Uses of insulin

By ANKITA SETHI
210101005
 Insulin is used in
1. Diabetes Mellitus
 Must for type 1 diabetes
 Can be used in type 2 diabetes
2. Diabetic Ketoacidosis (diabetic coma)
3. Hyperosmolar coma
 It is a must for post pancreatectomy cases and gestational diabetes
 1. Diabetes Mellitus
Insulin is effective in all forms of diabetes mellitus
• Must in type 1
• Type 2 cases can be controlled by lifestyle measures like diet, reduction in body weight and
exercise , supplemented by oral antidiabetics .
Insulin is needed by such patients when:
• Not controlled by diet or exercise
• When oral antidiabetics are not tolerated
• Under weight patients
• Temporarily to tide over infections, trauma, surgery, pregnancy.
 Insulin therapy has to be tailored according to the requirement and convenience of each patient.
 It is instituted and insulin requirement is assessed by monitoring the blood glucose levels.
 With severity of diabetes and body weight higher insulin doses are reqd to overcome insulin
resistance
 Insulin therapy should provide basal control by inhibiting
• Hepatic glucose output
• Lipolysis
• Protien breakdown
 It should provide extra amount to meet the post prandial needs for disposal of absorbed glucose
and amino acids
 Two regimens are most commonly used
1. Split mixed regimen
2. Basal bolus regimen
 Split mixed regimen
 A total daily dose of 30:70 or 50:50 mixture of
regular and NPH insulin is usually split into two
and injected s.c before breakfast and before
dinner
 Advantage: only two daily injections are
required
 Disadvantage:
• Post lunch glycaemia may not be adequately
covered
• Late postprandial hypoglycaemia may occur
 Basal – Bolus regimen
 Basal insulin is the background insulin which is required by the body to control the blood
glucose levels even when no food is consumed or fasting. It helps control blood glucose within
the normal range even when you are not eating and the body releases glucose into the blood
stream.
 Bolus insulin is released when the body consumes food to adjust the blood glucose levels.
 Bolus insulin is usually taken before the main
meals of the day which is breakfast, lunch and
dinner. Bolus dosages are usually fast-acting
 Basal insulin is taken just once a day either before
breakfast or before bed time.
 Advantage : objective of achieving round the
clock euglycaemia
 Disadvantage more demanding and expensive
2. Diabetic
Ketoacidosis
 Treatment of Diabetic Ketoacidosis
1.Insulin : used to rapidly correct the metabolic abnormalities
2. Intravenous fluids : for the correction of dehydration, iv initially at the rate of 1L/hr, progressively to
0.5l/hr , once blood sugar has reached 300mg/dl, 5% glucose in ½ N saline is the most app fluid because
blood glucose falls before ketones are fully cleared from circulation.
It is also needed to restore the depleted hepatic glycogen
3. KCl : to subside ketosis, K+ is driven back intracellularly
4. Sodium Bicarbonate : if arterial blood pH is < 7.0, acidosis is not corrected spontaneously or
hyperventilation is exhausting, 50 mEq of sod. bicarbonate is added to the i.v. fluid.
5. Phosphate: When serum PO4 is in the low-normal range, 3-4 m mol/hr of pot. phos- phate infusion is
advocated. Faster phosphate infusion can precipitate tetany
6. Antibiotics
 3.Hyperosmolar coma

 This is characterized by high blood glucose (>600 mg/di) and serum osmolality (>320 mOsm/L)
along with deteriorating mental status. It generally occurs in elderly type 2 diabetes patients.
 The general principles of treatment are the same as for ketoacidotic coma, except that faster fluid
replacement is to be instituted, insulin requirement is lower, less potassium replacement is generally
needed
 These patients are prone to thrombosis, hence prophylactically heparin therapy is recommended.
 Insulin Resistance
 Insulin resistance refers to suboptimal response of body tissues, especially liver, skeletal muscle and
fat to physiological amounts of insulin.
 Insulin Receptors affinity for receptors
 Common in type 2 diabetics, obese, women w PCOD, old age, sedentary life style
 Pregnancy and oral contraceptives often induce relatively low grade and reversible insulin
resistance.
 May be acute or chronic
 Causes of acute insulin resistance may be:
1. Infection, trauma, surgery, emotional stress induce release of corticosteroids
2. Ketoacidosis
 Treatment of acute insulin resistance: overcome the precipitating cause and to give high doses of
regular insulin.