Insulin & Oral Hypoglycemic Agents

Front 1

Type I DM

Back 1

-Insulin dependent diabetes mellitus (IDDM), juvenile onset DM.
Probably an autoimmune disorder
Antibodies found that destroy islets of Langerhans in the pancreas
Insulin in circulation is very low or completely absent

Front 2

Type II DM

Back 2

Non insulin dependent diabetes mellitus (NIDDM), maturity onset DM
May be no loss or may be moderate reduction in the -cell mass
Insulin circulation can be high, normal, or low

Exercise is the biggest management of disease

Front 3

Exercise and Type II

Back 3

Resting skeletal muscle need insulin to incr Glu4,
Exercise muscle upregulates Glu4

Front 4

Classification

Back 4

Ultra-rapid acting and with very short action
Rapid acting with short acting
Intermediate onset with intermediate action
Slow onset with long action

Front 5

Lispro

Back 5

Ultra Rapid Insulin
Insulin analogue - a lysine and proline residues are switched
This transposition allows lispro to dissolve more rapidly
Enters the circulation twice more faster
Suitable to inject just before a meal
Active within 5-10 mins.
Peak action at 30-90 mins.
Effect lasts 2-4 hrs.
Take with meals

Front 6

Crystalline Zinc insulin

Back 6

also called as regular insulin
Rapid Onset & Short Acting
given intravenously in emergencies
Otherwise given by routine subcutaneous route
Given alone or is mixed with intermediate or long acting preparations
Usually given 30 mins -1 hr before a meal

Front 7

Isophane insulin suspension

Back 7

Intermediate acting Insulin
NPH insulin
Effects lasts for 12 hours.
Given twice a day.

Front 8

Ultra lente

Back 8

Slow Onset & Long Acting
Ultra lente; NO hypoglycemia; on graph is peakless-KEY
Usually given in the morning when dosed once
Continuous flat effect (peakless) for 24 hours.
Doesn’t cause hypoglycemia.

Front 9

Potential toxicities of insulin

Back 9

Hypoglycemia
Allergy (common with older forms)
Lipodystrophy (can be avoided if injected in different sites each time)

Front 10

Rx of hypoglycemia

Back 10

SEVERE Hypoglycemia treated with IV dextrose
Mild hypoglycemia: Oral administration of high sugar liquid, such as corn syrup, chocolates may be effective only when experiencing initial signs