which use suction are examined. Guidelines for monitoring scavenging system function and controlling pollution in operating rooms are also provided.
Hand washing is essential to prevent the transmission of infections. Proper hand washing procedures include wetting hands, applying soap, rubbing hands together for 20 seconds, rinsing with water, and drying hands. For surgery, a surgical hand wash is performed which includes washing hands and forearms with an antimicrobial soap, cleaning under fingernails, and scrubbing for 5 minutes. Alcohol-based hand rubs are preferred over soap and water in most situations due to their effectiveness and convenience. Correct hand hygiene is vital both for patient safety and the prevention of spread of antimicrobial resistance.
- There are two essential fatty acids that humans must obtain from their diet: alpha-linolenic acid (ALA, an omega-3 fatty acid) and linoleic acid (LA, an omega-6 fatty acid).
- Good plant-based sources of ALA include chia seeds, flaxseeds, walnuts, canola oil, and walnut oil. While LA is more abundant and found in many plant foods like nuts and seeds.
- These essential fatty acids are polyunsaturated and cannot be made by the body, but they are important for metabolic processes and converting into longer chain omega-3s like EPA and DHA.
This document discusses vaporizers, which are devices used to convert liquid anesthetic agents into their gaseous state for inhalation. It covers the basic principles of vaporizers including:
- The process of vaporization and factors that affect it such as boiling point, critical temperature, and latent heat of vaporization.
- The two main types of vaporizers - draw-over and plenum vaporizers. Plenum vaporizers are more accurate due to mechanisms for temperature compensation and maximizing vaporization surface area.
- Features of modern vaporizers like the Tec series, which are agent-specific, temperature compensated, and able to deliver consistent concentrations across a wide range of flows.
This document provides an overview of basic physics concepts relevant to anesthesia. It discusses units of measurement, pressure, fluid mechanics including laminar and turbulent flow, gas laws, solubility, and diffusion. Key points include how pressure, volume, temperature, and amount of substance are interrelated for gases based on concepts like Boyle's law, Charles' law, Dalton's law of partial pressures, and the ideal gas law. The document also discusses factors that determine laminar vs turbulent flow and how gas solubility and diffusion impact anesthesia.
Regional anesthesia can be safely used in pediatric cases. While initially there was concern over its use in children, several large studies proved its efficacy and safety. Proper technique must account for anatomical differences in children, such as higher spinal levels and more flexible vertebrae. With the correct dose and placement of local anesthetic, regional anesthesia provides effective pain relief for pediatric surgeries and procedures.
Massive transfusion protocols aim to standardize the resuscitation of patients experiencing severe bleeding through the early administration of blood products. The key aspects of such protocols discussed in the document include:
- Definitions of massive transfusion as the replacement of over 50% of total blood volume within 3-4 hours or transfusion of over 10 units of packed red blood cells within 24 hours.
- Common clinical conditions requiring massive transfusion include severe trauma, ruptured aortic aneurysms, and obstetric or surgical complications.
- Current concepts favor permissive hypotension and minimal crystalloid resuscitation to control bleeding before aggressively restoring blood pressure and volume.
- Blood products administered according to protocols include packed red blood
This document discusses fluid resuscitation strategies in trauma patients. It outlines the goals of fluid resuscitation as replacing volume loss, improving blood pressure, and improving tissue perfusion and oxygenation. It describes the evolution from aggressive to restrictive fluid resuscitation strategies, including permissive hypotension which aims to increase systolic blood pressure while keeping it lower than normal until hemorrhage is controlled. The advantages and types of fluids used, including crystalloids, colloids, and blood products are discussed, along with considerations for different patient populations and injury types.
Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
The document discusses anaesthetic gas scavenging systems which collect excess anaesthetic gases from patient breathing circuits during medical procedures. It notes that while trace levels of waste gases are not conclusively linked to health issues, maintaining low levels is still recommended. The key components and types (passive vs. active) of scavenging systems are described. Guidelines on acceptable gas levels from various organizations are also provided. The document emphasizes the importance of scavenging systems and other measures to limit medical staff exposure to anaesthetic gases in operating rooms and other clinical areas.
Non Invasive Ventilation (NIV) involves delivering mechanical ventilation without the use of an endotracheal tube or surgical airway, instead using a tight-fitting face or nasal mask. NIV has been used since the 1940s but became more widely used starting in the 1980s for conditions like sleep apnea. It is now commonly used to treat acute respiratory failure from COPD exacerbations and cardiogenic pulmonary edema. NIV can be delivered via CPAP or BiPAP and involves optimizing settings like IPAP, EPAP, respiratory rate and oxygen flow to improve ventilation and oxygenation without the need for intubation. Proper patient selection, interface choice, and monitoring are important for successful NIV treatment.
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Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
3. Rapid-acting
• It works over a narrow, but more predictable
range of time.( Works quickly & drops blood sugar for a
shorter time). Onset 15 minutes, wear of 3-4 hours.
• Because they work quickly, used most often at
the start of a meal.
• Acts most like insulin that is produced by the
human pancreas.
• If a rapid-acting insulin is prefered instead of a
short-acting insulin at the start of dinner. ( may
prevent severe drops in blood sugar level in the middle of the
night).
4. Short-acting Insulin
• It take effect and wear off more quickly than long-
acting insulins. Onset 30 minutes, wear of 4-6 hours.
• A short-acting insulin is often used 30–60
minutes before a meal so that it has time to work.
• These liquid insulins are clear and do not settle out
when the bottle (vial) sits for a while.
5. Short-acting insulin analogues
• There are three short-acting insulin analogues,
(lispro, aspart, and glulisine)
• Have similar pharmacokinetic and pharmacodynamic
properties.
• With earlier onset and peak of biologic action, and
shorter duration of activity than regular insulin.
• In a meta-analysis comparing short-acting analogues with
human regular insulin, the most relevant difference reported
was a lower risk of severe hypoglycemia with the analogue
preparations.
• Better glycaemic control if administered 15-20 minutes before meal
6. Intermediate insulins
• Contain added substances (buffers) that make
them work over a long time and that may
make them look cloudy.
• When these types of insulin sit for even a few
minutes, the buffered insulin settles to the
bottom of the vial.
• But insulin glargine and insulin detemir are
clear liquids (not cloudy).
7. Isophane Insulin
• Insulin isophane is a recombinant human insulin analogue
(genetically modified insulin that is grown in a laboratory and
similar to human insulin). It is an intermediate acting insulin
preparation.
• Insulin Isophane is a man-made version of human insulin, produced
by the process of biotechnology called recombinant DNA
technology.
• Neutral Protamine Hagedorn (NPH) insulin, also known
as isophane insulin, is an intermediate-acting insulin .
• NPH insulin is made by mixing regular insulin and protamine in
exact proportions with zinc and phenol such that a neutral-pH is
maintained and crystals form.[
• It is sold as a sterile, aqueous, clear, and colorless solution.
• contains insulin aspart along with other constituents like glycerin,
phenol, metacresol, zinc, sodium chloride etc.
8. Long acting Insulin
• Insulin glargine and insulin detemir are long
acting insulins.
• They are clear liquids (not cloudy).
• They act for a period of 24 hours, onset slow
1-2 hours.
9. Long-acting insulin Analogues
• Longer-acting insulin analogues (insulin glargine and
insulin detemir) are produced by genetic engineering.
• The onset of action is within two hours and they have a longer
duration of action of up to 24 h.
• These insulins provide a steady basal insulin profile with
minimal peak action and are injected subcutaneously once
daily.
• Glargine: Insulin glargin is also known as Lantus.
10. Basal Insulin
The basal analogues have a longer duration of action
than insulin NPH and, more importantly, have more
stable and consistent biologic activity over a 24-hour
period, resulting in more predictable glycemic levels
and a lower risk of hypoglycemia.
Currently available basal insulin preparations include:
Insulin glargine U-100 (Lantus),
Insulin detemir (Levemir), &
2015 FDA-approved formulations
insulin glargine U-300 (Toujeo) and
insulin degludec (Tresiba).
11. Premixed
• For convenience, there are premixed rapid-
and intermediate-acting insulin.
• The insulin will start to work as quickly as the
fastest-acting insulin in the combination.
• It will peak when each type of insulin
typically peaks, and it will last as long as the
longest-acting insulin.
• Usually prescribed in two daily doses.
13. Inhaled Insulin
• Technosphere oral-inhaled insulin (Afrezza)— was approved by
(FDA)-a in 2014.
• Inhaled insulin has low bioavailability but is absorbed much more
rapidly into the circulation than the current short-acting insulin
analogues and has a shorter duration of biologic activity.
• However, the pharmacodynamics of inhaled insulin, when
compared with insulin lispro, show only a slightly faster onset of
action and a lower peak of biologic activity.
• The benefits of using inhaled insulin need to be carefully weighed
against the potential risks, especially given the increase in lung
cancer events in smokers that was observed with the prior inhaled-
insulin preparation Exubera.
• Inhaled insulin should not be used by smokers, patients with chronic
lung disease (such as asthma and chronic obstructive pulmonary
disease), and those with acute episodes of bronchospasm.
14. Inhaled Insulin
• A pilot study found evidence that compared with injectable
rapid-acting insulin, supplemental doses of inhaled insulin
taken based on postprandial glucose levels may improve
blood glucose management without additional
hypoglycemia or weight gain.
• Inhaled insulin is contraindicated in patients with chronic
lung disease, such as asthma and chronic obstructive
pulmonary disease, and is not recommended in patients
who smoke or who recently stopped smoking.
• All patients require spirometry (FEV1) testing to identify
potential lung disease prior to and after starting inhaled
insulin therapy.
15. Human Insulin
• Insulin was the first protein to be sequenced (in
1955), and it became the first human protein to
be manufactured through human recombinant
technology.
• It was introduced into clinical practice in 1982 as
synthetic “human” insulin, with the advantage of
being less allergenic than animal insulin
preparations.
• Eventually it replaced all of the animal insulin
preparations in the US market.
16.
17. Types of Insulin
Name Onset Peak Duration
Rapid Acting 15
minutes
1 hour 2 to 4 hours Right before a meal.
Regular/ Soluble 30
minutes
2 to 3 hours 3 to 6 hours 30 to 60 minutes
before a meal.
Intermediate 2 to 4
hours
4 to 12 hours 12 to 18
hours
Covers for half a day or
overnight.
Long Acting 2 hours Does not peak Up to 24
hours
Covers insulin needs
for about a full day.
Ultra Long 6 hours Dose not peak 36 hours or
longer
Provides steady insulin
for long periods.
Premixed
(intermediate+ short-
acting insulin)
5 to 60
minutes
Peak varies 10 to 16
hours
. Usually taken 10 to 30
minutes before
breakfast and dinner.
Inhaled Rapid 10 to 15
minutes
30 minute 3 hours Right before a meal.
19. Analogue Insulin
• Analog insulins are very similar to human insulin, but
they have one or two amino acids changed.
• Analog insulin preparations have been modified to
change how fast and how slow they act after injection
• . Examples of short-acting analog insulins are lispro,
glulisine, and aspart. Examples of long-acting analog
insulins are glargine and detemir.
• Studies have looked at NPH-regular regimens versus
glargine-lispro regimens and found that analog insulins
generally provide tighter blood sugar control with
less hypoglycemia.
20. NPH Insulin
• When regular insulin is suspended in a
substance called protamine, it is known
as NPH insulin (Neutral Protamine Hagedorn).
• NPH insulin is a special preparation of regular
insulin. The protamine suspension allows for
slower release of the insulin after injection, so
the NPH insulin can provide longer-term
control of metabolism. NPH insulin lasts
around 10 to 14 hours.
21. Determined which Insulin to Use.
• Whether to use a “human” insulin or an
analog insulin is based on the duration of
action required and the person’s risk of low
blood sugar, among other factors.
• (NPH insulin commonly leads to low blood
sugar, especially during overnight hours.)
22. IDDM ( Type-1)
• People with type 1 diabetes may be started on
a single daily injection of a long-acting insulin,
such as glargine, to meet the body’s insulin
requirements.
• Some people also require shorter-acting
forms of insulin, in addition to a long-acting
insulin, to help with high blood sugar after a
meal.
23. NIDDM ( Type-2)
• Type 2 patients who need insulin often first
require a single dose of long-acting insulin
each day, along with OHA.
• But as the condition progresses and pancreas
function continues to deteriorate over time,
they may require short-acting insulin with
their meals as well.
27. Insulin Therapy
• Basal Insulin: Start with initial dose of 0.1 – 0.2/kg/day,
increase gradually in small increments of 2 units.
• Longer-acting basal analogs ( U-300 glargine or
degludec) may convey a lower hypoglycemia risk compared
with U-100 glargine when used in combination with oral
agents )
• In clinical trials, long-acting basal analogs (U-100 glargine or
detemir) have been demonstrated to reduce the risk of
symptomatic and nocturnal hypoglycemia compared with
NPH insulin, although these advantages are modest and may
not persist
28. How to Calculate the Dose of Insulin
• Basal insulin Dose Approximately 40-50% of
the total daily insulin dose. It is to replace
insulin overnight, when you are fasting and
between meals.
• The basal or background insulin dose usually is
constant from day to day.
• The other 50-60% of the total daily insulin dose
is for carbohydrate coverage (food) and high
blood sugar correction. This is called the bolus
insulin replacement.
29. How to calculate top-up Dose for
Carbohydrate load
The insulin to carbohydrate ratio represents how
many grams of carbohydrate are covered or disposed
of by 1 unit of insulin.
• Generally, one unit of rapid-acting insulin will dispose
of 12-15 grams of carbohydrate. ( This range can vary from 4-
30 grams or more of carbohydrate depending on an individual’s sensitivity
to insulin).
• Insulin sensitivity can vary according to the time of
day, from person to person, and is also affected by
physical activity and stress.
• So if some one taking 60 gms of carbohydrate in Lunch,
then 6 units of regular insulin ( 60/10).
30. High blood sugar correction dose
• 1 unit will drop your blood sugar 50 points (mg/dl) and the high
blood sugar correction factor is 50.
• Pre-meal blood sugar target is 120 mg/dl.
• Your actual Measured blood sugar before lunch is 220 mg/dl.
• Now, calculate the difference between your actual blood sugar and
target blood sugar:
• 220 minus 120 mg/dl = 100 mg/dl
• To get the high blood sugar correction insulin dose, plug the
numbers into this formula:
• Correction dose = Difference between actual and target blood
glucose (100mg/dl)÷ correction factor (50) = 2 units of rapid acting
insulin.
• Total Meal Dose of Insulin is = 6+2 = 8 units
31. How to calculate daily dose of insulin
required
• Wt in Kg multiplied by factor 0.55 units.
• So for 70 kg the required dose will be ( 70x0.55= 38.5 units
daily.
• Basal/background insulin dose:
Basal/background Insulin Dose
= 40-50% of Total Daily Insulin Dose.
so, out of total 38.5 required 50% roughly 20 units can be given
as Basal Insulin.
32. Regimen of delivery
• Long-acting insulin (glargine/detemir or NPH) given
once a day.
• ( For efficient control A long acting & three
short acting before Break Fast, Lunch & Dinner).
• NPH ( Intermediate Acting) given twice a day.
• Pre-mixed (short-acting insulin analogs or Regular
and NPH) given twice a day.
• Short Acting ( Regular ) three times a day.
33. Sliding Scale
A “sliding scale” insulin dose.
The insulin dose is based on your blood sugar.
The higher the blood sugar, the higher the
insulin dose. – and visa versa.
35. Insulin Pump
• SCII ( Subcutaneous continuous insulin infusion):
Also known as insulin pumps, are the most
sophisticated form of insulin delivery.
• These are small, computerized devices that are
programmed to deliver insulin under the skin.
• The insulin pump is durable and lasts for years,
but the insulin supply and certain pump
components (insulin reservoir, tubing and
infusion set) are changed every few days.
38. Surgery & insulin
• For Minor Surgery:
• Pt on Long acting should be changed to intermediate acting.
• No insulin in the morning on the day of surgery.
• Morning Fasting Sugar.
• IV insulin + Glucose + Potassium should be started.
• Hourly monitoring of Blood Glucose.
• Restart the previous dose once the patient starts taking orally.
• The stoppage of infusion & starting of sc dose should be one hour.
The preoperative evaluation should include a thorough physical
examination (with particular focus on autonomic neuropathy and
cardiac status), measurement of serum electrolytes and creatinine
and urine ketones.
39. Pre-operative preparation for Major
Surgery:
• Admit 2-3 days before.
• HbA1c should be < 8 %
• Target Blood Sugar preprandial 80-120 mg/dL,
& Bed time 120-140mg/dL
• Gross metabolic and electrolyte abnormalities
(e.g. hyponatraemia, dyskalaemia, acidosis)
should also be corrected before surgery.
40. Intra-operative Insulin Delivery
• Two main methods of insulin delivery have
been used:
i. Combining insulin with glucose and
potassium in the same bag (the GKI
regimen)
ii. Delivering insulin separately with an
infusion pump.
41. GKI infusion
• The combined GKI infusion is efficient, safe
and effective in many patients but does not
permit selective adjustment of insulin delivery
without changing the bag.
• The glucose component can be either 5% or
10% dextrose.
42. Delivery through Insulin infusion
Pump.
• 1.Patients treated with oral antidiabetic agents
who require perioperative insulin infusion, as well
as insulin-treated type 2 diabetic patients, can be
given an initial infusion rate of 1–2 units/h.
• An infusion rate of 1 unit/h is obtained by mixing 25 units
of regular insulin in 250 mL saline (0.1 unit/mL) and infusing
at a rate of 10 mL/h. Or 50 units in 50ml saline infuse at 1ml
per hour through syringe pump.
• Maintain blood glucose between 120-180 mg /dL
43. Glucose Delivery
• The physiological amount of glucose required to prevent catabolism
in an average non-diabetic adult is approximately 120 g/day (or
5 g/h).
• With preoperative fasting, surgical stress and ongoing insulin
therapy the caloric requirement in most diabetic patients averages
5–10 g/h glucose.
• This can be given as 5% or 10% dextrose.
• An infusion rate of 100 mL/h with 5% dextrose delivers 5 g/h
glucose.
Adequate glucose should be provided to prevent:
•catabolism
•starvation
•ketosis
•insulin-induced hypoglycaemia.
44. Potassium
The infusion of insulin and glucose induces
an intracellular translocation of potassium,
resulting in a risk of hypokalaemia.
• If renal function is normal and the patient has
initially normal serum potassium, potassium
chloride (10 mmol/L) should be added routinely to
each 500 mL dextrose to maintain normokalaemia.
45. GIK regimen
• GIK stands for (Glucose + Insulin + Potassium).
• In surgical patients who are fasting ( NPO),
should receive insulin through GIK regimen.
• Glucose prevents break down of Glycogen
preventing negative nitrogen balance,
46. How to store Insulin
Store insulin in 2-8 C
Do not keep insulin in a hot place (eg. in a hot, closed
vehicle, on top of a television set) or expose it to heat or
sunlight.
Do not use the insulin if this happens.
Once the insulin has been first used, do not refrigerate, but
keep it in a cool dry place.
Discard the insulin 4 weeks (for vials that are stored at 30
degrees Celsius) and 6 weeks (penfill) after opening.
Keep this medication out of reach of children.
Throw away all expired medication.
47. Summary
• Insulin extracted from an animal pancreas was first administered in
1921; the first insulin analogue was marketed in 1996.
• Insulin is considered the therapeutic standard in patients with
advanced insulin deficiency.
• Types of available insulin products have different onset, peak, and
duration of action ranging from ultra-short-acting to ultra-long-
acting.
• The US Food and Drug Administration approved an inhaled insulin
product in 2014; all other products are administered
subcutaneously.
• Concentrated insulin preparations provide an alternative for
patients requiring consistently high daily doses of insulin.