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

1. INSULINTHERAPY
Presented by :
Meraj Fatima
PharmD
Sultan ul Uloom College of Pharmacy
Hyderabad
Guided by :
Dr S.P. Srinivas Nayak, Assistant professor, SUCP, HYD

2. INSULIN
• Polypeptide hormone.
• Produced by Beta-cells of islets of Langerhans in
pancreas.
• Profound effects on carbohydrate, fat & protein
metabolism and to some extent an water & electrolyte
balance.

3. Action of Insulin
■ Integrated action on carbohydrate, protein and fat metabolism.
■ Dominant effect on glucose homoeostasis predominantly exerted in 3 tissues
1. Liver
2. Skeletal muscle
3. Fat
In Liver
• Inhibition of glycogenolysis & gluconeogenesis.
• Stimulation of glycogenesis & storage.
In skeletal muscle & adipocytes
• Stimulation of glucose uptake, utilization & storage.
• Increases glucose transport.
• Activation/inactivation of enzymes responsible for storage & metabolism of glucose.

4. Insulin deficiency results in :
o Elevated plasma glucose hyperglycemia
o Elevated plasma lipid - hyertriglyceridemia
o Altered protein metabolism - metabolic Immune defects

5. INSULIN SECRETION
Normally secreted as
basal (between meals and night time) ;
bolus – meal related peaks (1st and 2nd phase)

6. TYPES OF INSULIN
■ Rapid-acting insulin (Analogs)
■ Short-acting Humulin (Regular)
■ Intermediate-acting insulin (NPH)
■ Premixed insulin
■ Long-acting insulin

7. TYPES OF INSULIN

11. COMMON INSULIN REGIMENS
 Split Mix Regimens
Two injections per day
Twice daily regimens
• Intermediate acting insulin(NPH)and short acting (regular) insulin
• 2/3 of insulin - morning(ratio 1:2)
• 1/3 of insulin - evening
before breakfast & before bedtime
Proportion/dosage of insulins titrated based on BG profile
Drawback
Mixing insulins is tedious and problematic
Inaccuracy of dose
Not preferred -more problems for patients

12.  MULTIPLE INJECTION REGIMEN
• Short acting- before meal
• Intermediate or long acting -once or twice daily
Advantage:
 Allows greater freedom with regard to meal timing
 More variable day to day physical activity

13.  BASAL INSULIN
o Usually given at night.
o Proportion dosage of insulin titrated based on FBG.
 Drawback
o Expensive.
o Fasting blood glucose is primary targeted.
o May be with sensitizer and or secretagogue.
 BASAL BOLUS INSULIN
o Basal insulin at night and one rapid acting insulin immediately before each major meal (3 times).
o Basal insulin is titrated following FBG
o Rapid acting insulin is titrated by post meal BGs
 Drawback
o Expensive
o 4 times needle prick a day

15.  Continuous subcutaneous insulin infusion (CSII)
• Very effective insulin regimen for type 1 DM
• Sophisticated device
• requires education of the patient and frequent interactions with diabetes management
team
 Advantages:
• programmed dose.
• basal infusion rates altered during exercise.
• different doses of insulin can be matched based on meals.
 Disadvantages:
• Infection.
• Hyperglycemia.
• Decrease potassium level.

16. INSULIN DEVICES
 Insulin syringes-10ml insulin vials
30 unit -0.3 ml,50 unit-0.5 ml, 100 unit-1ml
Need - 8mm to 13mm Use each syringe only once.
 Insulin pen-insulin catridge-3ml-300 units fits into the device.
Disposable, reusable
 Insulin pumps-reservoir of insulin-infusion set worn outside the body-abdomen
Only short or rapid acting insulin are used-mimics physiological pattern
 Inhaled insulin

18. SITES OF INSULIN INJECTION

19. Side effects of insulin therapy
• Hypoglycemia (predominantly seen in type 1 patients)
• Weight gain
• Peripheral edema (salt and water retention in short term)
• Insulin antibodies (with animal insulin)
• Local allergy
• Lipohypertrophy or lipoatrophy at site of injection

20. THANKYOU