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.
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
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
Various insulin pumps used to deliver insulin to the human body and its application along with its advantages and disadvantages are outlined in this presentation.
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
InsuPad is a non-invasive, simple, easy to use, medical device which enables patients on intensive insulin therapy to take control of their disease and reach treatment targets in more efficient way.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
Various insulin pumps used to deliver insulin to the human body and its application along with its advantages and disadvantages are outlined in this presentation.
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
InsuPad is a non-invasive, simple, easy to use, medical device which enables patients on intensive insulin therapy to take control of their disease and reach treatment targets in more efficient way.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Why Greater BP reduction in SAI
compared to PAI
• Some patients with SAI may have partial ACTH deficiency,
with higher circulating endogenous cortisol levels than
patients with PAI
• These patients may, therefore, be over-replaced on similar
doses of HC replacement to patients with PAI
• Study included a smaller number of patients with PAI and
therefore was potentially underpowered to appreciate a
significant difference
• PAI have concurrent mineralocorticoid deficiency, making
them vulnerable to fluctuations in salt and water balance
and therefore blood pressure homeostasis
3. Contents
• Various ways of delivering Insulin
• Vials & Syringes
• Insulin pens
• CSII
• Closed loop insulin delivery: Artificial Pancreas
• Inhaled Insulin
• Oral Insulin
• Other Novel ways of delivering Insulin
4. Introduction
• The prevalence of diabetes is increasing
throughout the world
• The International Diabetes Federation estimated
366 million people had diabetes in 2011 and is
expected rise to 552 million by 2030
The Global Burden. International Diabetes Federation. IDF Diabetes Atlas. 6th ed. Brussels, Belgium: InternationalDiabetes Federation; 2013.
Available from: http://www.idf.org/diabetesatlas/5e/theglobal- burden. [Last accessed on 2013 Sep
5. Insulin & its beginnings
• Discovery of insulin one of the greatest medical discoveries of the
last century
• All patients with T1DM and many patients with long standing T2DM
require insulin therapy to achieve good glycemic control
• The early insulins were derived from bovine and porcine pancreas
and were associated with immunological reactions, lipodystrophy
and unpredictable insulin absorption from subcutaneous tissue
• Hence, initial research focused on the purification of insulin
• There has been marked progression in the development of insulins
such as rapid and long acting insulin analogs in the last five decades
6. To simulate endogenous insulin
secretion
• Emphasis evolved to achieving tight glycemic
control with minimal hypoglycemia by
focusing on delivering insulin that mimics
endogenous insulin secretion by the pancreas
7. Routes of insulin administration
• Peptide hormone, therefore, destroyed by gastric
acid if taken orally
• Intra-dermal absorption of insulin not reliable,
and can’t mimic physiological insulin secretion
• Intra-dermal, intramuscular and intravenous
therapy not suitable for self-administration daily
• Subcutaneous route of administration widely
preferred method
8. Newer Insulin techniques
• The newer methods of insulin delivery aim to
deliver insulin with minimal invasiveness in an
accurate and precise manner
11. Vial & Syringe
• In 1924, 2 years after the discovery of insulin, Becton, Dickinson
and Company (BD) made a syringe specifically designed for the
insulin injection
• Initial syringes were made of metals and/or glass, reusable and
required boiling after each use to sterilize
• Despite all these advances, many patients do not feel to inject
insulin 3-4 times a day as a result of needle phobia
• Insulin syringes with three different needle lengths 6, 8 and 12.7
mm are available
• Also, three gauge sizes, 31, 30 and 29 are available
The history of injecting and the development of the syringe. Exchange supply tools for harm reduction. Available from: http://
www.exchangesupplies.org/article_history_of_injecting_and_ development_of_the_syringe.php
12. i-port advance
• 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
• Virtually painless insertion, leaving a soft cannula
under the skin and giving a means to inject
• Normal activity - including showering, swimming and
exercising can be done
• Compatible with pens and syringes
15. History & Advancement
• First insulin pen manufactured by Novo Nordisk in 1985
• 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
• Another advancement in the pen device (HumaPen®
Memoir™) is built-in recording of the time and date of the
last 16 injections
• Recently, NovoPen Echo® has been designed to give
children and parents increased confidence, combines
dosing in half-unit increments with a simple, easy-to use,
memory function
16.
17.
18. Advantages with pen
• More accurate, convenient, less painful and
patient friendly but associated with higher
cost in comparison with vial and syringe
• 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
19. Pen needles
• Available in 4, 5, 6 and 8 mm sizes and are of 32,
31 and 30 gauge
• Shorter needles alleviate the risk of intramuscular
injections while avoiding intra-dermal delivery as
well
• Long enough to pass through the skin into the fat
layer but are short enough not to reach the
muscle tissue.
20. Needle length
• There is no medical reason to recommend
needles longer than 4–6 mm to either children or
adults
• Extremely lean patients should be using a skin
fold to inject even with a 4-mm and 5-mm needle
• Shorter needle length (4-6 mm) considered safe
and efficacious in children
Forum for Injection Technique (FIT), India: The Indian Recommendations 2.0, for Best Practice in Insulin Injection Technique 2015
22. History & Background
• Physiologic delivery of insulin has been a long-standing goal
• High glycemic variability associated with MSI
• The first portable insulin pump invented by Kadish in 1963;
however, it was limited by its size and technical issues
• The first commercial insulin pump introduced in 1979 in the
USA
• Current generation of insulin pumps are more patient
friendly as a result of smaller size and smart features such
as built-in-dose calculators and alarms
Kadish AH. A servomechanism for blood sugar control. Biomed Sci Instrum 1963;1:171
23.
24.
25. Function & Evidences
• Consist of an insulin reservoir and a delivery
catheter that infuses insulin continuously into the
subcutaneous tissue
• CSII use in people with T1DM is associated with
0.4–0.5% lower HbA1c than from MSI
• In T2DM, mean HbA1c declined by 1.1% in the
CSII group and by 0.4% in the MDI group (p <
0.0001)
26. Mechanism
• Generally placed in the anterior subcutaneous
tissue of chest/abdomen
• Primary driving force for delivery is the
pressure difference generated by pressurizing
a drug reservoir with a pump
by osmotic action (osmotic pumps)
by direct mechanical actuation
27. Bolus calculators & insulin on board
• The insulin : carbohydrate ratio (the number of grams of
carbohydrate covered by 1 unit of insulin) and correction/sensitivity
factor (a measure of the glucose-lowering effect of 1 unit of insulin)
is programmed into the pump software
• When calculating an insulin dose, the pump software will consider
the amount of active insulin on-board resulting from earlier boluses
(commonly referred to as IOB) and subtract this IOB from the
recommended dose
• In practice, the major consideration in setting the insulin duration
of action in the bolus calculator software is usually a best guess
based on a clinical assessment of the hypoglycemia risk of the
individual and imperative for achieving tight glycemic control
28. Basic advantages
• Accurate dosing of insulin boluses in fractions of a unit
allows the patient to correct hyperglycemia more precisely
without overshooting and causing hypoglycemia
• Diurnal variations in basal insulin requirements caused by
the dawn phenomenon and steroid therapy have been
reported to be more readily managed using the multiple
basal rates provided by the pump than by long-acting
injected insulins
• Special benefit for the person with diabetes post-renal
transplant, pre-conception, pregnancy
29. Characteristics of Ideal pump
• Deliver drug within prescribed rates for extended periods (2-5 yrs)
• Accuracy & precision
• Reliability
• Chemical, physical & biological stability
• Compatibility with drugs
• Non-antigenic & non-carcinogenic
• Must have overdose protection
• Convenient to use
• Able to monitor the performance of the pump
• Must be sterilizable
• Have wide delivery rate for basal & bolus deliveries to meet patient
variability
• Long reservoir & battery life and easy Programmability
31. Peristaltic pump
• Performed using local anesthesia & on outpatient
basis
• Use of wide variety of drugs
• Precise delivery
• Less risk of infection since it is fully implanted
• Presence of alarm system makes the pump more
safe
32. Fluorocarbon propellant-driven pump
• Construction:
Hollow titanium disk, moveable pistons
2 chambers—inner-->drug; outer-->flurocarbon liquid
Self-sealing silicon rubber & Teflon, bacterial filters,
catheter
• Working:
Vaporization of flurocarbon leads to drug release
through catheter
Adjust flow rate by increasing viscosity
33. Osmotic pump
• Moveable piston
maintain pressure in
reservoir
• Presence of Semi-
permeable membrane
34. Controlled release micro pump
• Diffusion across a rate-controlling membrane
for basal delivery
• Augmented by rapidly oscillating piston acting
on a compressible disk of foam
• Achieved without valves
35. Limitations
• Higher cost compared with MDI
• Increased risk for subcutaneous infections
• Inconvenience of being attached to a device
36.
37.
38.
39. Sensor augmented pump therapy
• It has become feasible to combine two
technologies (pump and CGM)
• CGM readings used to adjust insulin delivery
through insulin pump
• The use of SAP reduces A1c by 0.7-0.8%
compared to baseline or MDI therapy in patients
with T1DM
• SAP requires patient involvement for using CGM
glucose readings to adjust
• SAP susceptible to human errors
40.
41. Alternate Controller Enabled infusion
pump (ACE pump)
• Can be used with
different components
that make up diabetes
therapy systems
• Other compatible medical
devices, including
automated insulin dosing
systems, continuous
glucose monitors, blood
glucose meters or other
electronic devices
42. Patch pumps
• Low, flat profile that fit snugly against the body
• Generally do not have the ability to deliver
multiple basal rates or preprogrammed boluses
• Primarily intended for use in T2DM, various
configurations of patch pumps may deliver only
basal insulin at a prefixed rate
• Insulin boluses in fixed increments when
manually activated by the user
45. Closed loop insulin delivery: Artificial
pancreas
• Integrates a continuous glucose monitor and
insulin pump, together with an automated
algorithm to control insulin delivery
• Technical obstacles:
Glucose sensors need to be both accurate and
reliable (e.g. minimal calibration drift, limited
potential mechanisms for sensor failure)
Physiological lag, which can be particularly
problematic during times of rapid rates of change
in blood glucose levels
50. Minimed 780G
• Advanced hybrid closed
loop
• Automated correction
boluses for high blood
sugars, Bluetooth and a
mobile app for remote
monitoring
• More than 80% Time in
Range (TIR)
51. Hybrid Closed-loop system DBLG1
• Kaleido insulin pump
worn on the body
• Dexcom G6 CGM
• Diabeloop’s own
locked-down touch-
screen controller
52. Inhaled insulin
• It has long been appreciated that insulin
delivery by aerosol reduces blood glucose
• Advantages of the pulmonary route include
a vast and well perfused absorptive surface
absence of certain peptidases that are present
in the GI tract that breaks down insulin
the ability to bypass the first pass metabolism
53. History
• The first inhaled product, Exubera® was approved by the US
FDA in year 2006
• Dry power formulation available as 1 mg and 3 mg doses to
be taken with the help of an Inhance™ inhaler device
• Found to have pharmacokinetic and pharmacodynamic
(PK/PD) properties similar to insulin aspart with a faster
onset of action (10-15 min)
• Contraindicated in smokers as it increased the risk of
hypoglycemia due to greater absorption compared to
nonsmokers
Heinemann L. Alternative delivery routes: Inhaled insulin. Diabetes Nutr Metab 2002;15:417-22.
54. Other issues
• Patients required to undergo pulmonary function
tests before treatment initiation, after 6 months
and annually thereafter
• Transient nonproductive cough and a modest
reduction in lung function initially are the
common side-effects
• The bioavailability approximately 10%
• One 1mg and one 3 mg blisters are equivalent to
approximately 3 IU and approximately 8 IU
subcutaneously administered insulin
55. Afreeza
• Based on Technosphere® dry powdered
formulation
• The onset of action of Afrezza inhaled insulin
is 15 min and duration is 2-3 h
56. Newer inhalational therapy
• The AERx insulin Diabetes Management
System, Aerodose, ProMaxx (protein matrix
microsphere) and advance inhalational
research are newer inhalational devices being
investigated in clinical trials
57.
58. Characteristics
• In healthy males receiving inhaled insulin, rates of glucose
infusion were higher in the first hour after dosing than in
those receiving regular insulin by injection correlating with
the more rapid rise in serum insulin levels
• Total glucose consumption was comparable for
bioequivalent doses of inhaled vs regular insulin
• In individuals with T1DM, the glucose infusion rate profile
showed an early peak rate with inhaled insulin vs regular
insulin with a similar glucose consumption
59. Cough & Inhaled Insulin
• Cough has been reported in 22% to 30% of patients with diabetes on both
Exubera & Afreeza
• The cough tended to occur within seconds to minutes after inhalation and
was generally rated as mild
• The cough was rarely productive and rarely occurred at night
• Cough prevalence was greatest in the first month of use, then decreased
by 20% to 40% over the next 3 months, and remained constant thereafter
• In clinical studies only 4% of patients discontinued because of cough
Raskin P, Heller S, Honka M, et al. Pulmonary function over 2 years in diabetic patients treated with prandial inhaled Technosphere insulin or
usual antidiabetes treatment: a randomized trial. Diabetes Obes Metab 2012;14:163–173
60. Oral Insulin
• Challenges in making oral insulin include:
Inactivation by proteolytic enzymes in the GI tract
Low permeability through the intestinal membrane due to
larger size
Hydrophobicity of insulin resulting in poor bioavailability
• Several pharmaceutical companies are engaged in
developing carriers to protect insulin from GI degradation
and facilitate intestinal transport of insulin to deliver insulin
to the circulation with sufficient bioavailability
Soares S, Costa A, Sarmento B. Novel non-invasive methodsof insulin delivery. Expert Opin Drug Deliv 2012;9:1539-58
Flood T. Advances in insulin delivery systemsand devices: Beyond the vial and syringe. Insulin 2006;1:99-108
61. • Certain oral insulin preparations such as
Capsulin, ORMD-0801, IN-105, oral hepatic
directed vesicles and Eligen completed phase
1 and phase 2 trials with promising results
• Recently, multifunctional polymers and Self
Nano Emulsifying Drug Delivery System
(SNEDDS) has been tried for oral insulin
Heinemann L. New ways of insulin delivery. Int J Clin Pract Suppl 2010;166:29-40
63. Colonic insulin delivery
• Under extensive investigation as a possible
strategy to improve the oral bioavailability of
peptide and protein drugs
• Oral delivery systems intended for colonic release
of insulin devised according to microflora, pH and
time-dependent strategies well described
• Bioavailability and pharmacological availability
data generally still far from being reliable
Maroni A, Zema L, Del Curto MD, Foppoli A, Gazzaniga A. Oral colon delivery of insulin with the aid of functional
adjuvants. Adv Drug Deliv Rev 2012;64:540-56
64. Nasal Insulin
• Shortcomings such as limited permeability of a large
molecule through the nasal mucosa and rapid muco-ciliary
clearance resulting in variable absorption
• 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 3 clinical trials awaited
Illum L. Nasal drug delivery — Recent developments and future prospects. J Control Release 2012;161:254-63.
Stote R, Marbury T, Shi L, Miller M, Strange P. Comparison pharmacokinetics of two concentrations (0.7% and 1.0%) of
Nasulin, an ultra-rapid-acting intranasal insulin formulation. J Diabetes Sci Technol 2010;4:603-9
65. • The substances such as bile salt, surfactant
and fatty acid derivatives are being
investigated to enhance mucosal permeability
of insulin but they increase the risks for local
irritation, nasal secretion, sneezing or burning
sensation
66. Other effects
• Treatment with intranasal insulin improved
memory, preserved caregiver-rated functional
ability and preserved general cognition without
any significant hypoglycemic event
• Improvements in cognitive functions were
correlated with changes in the Aβ42 level and in
the tau protein-to-Aβ42 ratio in cerebrospinal
fluid
Benedict C, Frey WH 2nd, Schiöth HB, Schultes B, Born J, Hallschmid M. Intranasal insulin as a therapeutic option in the treatment of cognitive
impairments. Exp Gerontol 2011;46: 112-5
67. Buccal insulin
• Buccal delivery of insulin has similar benefits as oral
insulin with the advantage of bypassing GI degradation
• Furthermore, the relatively large surface area results in
better bioavailability
• Oral-lyn™ which is a liquid formulation of short acting
insulin that is administered using Generex’s metered
dosage aerosol applicator & Shreya Life Sciences Pvt.
Ltd oral Recosulin® has been used as buccal insulin
Heinemann L, Jacques Y.Oral insulin and buccal insulin: A critical reappraisal. J Diabetes Sci Technol 2009;3:568-84
World’s First Oral Insulin Spray Launched in India. Asia Pacific Biotech News 2008;12:60
68. Transdermal
• Penetration of insulin is halted by the stratum
corneum, the outer most layer of the skin
• Ways of administering: Iontophoresis,
Sonophoresis, Microdermal ablation, as
Transfersulin, Insupatch, Recombinant human
hyaluronidase
Bariya SH, Gohel MC, Mehta TA, Sharma OP. Microneedles: An emerging transdermal drug delivery system. J Pharm Pharmacol 2012;64:11-
29
69. Intra peritoneal
• Direct delivery of insulin in the portal vein mimics
the high portal insulin concentration
• Implanted beneath the subcutaneous tissue in
the lower abdomen
• From this subcutaneous pocket, the peritoneum
is opened, and the tip of the catheter is carefully
inserted and directed towards the liver
Renard E. Insulin delivery route for the artificial pancreas: Subcutaneous, intraperitoneal, or intravenous? Pros and
cons. J Diabetes Sci Technol 2008;2:735-8
70. Take Home Messages
• S/C way of delivering Insulin is still the most rational &
scientific method among all other modes of delivery
• Modern times are the era of ‘Modern Insulin pen’
which patients needs to be educated adequately
• CSII : One of the most attractive choice for T1DM
patients specially who can afford
• Oral Insulin can be the path-breaking discovery in
future times