Dr. Luis R. Rucobo G.

MG-LCFD-MNC
Los usos de la insulina
Dr. Luis R. Rucobo G.
Farmacología
 PÁNCREAS

Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
 Páncreas

Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
 PÁNCREAS

Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
 PÁNCREAS

Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J., Desai, M., & King, A. C. (2018). Effect of Low-
Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin
Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
 PÁNCREAS

Kahleova, H., Tura, A., Klementova, M., Thieme, L., Haluzik, M., Pavlovicova, R., Hill, M., & Pelikanova, T. (2019). A
Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched
Standard Meal in Type 2 Diabetes: A Randomized Crossover Study. Nutrients, 11(3), 486.
https://doi.org/10.3390/nu11030486
 PÁNCREAS

                                  

                                  

Kahleova, H., Tura, A., Klementova, M., Thieme, L., Haluzik, M., Pavlovicova, R., Hill, M., & Pelikanova, T. (2019). A
Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched
Standard Meal in Type 2 Diabetes: A Randomized Crossover Study. Nutrients, 11(3), 486.
https://doi.org/10.3390/nu11030486
Kahleova, H., Tura, A., Klementova, M., Thieme, L., Haluzik, M., Pavlovicova, R., Hill, M., & Pelikanova, T. (2019). A
Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched
Standard Meal in Type 2 Diabetes: A Randomized Crossover Study. Nutrients, 11(3), 486.
https://doi.org/10.3390/nu11030486
 PÁNCREAS: CELULARIDAD

Kahleova, H., Tura, A., Klementova, M., Thieme, L., Haluzik, M., Pavlovicova, R., Hill, M., & Pelikanova, T. (2019). A
Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched
Standard Meal in Type 2 Diabetes: A Randomized Crossover Study. Nutrients, 11(3), 486.
https://doi.org/10.3390/nu11030486
 PÁNCREAS: ENDOCRINO

Alfa: glucagón
Beta: insulina
Delta: somatostatina

Kahleova, H., Tura, A., Klementova, M., Thieme, L., Haluzik, M., Pavlovicova, R., Hill, M., & Pelikanova, T. (2019). A
Plant-Based Meal Stimulates Incretin and Insulin Secretion More Than an Energy- and Macronutrient-Matched
Standard Meal in Type 2 Diabetes: A Randomized Crossover Study. Nutrients, 11(3), 486.
https://doi.org/10.3390/nu11030486
Mey, J. T., Solomon, T., Kirwan, J. P., & Haus, J. M. (2019). Skeletal muscle Nur77 and NOR1 insulin responsiveness is blunted in obesity
and type 2 diabetes but improved after exercise training. Physiological reports, 7(6), e14042. https://doi.org/10.14814/phy2.14042
 GLUT 2
Alimentación Hiperglucemia Células Beta
Hipotálamo

Gl
u
co
Hormonas del Insulina

sa
apetito

GLUT 4
Glucogenólisis
Glucagón
Gluconeogénesis
Absorción intestinal
Células

sa
co
lu
G
Células Alfa Hipoglicemia Funciones
Energía
celulares
 Autoinomune e
GLUT 2 ideopática
Alimentación Hiperglucemia Células Beta
Hipotálamo

Resistencia a la
insulina

POLIFAGI

Gl
A

u
Lactógeno

co
Hormonas del Insulina

sa
MAYOR placentario
apetito
Hiperglucemia y prolactina
Diabetes
inhiben a
gestacional
insulina
Mayor
Glucogenólisis eliminación vía

GLUT 4
Glucagón Otras
Gluconeogénesis urinaria
diabetes
Absorción intestinal
Genética ,
Células fármacos y
daño exógeno
Otros efectos: POLIURIA
-Dislipidemias
-Glucotoxicidad Mayor
-Lipotoxicidad deshidratación
Células Alfa Funciones
y sed Energía
POLIDIPSIA celulares

Señal de que no llega glucosa adecuadamente Daño celular

 DOSIS
Dosis habituales de mantenimiento oscilan entre 0.5-1.5 UI/kg/día

Culturismo inicial 0.1-0.2 UI/kg/día

𝑰𝒏𝒔𝒖𝒍𝒊𝒏𝒂 𝒈 𝑯𝑪𝑶 𝒆𝒏 𝒖𝒏𝒂 𝒄𝒐𝒎𝒊𝒅𝒂

=
𝑯𝑪𝑶 𝑼 𝒅𝒆 𝒊𝒏𝒔𝒖𝒍𝒊𝒏𝒂 𝒓 á 𝒑𝒊𝒅𝒂 𝒂𝒑𝒍𝒊𝒄𝒂𝒅𝒂𝒔

Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev. 2018;98(4):2133–223.

Pérez A, Mendoza L. Insulinoterapia. Med. 2015;11(92):5510–8.

 EJERCICIO PRÁCTICO
• Paciente masculino 78 kg de peso.

• 78x0.1= 7.8 UI 8
• 8 UI de Insulina de acción prolongada
• 5 UI de insulina NPH (mañana) y 3 UI en la tarde
• 2 UI de insulina acción prolongada 4 UI NPH Mañana y 2 UI NPH
en la tarde
• 2 UI insulina rápida en las primeras cuatros comidas del día 1 hr
antes de comer
• 2 UI insulina prolongada + 1 en cada comida
• Mujer 98 kg

• 98x 0.5= 49
• 49 prolongada
• 32 UI NPH mañana y 17 UI NPH tarde
• 9 UI prolongada 26 UI NPH mañana y 14 UI NPH tarde
• Karla consume 1 porción de jugo de naranja.
• Se toma glicemia antes de comer 100 mg/dl
• Se eleva a 140 mg/dl

• Se toma la glicemia + el jugo

• 10 UI de insulina
• Se disminuyó a 90 mg/dl
• 50 mg/dL = 50/10 5
¿Hay alguna
pregunta?
Dr. Luis Rucobo
FB: Dr Luis Rucobo
Cel. 4777277484