This document discusses various methods of insulin delivery, including subcutaneous, inhaled, oral, nasal, buccal, intraperitoneal, and transdermal routes. It focuses on subcutaneous delivery methods like vials and syringes, insulin pens, and insulin pumps. It provides details on the development of each method, how to administer them, their advantages and disadvantages. Inhaled insulins like Exubera and Afrezza are also summarized, including indications, side effects and limitations.
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.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
- Insulin is a hormone produced by beta cells in the pancreas that regulates carbohydrate and fat metabolism. It promotes the absorption of glucose from the blood into liver, muscle, and fatty tissue.
- Insulin was first isolated in 1922 which revolutionized treatment for diabetes. It binds to insulin receptors on cells and triggers effects like increasing glucose uptake and glycogen/lipid synthesis while inhibiting gluconeogenesis and lipolysis.
- Insulin secretion is stimulated by high blood glucose levels after eating to promote storage of excess glucose. Multiple factors affect its secretion including hormones like glucagon, growth hormone, cortisol, and epinephrine.
This document discusses various methods for delivering insulin, including current and future technologies. It begins by covering traditional insulin delivery methods like vials and syringes as well as insulin pens. It then discusses continuous subcutaneous insulin infusion (CSII) using insulin pumps in more detail, including how they work, advantages over multiple daily injections, and types of pumps. Finally, it briefly introduces sensor augmented pump therapy, which combines insulin pumps with continuous glucose monitors to help adjust insulin delivery.
The document provides information on various types of insulin, including their names, appearances, durations of action, and appropriate times for administration. It discusses basal insulins like glargine and detemir, mealtime insulins like lispro and aspart, and premixed insulins. Insulin regimens for type 2 diabetes are presented, ranging from a single basal insulin to multiple daily injections of basal and mealtime insulins or premixed insulins. Proper storage, preparation, and injection techniques are also reviewed.
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.
Insulin is a hormone produced in the pancreas that allows cells to take up glucose from the bloodstream. It was discovered in the 1920s and has since been used to treat diabetes. There are various types of insulin that differ in their onset, peak, and duration of action. Insulin therapy is indicated when fasting blood glucose is above 250 mg/dL or HbA1c is over 9.0%. Common types of insulin regimens and delivery methods are also discussed.
This document presents information on inhaled insulin as a new method of drug delivery for treating diabetes. It discusses the role of insulin, inhaled insulin devices, the pharmacology and pharmacokinetics of inhaled insulin, its effects on blood glucose levels, equivalent dosing compared to other insulins, and its use in treating type 1 and type 2 diabetes. Adverse effects are noted to include the potential for hypoglycemia, weight gain, and pulmonary issues. Inhaled insulin may provide benefits over injected insulin such as improved patient satisfaction and convenience.
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.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
- Insulin is a hormone produced by beta cells in the pancreas that regulates carbohydrate and fat metabolism. It promotes the absorption of glucose from the blood into liver, muscle, and fatty tissue.
- Insulin was first isolated in 1922 which revolutionized treatment for diabetes. It binds to insulin receptors on cells and triggers effects like increasing glucose uptake and glycogen/lipid synthesis while inhibiting gluconeogenesis and lipolysis.
- Insulin secretion is stimulated by high blood glucose levels after eating to promote storage of excess glucose. Multiple factors affect its secretion including hormones like glucagon, growth hormone, cortisol, and epinephrine.
This document discusses various methods for delivering insulin, including current and future technologies. It begins by covering traditional insulin delivery methods like vials and syringes as well as insulin pens. It then discusses continuous subcutaneous insulin infusion (CSII) using insulin pumps in more detail, including how they work, advantages over multiple daily injections, and types of pumps. Finally, it briefly introduces sensor augmented pump therapy, which combines insulin pumps with continuous glucose monitors to help adjust insulin delivery.
The document provides information on various types of insulin, including their names, appearances, durations of action, and appropriate times for administration. It discusses basal insulins like glargine and detemir, mealtime insulins like lispro and aspart, and premixed insulins. Insulin regimens for type 2 diabetes are presented, ranging from a single basal insulin to multiple daily injections of basal and mealtime insulins or premixed insulins. Proper storage, preparation, and injection techniques are also reviewed.
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.
Insulin is a hormone produced in the pancreas that allows cells to take up glucose from the bloodstream. It was discovered in the 1920s and has since been used to treat diabetes. There are various types of insulin that differ in their onset, peak, and duration of action. Insulin therapy is indicated when fasting blood glucose is above 250 mg/dL or HbA1c is over 9.0%. Common types of insulin regimens and delivery methods are also discussed.
This document presents information on inhaled insulin as a new method of drug delivery for treating diabetes. It discusses the role of insulin, inhaled insulin devices, the pharmacology and pharmacokinetics of inhaled insulin, its effects on blood glucose levels, equivalent dosing compared to other insulins, and its use in treating type 1 and type 2 diabetes. Adverse effects are noted to include the potential for hypoglycemia, weight gain, and pulmonary issues. Inhaled insulin may provide benefits over injected insulin such as improved patient satisfaction and convenience.
The worldwide explosion of obesity has resulted in an ever-increasing prevalence of type 2 diabetes. The importance of insulin resistance and β-cell dysfunction to the pathogenesis of type 2 diabetes was debated for a long time; many thought that insulin resistance was the main abnormality in type 2 diabetes, and that inability to secrete insulin was a late manifestation. This notion is now challenged. This presentation deals with the important contributing factors in the development of type 2 diabetes mellitus.
Shashikiran Umakanth made this presentation at the "First Endocrine Update Program” – ENDO EGYPT 2015, from 17-20 December 2015 in the Historic City of Luxor, Egypt. This endocrine update was organised by the Egyptian Association of Endocrinology , Diabetes and Atherosclerosis (EAEDA) in collaboration with the Endocrine Society, USA.
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.
Recent advances in the management of Diabetes MellitusShailaBanu3
This document discusses recent advances in the management of diabetes mellitus. It outlines the goals of diabetes treatment which include maintaining normoglycemia, preventing complications, and improving quality of life. It describes various modalities for diabetes treatment including insulin analogs like glargine, degludec and detemir which have improved pharmacokinetic profiles compared to traditional insulins. It also discusses newer non-insulin therapies like GLP-1 receptor agonists liraglutide, albiglutide and dulaglutide which mimic the effects of endogenous GLP-1 and help with glycemic control and weight loss. The document provides a comprehensive overview of the therapy options available for type 1 and type 2 diabetes
Insulin is a polypeptide hormone produced by the pancreas that has profound effects on carbohydrate, fat, and protein metabolism. Insulin deficiency results in hyperglycemia and other metabolic issues. There are various types of insulin that are classified by their onset and duration of action, including rapid-acting, short-acting, intermediate-acting, long-acting, and premixed insulins. Common insulin regimens include split-mixed, multiple injection, basal-bolus, and continuous subcutaneous insulin infusion. Insulin is administered via syringes, pens, or pumps and is injected into approved sites in the body. Potential side effects of insulin therapy include hypoglycemia, weight gain, and local injection
Insulin is a polypeptide hormone composed of two chains of amino acids that is produced by beta cells in the pancreas. It plays an important role in regulating blood glucose levels. Insulin binds to receptors on cells and signals the translocation of glucose transporters to cell membranes, allowing glucose uptake. It also stimulates the synthesis of enzymes involved in glycolysis. Diabetes occurs when the body does not produce enough insulin or the cells ignore the insulin signal, resulting in high blood glucose levels. The document provides details on the structure, function, biosynthesis and role of insulin.
The document summarizes information about insulin pumps. Insulin pumps are external devices that mimic the pancreas by continuously measuring blood sugar levels and injecting insulin to maintain normal levels. Traditional pumps include the pump unit to control insulin delivery, a disposable insulin reservoir, and a disposable infusion set including a cannula and tubing. Insulin pumps offer benefits over multiple daily injections such as increased flexibility and more precise insulin delivery to reduce complications. However, disadvantages include risks of infection and malfunction leading to ketoacidosis as well as the high cost of pumps.
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.
Treatment of Type 1 Diabetes mellitus involves lifelong insulin administration. Insulin is produced in the pancreas and regulates blood glucose levels. Type 1 diabetes results from autoimmune destruction of insulin-producing pancreatic beta cells leading to complete insulin deficiency. Various insulin preparations have been developed with differing durations of action to mimic normal insulin secretion. Treatment involves calculating total daily insulin dose and dividing into short and long-acting insulins administered multiple times daily. Adverse effects and methods to overcome insulin resistance are also discussed.
This document discusses the management of diabetes mellitus. It covers non-pharmacological and pharmacological treatment methods, goals of treatment for type 1 and type 2 diabetes, steps in glycemic control, drug classifications including sulfonylureas, metformin, alpha-glucosidase inhibitors, thiazolidinediones, and incretins. It also discusses indications for insulin use, characteristics of insulin preparations, hypoglycemia, and combination therapy approaches.
Insulin is a hormone produced by the pancreas that regulates blood sugar levels. It allows the body to use and store carbohydrates from food. Without enough insulin, blood sugar levels rise and a person develops diabetes. There are different types of insulin that work in various timeframes to mimic the body's natural insulin release and keep blood sugar stable. Insulin is essential for diabetes treatment but requires careful dosing to avoid hypoglycemia from too much insulin or hyperglycemia from too little insulin. New delivery methods like insulin pens and pumps aim to more closely match a person's changing insulin needs.
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.
Before the discovery of insulin in 1921, people with type 1 diabetes died within weeks to years of disease onset. In the early 1900s, attempts were made to treat diabetes with pancreatic extracts with temporary success. In 1921-1922, Banting, Best, Macleod, and Collip discovered insulin by extracting it from pancreatic islets, and tested it successfully on the first patient Leonard Thompson. Insulin production began commercially in 1922 and significantly increased life expectancy for people with diabetes from average ages of 11-34 years before insulin to 45-65 years by the 1940s.
This document summarizes key aspects of insulin including its history, structure, biosynthesis, transport, degradation, effects, and clinical correlations. It describes how insulin was first extracted from dog pancreases in 1921. Insulin is a polypeptide hormone composed of two chains that are held together. It regulates carbohydrate, lipid, and protein metabolism. Insulin increases glucose uptake and storage while decreasing gluconeogenesis. Clinically, insufficient insulin production can lead to symptoms of diabetes like frequent urination.
This presentation is intended to allied health professional to have a overview of different types of insulin. It is meant to be a memory refresh. It was presented as part of continuing medical education session
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
INSULIN DELIVERY METHODS : Overview on Past, Present and FutureAaromal Satheesh
Different methods ( overview of past , present and future ) of administering insulin with its advantages and disadvantages . Counselling points about the use of insulin pumps, pens and syringes : - method of administration . A brief info about the future trends ( delivery methods ) currently under various phases of the clinical trial . General information about the inhaled insulin: Afreeza
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 is a hormone produced by the pancreas that regulates blood sugar levels. It allows glucose in the bloodstream to enter cells and be used for energy. Without insulin, blood sugar builds up and cells are deprived of energy, leading to serious health issues. Diabetes occurs when the body does not produce enough insulin or the cells do not respond properly to insulin. Historically, insulin was purified from animals but is now commonly produced through recombinant DNA technology using modified bacteria. This process involves isolating the human insulin gene, inserting it into bacterial DNA, and causing the bacteria to express and mass produce human insulin.
Afrezza is an inhaled insulin that was approved by the FDA in 2014 for treatment of type 1 and type 2 diabetes. It provides a rapid-acting form of insulin through inhalation that is absorbed in the lungs. However, it must be used with a long-acting insulin for type 1 diabetes and is contraindicated in patients with lung diseases like asthma or COPD due to the risk of acute bronchospasm. The document outlines the limitations, warnings, dosing instructions, and contraindications for use of Afrezza inhaled insulin.
The document summarizes the management of diabetes mellitus. It discusses the types and pathophysiology of diabetes, signs and symptoms, diagnosis, treatment goals, and management of type 1 and type 2 diabetes. Recent advances discussed include new insulin regimens, hypoglycemic drugs for type 1 diabetes, and combination drug therapies for type 2 diabetes.
The document discusses various routes of insulin administration including subcutaneous, inhaled, oral, buccal, nasal, transdermal, and intraperitoneal. Subcutaneous delivery via insulin pens and pumps is currently standard but associated with pain and noncompliance. Inhaled insulins like Exubera and Afrezza provide noninvasive delivery but have limitations. Oral and buccal routes are being investigated but face challenges with bioavailability. Future trends may include islet cell transplantation, gene therapy, and alternative routes like ocular and rectal though more research is needed. An effective noninvasive insulin delivery method could greatly improve quality of life for diabetes patients.
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 worldwide explosion of obesity has resulted in an ever-increasing prevalence of type 2 diabetes. The importance of insulin resistance and β-cell dysfunction to the pathogenesis of type 2 diabetes was debated for a long time; many thought that insulin resistance was the main abnormality in type 2 diabetes, and that inability to secrete insulin was a late manifestation. This notion is now challenged. This presentation deals with the important contributing factors in the development of type 2 diabetes mellitus.
Shashikiran Umakanth made this presentation at the "First Endocrine Update Program” – ENDO EGYPT 2015, from 17-20 December 2015 in the Historic City of Luxor, Egypt. This endocrine update was organised by the Egyptian Association of Endocrinology , Diabetes and Atherosclerosis (EAEDA) in collaboration with the Endocrine Society, USA.
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.
Recent advances in the management of Diabetes MellitusShailaBanu3
This document discusses recent advances in the management of diabetes mellitus. It outlines the goals of diabetes treatment which include maintaining normoglycemia, preventing complications, and improving quality of life. It describes various modalities for diabetes treatment including insulin analogs like glargine, degludec and detemir which have improved pharmacokinetic profiles compared to traditional insulins. It also discusses newer non-insulin therapies like GLP-1 receptor agonists liraglutide, albiglutide and dulaglutide which mimic the effects of endogenous GLP-1 and help with glycemic control and weight loss. The document provides a comprehensive overview of the therapy options available for type 1 and type 2 diabetes
Insulin is a polypeptide hormone produced by the pancreas that has profound effects on carbohydrate, fat, and protein metabolism. Insulin deficiency results in hyperglycemia and other metabolic issues. There are various types of insulin that are classified by their onset and duration of action, including rapid-acting, short-acting, intermediate-acting, long-acting, and premixed insulins. Common insulin regimens include split-mixed, multiple injection, basal-bolus, and continuous subcutaneous insulin infusion. Insulin is administered via syringes, pens, or pumps and is injected into approved sites in the body. Potential side effects of insulin therapy include hypoglycemia, weight gain, and local injection
Insulin is a polypeptide hormone composed of two chains of amino acids that is produced by beta cells in the pancreas. It plays an important role in regulating blood glucose levels. Insulin binds to receptors on cells and signals the translocation of glucose transporters to cell membranes, allowing glucose uptake. It also stimulates the synthesis of enzymes involved in glycolysis. Diabetes occurs when the body does not produce enough insulin or the cells ignore the insulin signal, resulting in high blood glucose levels. The document provides details on the structure, function, biosynthesis and role of insulin.
The document summarizes information about insulin pumps. Insulin pumps are external devices that mimic the pancreas by continuously measuring blood sugar levels and injecting insulin to maintain normal levels. Traditional pumps include the pump unit to control insulin delivery, a disposable insulin reservoir, and a disposable infusion set including a cannula and tubing. Insulin pumps offer benefits over multiple daily injections such as increased flexibility and more precise insulin delivery to reduce complications. However, disadvantages include risks of infection and malfunction leading to ketoacidosis as well as the high cost of pumps.
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.
Treatment of Type 1 Diabetes mellitus involves lifelong insulin administration. Insulin is produced in the pancreas and regulates blood glucose levels. Type 1 diabetes results from autoimmune destruction of insulin-producing pancreatic beta cells leading to complete insulin deficiency. Various insulin preparations have been developed with differing durations of action to mimic normal insulin secretion. Treatment involves calculating total daily insulin dose and dividing into short and long-acting insulins administered multiple times daily. Adverse effects and methods to overcome insulin resistance are also discussed.
This document discusses the management of diabetes mellitus. It covers non-pharmacological and pharmacological treatment methods, goals of treatment for type 1 and type 2 diabetes, steps in glycemic control, drug classifications including sulfonylureas, metformin, alpha-glucosidase inhibitors, thiazolidinediones, and incretins. It also discusses indications for insulin use, characteristics of insulin preparations, hypoglycemia, and combination therapy approaches.
Insulin is a hormone produced by the pancreas that regulates blood sugar levels. It allows the body to use and store carbohydrates from food. Without enough insulin, blood sugar levels rise and a person develops diabetes. There are different types of insulin that work in various timeframes to mimic the body's natural insulin release and keep blood sugar stable. Insulin is essential for diabetes treatment but requires careful dosing to avoid hypoglycemia from too much insulin or hyperglycemia from too little insulin. New delivery methods like insulin pens and pumps aim to more closely match a person's changing insulin needs.
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.
Before the discovery of insulin in 1921, people with type 1 diabetes died within weeks to years of disease onset. In the early 1900s, attempts were made to treat diabetes with pancreatic extracts with temporary success. In 1921-1922, Banting, Best, Macleod, and Collip discovered insulin by extracting it from pancreatic islets, and tested it successfully on the first patient Leonard Thompson. Insulin production began commercially in 1922 and significantly increased life expectancy for people with diabetes from average ages of 11-34 years before insulin to 45-65 years by the 1940s.
This document summarizes key aspects of insulin including its history, structure, biosynthesis, transport, degradation, effects, and clinical correlations. It describes how insulin was first extracted from dog pancreases in 1921. Insulin is a polypeptide hormone composed of two chains that are held together. It regulates carbohydrate, lipid, and protein metabolism. Insulin increases glucose uptake and storage while decreasing gluconeogenesis. Clinically, insufficient insulin production can lead to symptoms of diabetes like frequent urination.
This presentation is intended to allied health professional to have a overview of different types of insulin. It is meant to be a memory refresh. It was presented as part of continuing medical education session
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
INSULIN DELIVERY METHODS : Overview on Past, Present and FutureAaromal Satheesh
Different methods ( overview of past , present and future ) of administering insulin with its advantages and disadvantages . Counselling points about the use of insulin pumps, pens and syringes : - method of administration . A brief info about the future trends ( delivery methods ) currently under various phases of the clinical trial . General information about the inhaled insulin: Afreeza
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 is a hormone produced by the pancreas that regulates blood sugar levels. It allows glucose in the bloodstream to enter cells and be used for energy. Without insulin, blood sugar builds up and cells are deprived of energy, leading to serious health issues. Diabetes occurs when the body does not produce enough insulin or the cells do not respond properly to insulin. Historically, insulin was purified from animals but is now commonly produced through recombinant DNA technology using modified bacteria. This process involves isolating the human insulin gene, inserting it into bacterial DNA, and causing the bacteria to express and mass produce human insulin.
Afrezza is an inhaled insulin that was approved by the FDA in 2014 for treatment of type 1 and type 2 diabetes. It provides a rapid-acting form of insulin through inhalation that is absorbed in the lungs. However, it must be used with a long-acting insulin for type 1 diabetes and is contraindicated in patients with lung diseases like asthma or COPD due to the risk of acute bronchospasm. The document outlines the limitations, warnings, dosing instructions, and contraindications for use of Afrezza inhaled insulin.
The document summarizes the management of diabetes mellitus. It discusses the types and pathophysiology of diabetes, signs and symptoms, diagnosis, treatment goals, and management of type 1 and type 2 diabetes. Recent advances discussed include new insulin regimens, hypoglycemic drugs for type 1 diabetes, and combination drug therapies for type 2 diabetes.
The document discusses various routes of insulin administration including subcutaneous, inhaled, oral, buccal, nasal, transdermal, and intraperitoneal. Subcutaneous delivery via insulin pens and pumps is currently standard but associated with pain and noncompliance. Inhaled insulins like Exubera and Afrezza provide noninvasive delivery but have limitations. Oral and buccal routes are being investigated but face challenges with bioavailability. Future trends may include islet cell transplantation, gene therapy, and alternative routes like ocular and rectal though more research is needed. An effective noninvasive insulin delivery method could greatly improve quality of life for diabetes patients.
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.
Insulin is a hormone produced by the pancreas that allows cells to use glucose for energy. There are two main types of diabetes based on insulin production and resistance. Insulin can be administered through injection into subcutaneous tissue using a syringe or insulin pen, through infusion into intravenous fluids in a hospital setting, or through inhalation though this route has safety concerns. Proper administration of insulin involves rotating injection sites, preparing and labeling insulin correctly, using proper injection technique, and taking precautions to prevent adverse effects like hypoglycemia.
Insulin pumps are small, computerized devices that mimic the pancreas's function by continuously delivering rapid-acting insulin through a cannula inserted under the skin. Pumps allow users to program both a continuous basal insulin rate and bolus doses around meals. Popular pump brands include Medtronic, Tandem, Animas, and Insulet Omnipod. Pumps provide improved blood sugar control and flexibility over multiple daily injections but require diligent care and monitoring. New hybrid closed-loop systems like the Medtronic 670G can automatically adjust insulin based on continuous glucose monitor readings.
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.
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.
- 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.
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.
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.
Insulin pens are portable, pen-shaped devices that contain a disposable needle and insulin reservoir or cartridge for self-administering insulin doses. They provide an accurate and timely way for diabetes patients to dose insulin. Their use is becoming more important as over 422 million people worldwide now suffer from diabetes. Insulin pens are classified as Class II medical devices and come in two types - prefilled pens or reusable pens with cartridges. They work by depressing a button to advance a piston and inject the intended insulin dose under the skin.
1) The document presents information on various insulin drug delivery systems including different routes of administration such as nasal, transdermal, buccal, ocular, rectal, and inhaled delivery. It discusses marketed examples for each route and devices used for insulin delivery including insulin pens, jet injectors, prefilled syringes, pumps, and vials/syringes.
2) A case study is presented on the marketed insulin product Recosulin R manufactured by Shreya Life Sciences Pvt. Ltd. Details provided on the product include the name, manufacturer, and route of administration but not further information on the case study.
3) Different technologies and formulations that have been investigated for various routes
Technology in insulin delivery systems future directions.pptxMsccMohamed
This document discusses various methods for delivering insulin, including current and future directions. It begins by covering traditional delivery methods like vials and syringes as well as insulin pens. It then discusses continuous subcutaneous insulin infusion systems and closed loop artificial pancreas systems. The document also discusses inhaled insulin, oral insulin, and novel delivery methods under investigation like colonic insulin delivery. Overall, the document provides an overview of insulin delivery technologies, both established methods and areas of ongoing research.
This document discusses insulin pump therapy for diabetes. It explains that an insulin pump aims to mimic the body's natural basal-bolus insulin production and delivery pattern. Basal insulin is continuously delivered to suppress glucose production, while bolus insulin is administered with meals based on blood sugar levels and carbohydrate intake. The document provides details on programming and using an insulin pump, benefits and challenges of pump therapy, and topics to cover in patient education.
This document provides information on proper and safe insulin use, including:
- It describes the different types of insulin based on how fast they work, including rapid-acting, short-acting, intermediate-acting, and long-acting insulins.
- It provides instructions for filling a syringe with the correct dose of insulin from a bottle and giving an injection, including choosing injection sites and angles.
- It emphasizes the importance of monitoring blood sugar levels and how food intake affects insulin needs. Proper insulin administration and management is key for diabetes patients.
The document provides guidance on proper storage, transportation, and injection technique for insulin. It discusses that insulin retains potency when stored at temperatures under 30°C for 2-4 weeks. Refrigeration is recommended for unopened insulin vials and pens. When traveling, insulin should be kept cool and never placed in checked baggage. The optimal injection technique involves rotating sites, using a small needle at a 90 degree angle, and ensuring the site is clean. Factors like temperature, exercise and injection site can impact absorption rate, but the mode of injection (pen vs vial) does not.
This document discusses different types of insulin delivery devices including syringes, insulin pens, and insulin pumps. It provides details on how each device works and considerations for which may be best for different patients. The document focuses on insulin pumps, describing how they work to provide continuous insulin infusion. It discusses criteria for when insulin pumps are recommended for pediatric patients with type 1 diabetes and the benefits pumps can provide, such as improved blood glucose control and flexibility. However, it also notes pumps require significant patient commitment and understanding to operate effectively.
Ueda2015 giudelines type 1 dr.hesham el-hefnawyueda2015
- Prof. Dr. Mohamed Hesham El-Hefnawy is the Dean of Egypt National Institute for Diabetes & Endocrinology. He has certifications in medical diabetes education and is a professor of diabetes and endocrinology.
- The document discusses guidelines for type 1 diabetes management, including recommendations for initial insulin dosing ranges, classifying basal and bolus insulin, and tips for titrating insulin doses based on factors like glucose monitoring, activity levels, and medical conditions.
- Methods of insulin injection like syringes and pen devices are outlined as well as why the slides are presented in white color.
This document provides an overview of insulin therapy, including:
1) A brief history of insulin discovery and the types of insulin including basal, mealtime, premixed, and newer combination insulins.
2) Insulin administration including vials, syringes, pens, injection sites and timing of injections in relation to meals.
3) Common insulin regimens for type 2 diabetes including once or twice daily basal insulin, basal-bolus regimens, and multiple daily injections of premixed insulin.
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.
The document discusses novel methods in the management of diabetes that will be presented by a panel of speakers. The panel will cover topics such as continuous glucose monitoring, insulin pumps and pens, smart insulin capsules, use of intestinal bacteria and fecal microbiota transplant to treat diabetes, artificial pancreas systems, diabetes patches, immunotherapy and vaccines, pancreatic islet transplant, and pancreatic stem cell replacement therapy. The objectives are for attendees to learn about diabetes, innovations in diabetes management, and acquire skills to manage diabetes using recent innovations.
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4. ▪ Insulin can be administered subcutaneously via various methods such as vial and
syringe, insulin pen and continuous subcutaneous insulin infusion (CSII)
▪ Though subcutaneous insulin delivery is the standard route of insulin administration, it
is associated with injection pain, needle phobia, lipodystrophy, noncompliance and
peripheral hyperinsulinemia
▪ Each method has its own advantages and disadvantages.
5. A) Vial and Syringes
▪ The development of syringes dates back to 1853 (Fergusson syringe) that paved the way
for the development of the modern syringes.
▪ In 1924, 2 years after the discovery of insulin, Becton, Dickinson and Company (BD)
made a syringe specifically designed for the insulin injection.
▪ To reduce the incidence of needle associated infections, disposable syringes were
developed. BD mass produced the first glass disposable syringes in 1954, called the BD
Hypak
▪ Despite all the advancements in modern syringes, many patients do not feel to inject
insulin 3-4 times a day as a result of needle phobia
6. ▪ Recently, an injection port has been designed know as i-port Advance®.
▪ It is the first device to combine an injection port and an inserter in one complete set
that eliminates the need for multiple injections without having to puncture the skin for
each dose.
▪ This device is helpful for the insulin requiring patients having needle phobia and helps
them to achieve glycemic control effectively
7.
8. i –Port Advance
▪ The i-Port is applied with a virtually
painless insertion, leaving a soft cannula
under the skin and giving you a means
to inject medications, with fewer
punctures, over three days of normal
activity (including showering, swimming
and exercising). It is compatible with
pens and syringes and can be used by
children and adults.
If you take an average of five shots a day, you can reduce the number of times you poke yourself from 150 to 10
in just 1 month! That’s 93% less pokes.
9. Syringes
▪ Syringes come in different sizes.
▪ Each line on a 100-unit syringe marks 2 units of insulin.
▪ Each line on a 50-unit or 30-unit syringe marks 1 unit of insulin.
▪ Use a syringe large enough to hold the whole dose of insulin.
▪ The standard needle is 1/2-inch long.
▪ Needles also come in 5/16-inch and 3/16-inch lengths.
▪ The 3/16-inch length is often used for children.
▪ The thinner the needle, the higher its gauge
15. ADVANTAGES DISADVANTAGES
Most widely available o Less accurate
Dependable, Easy to use o Chances of human error
Less expensive o Not patient friendly
Disposable
Can use most types of insulin
Lets you mix two different types of insulin into
one injection (with variable doses)
16. B)Insulin Pens
▪ Insulin pen injectors are convenient and discreet way of administering insulin. They have a built-in dial
that allows us to determine the amount of insulin to be injected, a short needle at one end and a
plunger at the other.
▪ Insulin pens are particularly useful if we need to take premixed insulin
▪ The first insulin pen was manufactured by NovoNordisk in 1985. This was followed by refinements by
various pharmaceutical companies over the past 30 years
▪ The newer insulin pens are reusable, more accurate and equipped with safety features such as audible
clicks with each dose to improve accuracy and reduce the chances of human errors
17. ▪ Another advancement in the pen device includes:-
▪ (HumaPen® Memoir™) is built-in recording of the time and date of the last 16 injections.
▪ NovoPen Echo® has been designed to give children and parents increased confidence,
combines dosing in half-unit increments with a simple, easy-touse, memory function.
▪ Recently developed pen needles are shorter and thinner (31-32 G × 4-5 mm), less painful
and requires less thumb force and time to inject insulin resulting in improved patient
satisfaction
▪ The newer smart pens are designed to guide the individual about the insulin dosage (by
means of in-built calculators), they have memory functions to remember the amount
and time of insulin dosage and automatic transmission of insulin dose to the mobile
logbook through Bluetooth technologies.
21. Method of Administration
▪ Prepare the skin.
▪ Prime the pen.
▪ Check the pen for air bubbles ( Safety Check)
▪ Dial the required dose of insulin
▪ Inject at a 90-degree angle.
▪ Expose the site of injection
▪ Safely dispose the injected needle in a solid lid container
22. ADVANTAGES DISADVANTAGES
More Accurate o Cannot mix different types of insulin together
Less human error o Expensive than syringes
Doses are easily dialed o Modest hand strength is required to push
button on pen or doser
Can use most type of insulin o Takes more time to push the pen “button” than
a syringe.
Reusable
23. C) Insulin Pumps
▪ Insulin pumps are small devices of size of a pager that can be attached to our belt or placed in our
pocket.
▪ They are made up of an insulin reservoir connected to a tube, ending in a cannula or catheter,
which is inserted under the skin of our abdomen.
▪ They can be set to deliver insulin at a slow, continuous rate throughout the day, or to release larger
quantities at meal times or when blood sugar is high.
▪ The main advantage of a pump is that it closely mimics the slow but continual release of insulin by
the pancreas
▪ At present due to its prohibitive cost its usage is very limited. All patients who qualify for insulin
pump therapy should be referred to a centre where expertise for a pump is available.
▪ Pump therapy requires a lot of motivation and time from both - the patient and the clinician
24.
25. Indications
▪ All Type -1 diabetics who are poorly controlled with basal-bolus therapy.
▪ Pregnancy
▪ Frequent hypoglycemia or hypoglycaemic unawareness
▪ Persistently elevated fasting glucose (Dawn phenomenon)
▪ Multiple chronic complications with labile glucose requiring fine tuning of glycemic control
▪ Management of labile diabetes after renal or hepatic transplant
▪ In situations where insulin requirement is very high a trial of pump therapy can be given.
26. Types of Insulin Pumbs
▪ Continuous Subcutaneous Insulin Infusion (CSII)
▪ Implantable insulin pumps
▪ Closed insulin delivery system with CGMS insulin delivery (artificial endocrine pancreas)
▪ Nano pump with closed insulin delivery system and continuous glucose sensing.
27. ADVANTAGES DISADVANTAGES
Designed to allow a more flexible lifestyle Breakdowns in equipments can occur
Eliminates Injection Cost and maintenance is usually more expensive.
Better matches insulin to food, exercise and lifestyle. Insulin delivery can be stopped by a leak in tubing; a
crimp in the catheter
Allows insulin to be given discreetly More advanced diabetes education and skills are
required to properly use
Delivers insulin in tiny amounts as much as 1/10 to
1/20 unit – important for people receiving small doses
of insulin.
Requires a lot of work in daily care (diet, dose
adjustments, checking blood glucose).
Often results in better blood glucose control. Always attached to the pumb
29. Exubera ( by Pfizer)
▪ Approved by US FDA in 2006 and it was later withdrawn in 2007
▪ It was available as 1mg,3mg dry powder form that to be taken with inhaler
▪ It was found to have pharmacokinetic and pharmacodynamic (PK/PD) properties
similar to insulin aspart with a faster onset of action (10-15 min.
▪ In clinical trials in patients with uncontrolled T1DM and T2DM, Exubera® was found to
reduce postprandial blood glucose and A1c significantly.
▪ However, Exubera® was contraindicated in smokers as it increased the risk of
hypoglycemia due to greater absorption compared to nonsmokers.
▪ patients were required to undergo pulmonary function tests before treatment
initiation, after 6 months and annually thereafter.
30. Advantages
▪ Noninvasive
▪ ↑Patient compliance
▪ Rapid onset of action (10-15 min)
▪ Better PPBG control
Disadvantages
• Bulky delivery device
• Patient need to undergo frequent PFT
• Expensive
31. Afrezza
▪ Prescription Afrezza® is a man-made rapid-acting mealtime inhaled insulin breathed in
through your lungs and is used to control high blood sugar in adult patients with diabetes.
▪ FDA-approved AFREZZA is the only inhaled insulin working to help control blood sugar
during mealtime.
▪ When using the AFREZZA inhaler at the beginning of a meal, insulin enters the
bloodstream through your lungs.
▪ AFREZZA is rapid acting mealtime insulin that starts to work in approximately 12 minutes,
peaks at about 35 to 45 minutes and is done working in 90 to 180 minutes (for the 4 unit
and 12 unit respectively). For the 48 unit dose, it starts working in about 12 minutes,
peaks at about 55 minutes and is done working in approximately 4.5 hours.
32. CONTRAINDICATIONS
AFREZZA is contraindicated in patients:
▪ During episodes of hypoglycemia.
▪ With chronic lung disease (such as asthma or chronic obstructive pulmonary disease
[(COPD)] because of the risk of acute bronchospasm.
▪ With hypersensitivity to regular human insulin or any of the AFREZZA excipients.
SIDE EFFECTS
• Hypoglycemia (sweating, confusion, headache, blurred vision, slurred speech etc)
• Decreased Lung function
• Severe allergic reactions
• Hypokalemia
33. Limitations
▪ AFREZZA is not a substitute for long-acting insulin. AFREZZA must be used in combination
with long-acting insulin in patients with type 1 diabetes mellitus.
▪ AFREZZA is not recommended for the treatment of diabetic ketoacidosis.
▪ The use of AFREZZA is not recommended in patients who smoke or who have recently
stopped smoking (less than 6 months).
▪ It is not known if AFREZZA is safe and effective in children under 18 years of age.
35. ▪ AERODOSE
▪ TECHNOSPHERE
▪ AERx
Advanced inhalational
research devices
currently under Phase
3 : result awaited
Challenges
• Technical issues
• Cost
• Long Term Safety
37. ORAL INSULIN
▪ Oral route of insulin administration may be the most patientfriendly way of taking insulin and it
could more closely mimic physiological insulin delivery
▪ Natural and synthetic nanoparticles have been used as a carrier or vehicle for insulin such as
chitosan, liposomes, polymeric nanovesicles, polylactides etc inorder to overcome the main
challenge of oral insulin : poor bioavailability
▪ Combination of Self-Nano Emulsifying Drug Delivery System (SNEDD’s) and Thiolated Chitosan is
promising and innovative approach to improve bioavailability
38. BUCCAL INSULIN
▪ Initially, Generex Biotechnology developed Oral-lyn™ which is a liquid formulation of
short acting insulin that is administered using Generex’s metered dosage aerosol
applicator (RapidMist™) .
▪ Phase 1 and 2 trials showed progressive report, currently its under phase 3 studies
▪ Another molecule being developed by Shreya Life Sciences Pvt. Ltd., India is oral
Recosulin® and the results of the phase 2 and phase 3 trials are awaited
▪ Another formulation “insulin loaded orally dissolved films” is undergoing PK/PD
investigation
40. ▪ Currently, two technologies are under investigation: Nasulin™ (CPEX pharmaceuticals)
and nasal insulin by Nastech Pharmaceutical Company Inc.
▪ Both insulin preparations have bioavailability of about 15-25% with the onset of action
~10-20 min.Results from the phase 2 and 3 clinical trials are awaited.
▪ Intranasal delivery has several advantages over oral (bypass GI peptidases), subcutaneous
(noninvasive and painless) and inhalation route (no issue with lung function) which makes
this route attractive for the delivery of insulin.
▪ Intranasal delivery has shortcomings such as limited permeability of a large molecule
through the nasal mucosa and rapid mucociliary clearance resulting in variable
absorption.
42. ▪ Trans-dermal insulin delivery eliminates the problems associated with needles and injections
and large surface area of the skin makes it a convenient route for insulin delivery.
▪ However, the penetration of insulin is halted by the stratum corneum, the outer most layer of
the skin. Numerous methods have been explored to overcome the barrier of stratum
corneum.
▪ (a) Iontophoresis, the technique that uses small electric currents
▪ (b) Sonophereis or phonopheresis uses ultrasound waves,
▪ (c) Microdermal ablation by removing the stratum corneum,
▪ (d) Electroporation utilizes high voltage pulses that are applied for a very short time
▪ e) Transfersulin is the insulin encapsulated in transferosome, an elastic, flexible vesicle which
squeeze by itself to deliver drugs through skin pores
▪ (f) Insupatch™, a device developed as an add-on to an insulin pump that applies local heat to the skin
in order to increase the absorption of insulin
44. ▪ Direct delivery of insulin in the portal vein mimics the high portal insulin concentration.
This route of insulin delivery has been investigated since the 1970s.
▪ The pump (The MIP 2007C Medtronic/Minimed, Northridge, CA, USA) is implanted
beneath the subcutaneous tissue in the lower abdomen under general anesthesia.
▪ From this subcutaneous pocket, the peritoneum is opened, and the tip of the catheter is
carefully inserted and directed towards the liver.
▪ After implantation, the pump reservoir is refilled in the outpatient clinic transcutaneously
at least every 3 months, depending on the individual insulin requirement.
▪ Clinical trials have shown safety and efficacy of intraperitoneal insulin delivery.
▪ The limitations of this route of insulin administration include it is invasive, may be
associated with subcutaneous infections, cannula blockage, higher cost, portal-vein
thrombosis and peritoneal infection
46. ▪ Islet cell transplantation
This is a recently developed surgical procedure - called the Edmonton protocol - whereby islet cells
from a donated human pancreas are injected into the liver of a recipient with type 1 diabetes.
The transplanted cells begin to secrete insulin, while the recipient needs to take immunosuppressive
medications for life to prevent rejection of the transplanted tissue.
Clinical trials continue to establish the safety and long- term effectiveness of this procedure as a
means of supplying insulin.
STEM CELL THERAPY
Embryonic or bone marrow derived stem cells are a hot topic for research. Voltarelli, et al (2007),
transplanted 15 Type 1 diabetics with autologous stem cells and 14 were able to stop their insulin for
7 to 35 month.50
The stem cells from the bone marrow are more likely to differentiate into insulin producing cells and
also become glucose responsive. This method holds great promise for the future.
47. ▪ GENE THERAPY
– Scientists have identified a gene called SHIP2 that appears to regulate insulin. Such findings make
SHIP2 a potential gene therapy target for the treatment of type 2 diabetes aimed at improving the
individual insulin regulation.
– A protein that blocks the overgrowth of blood vessels in the eye is being studied as possible gene
therapy for diabetic retinopathy.
– A recent study showed that treatment with the protein, called pigment epithelium-derived factor, or
PEDF, prevented excessive new blood vessel formation in an animal model of retinopathy.
– It may also be used to treat macular degeneration.
49. ▪ Ocular route
– Until date, no human trial has been reported with this route and an animal study failed to
achieve significant plasma insulin concentration.
▪ Rectal route
– Rectal gels and suppositories showed fair results. However, this route is not commercially
viable.
▪ Intra-tracheal
– Administration of insulin was reported in 1924 but is not practical so not taken up for further
development.
51. ▪ There is a long history of research focusing on identifying a route of administration for
insulin that is minimally or noninvasive, effective, safe, convenient and cost-effective for
patients.
▪ Each route and delivery method has its own potential advantages and disadvantages.
▪ However, if successful, alternative routes of administration could revolutionize the
treatment of diabetes mellitus and help improve patients’ quality of life.
▪ The success of commercial technologies and the emergence of new ones will be
demonstrated only with time.
▪ An oral delivery system of insulin will have tremendous benefits in terms of a decreased
number of injections for diabetic patients and a reduced incidence of side effects.