Drug Information

   





Insulins



 










 

Pharmacokinetics



Insulin is a peptide hormone produced by the pancreas. It gets distributed
extracellularly. Since the drug is a peptide it gets degraded in the gut
when given orally. Subcutaneous Insulin is cleared more by the kidney than
by the liver when compared to the endogenous insulin. The liver clears
only 30-40% of the insulin.


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Indication
& Dosage



SC

ALL PATIENTS WITH TYPE I DIABETES: Start with 0.2-0.3units/kg/day.
Increase gradually upto 0.5-1 u/kg/day according t oblood glucose values.
Obese patients may require up to 2 U/kg/day because of insulin resistance
40-60% of the daily dose is given as basal insulin with 1 or 2 
injection’s of intermediate or long acting insulins. The balance is given
as premeal boluses of reugla insulin 30mins before meal. Alternatively,
the daily dose may be given as 1 or 2 daily inj of mixture of regular and
inermediate acting insulins

IV INFUSION

ACUTE DIABETIC KETOACIDOSIS AND HYPEROSMOLAR, NONKETOTICCOMA: Regular
insulin as IV infusion at a rate of 6 unit/hour or 20U intramuscularly
followed by 6 units every hour. Potassim chloride and saline are also
infused.

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Action

 


Insulin lowers blood glucose levels. Facilitates glucose
transport in cells and glucose utilisation. Increases lipid and glycogen
synthesis. Inhibits glycogenolysis and gluconeogenesis. Insulin increases
amino acid transport into cells and prevents release of amino acids from
muscle. Increases movemnet of K+ and mg2+ into cells. Insulin preparations
irrespective of their source, are classified according to their onset and
duration of action into rapid, intermediate or long-acting.

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Interactions

Higher doses of insulin may be needed during
Corticosteroid treatment and for a period of time after
Corticosteroid treatment ends. If the pancreas can still produce
some insulin, then administration of Pentamidine can cause
pancreas to release its insulin. Alcohol can increase the effect
of insulin, to lower blood sugar. Beta-blockers can mask the
symptoms of hypoglycaemia.


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Adverse
Effect & Precautions




Insulin resistance
occurs rarely, hypoglycaemia may result form excessive insulin
dose. Local allergy at the injection site may develop.
Lipodystrophy at the injection site may occur.


 


Conditions like puberty, pregnancy, menstruation, severe pyrexia,
Infection, Psychological stress may increase blood sugar and may
increase the amount of insulin needed. In Hypopituitarism,
addison’s disease, and diabetes secondary to pancreatic disease
the dose of insulin should be halved. Diarrhea, Gastroparesis,
Intestinal obstruction, Vomiting may slow the metabolism time and
absorption of food, hence may change the amount of insulin needed.
Effects of insulin may be increased or decreased in surgery, renal
and hepatic disease.

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Drug Information
   


Insulins
 

 
Pharmacokinetics

Insulin is a peptide hormone produced by the pancreas. It gets distributed extracellularly. Since the drug is a peptide it gets degraded in the gut when given orally. Subcutaneous Insulin is cleared more by the kidney than by the liver when compared to the endogenous insulin. The liver clears only 30-40% of the insulin.

Top 
  

Indication & Dosage

SC
ALL PATIENTS WITH TYPE I DIABETES: Start with 0.2-0.3units/kg/day. Increase gradually upto 0.5-1 u/kg/day according t oblood glucose values. Obese patients may require up to 2 U/kg/day because of insulin resistance 40-60% of the daily dose is given as basal insulin with 1 or 2  injection’s of intermediate or long acting insulins. The balance is given as premeal boluses of reugla insulin 30mins before meal. Alternatively, the daily dose may be given as 1 or 2 daily inj of mixture of regular and inermediate acting insulins
IV INFUSION
ACUTE DIABETIC KETOACIDOSIS AND HYPEROSMOLAR, NONKETOTICCOMA: Regular insulin as IV infusion at a rate of 6 unit/hour or 20U intramuscularly followed by 6 units every hour. Potassim chloride and saline are also infused.

Top  
  

Action
 

Insulin lowers blood glucose levels. Facilitates glucose transport in cells and glucose utilisation. Increases lipid and glycogen synthesis. Inhibits glycogenolysis and gluconeogenesis. Insulin increases amino acid transport into cells and prevents release of amino acids from muscle. Increases movemnet of K+ and mg2+ into cells. Insulin preparations irrespective of their source, are classified according to their onset and duration of action into rapid, intermediate or long-acting.

Top  

Interactions

Higher doses of insulin may be needed during Corticosteroid treatment and for a period of time after Corticosteroid treatment ends. If the pancreas can still produce some insulin, then administration of Pentamidine can cause pancreas to release its insulin. Alcohol can increase the effect of insulin, to lower blood sugar. Beta-blockers can mask the symptoms of hypoglycaemia.

Top  
  

Adverse Effect & Precautions

Insulin resistance occurs rarely, hypoglycaemia may result form excessive insulin dose. Local allergy at the injection site may develop. Lipodystrophy at the injection site may occur.
 

Conditions like puberty, pregnancy, menstruation, severe pyrexia, Infection, Psychological stress may increase blood sugar and may increase the amount of insulin needed. In Hypopituitarism, addison’s disease, and diabetes secondary to pancreatic disease the dose of insulin should be halved. Diarrhea, Gastroparesis, Intestinal obstruction, Vomiting may slow the metabolism time and absorption of food, hence may change the amount of insulin needed. Effects of insulin may be increased or decreased in surgery, renal and hepatic disease.

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By |2022-07-20T16:41:41+00:00July 20, 2022|Uncategorized|Comments Off on Insulins

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