Usually the inefficiency and lack of insulin are bracketed together, as both situations result in diabetes. There are two types of diabetes, diabetes insipidus and diabetes melitus, which is by far, the most common. Diabetes mellitus in turn has two types: Type 1, also known as insulin dependent diabetes mellitus, IDDM Type 1 is characterized by decreased productions of insulin so must be treated with insulin. It is most often found in children and adolescents. Type 2, also known as non-insulin dependent diabetes melitus, NIDDM.
Type 2 is caused by either decreased insulin production or abnormal cell sensitivity to the insulin that is present. It may be treated with diet alone, with oral hypoglycemic agents, or with insulin. It is more commonly diagnosed in adults. (Perspective Press, 240-43) Insulin does not cure diabetes. It is merely a treatment for the diabetes. Over time, many complications can occur in diabetic patients taking insulin. Some of these are coronary heart diseases, peripheral vascular diabetes, eye disorders, renal failure, and limb amputations.
Because of reduced circulation and nerve damage, diabetic patients are essentially prone to developing foot ulcers, a major cause of amputations. They are able to feel foot infections, which allow it to grow and cause permanent damage. Proper foot care is essential and includes avoiding injuries oral restricting circulations, cleaning wounds, controlling infections, relieving weight from the ulcer area, and improving circulation. A new genetically engineered drug, becaplermin, promotes the healing process in diabetic foot ulcer. Lack of insulin or ineffectiveness of it may trigger some response from the body.
The predominant tissue responding to signals that indicates fluctuating blood glucose levels is the liver. One of the most important functions of the liver is to produce glucose for circulation. Both elevated and reduced levels of blood glucose trigger hormonal responses to initiate pathways designed to restore glucose homeostasis. Low blood glucose triggers release of glucagon from pancreatic Alpha-cells. High blood glucose triggers release of insulin from pancreatic Beta-cells. In elderly people pancreas either fails or does not secrete right amount of insulin.
In this patient insulin per injection becomes drug of choice when oral antidiabetics have failed. Insulin was also used to induce shocks in schizophrenics. Insulin secretion is controlled by concentrations circulating glucose, amino acids, and fatty acids, various hormones and neuron-transmitter agents. In the fasting state, when glucose concentrations are low, insulin secretion is minimal. As glucose concentrations rise after the utilizing carbohydrates meal the raised glucose concentration stimulates insulin secretion. Insulin resistance develops over time.
Therefore, doses have to be increased. This occurs because of the development of insulin antibodies in the blood. This also can be somewhat corrected by changing the type of insulin injection and by giving cortiscosteroids which are immunity suppressant drugs. Yet, it also produces negative effect by increasing blood sugar and this is why they are not used. Types of Insulin There are many types of insulin and many salt forms of it. It can be derived synthetically of from different animal sources such as beef and pork. There is now genetically engineered human insulin available.
Different insulin differs in the onset of action and the duration of action. Some are mixed together to achieve a desired effect such as a quick onset but a longer duration of action. The most common mixtures is regular insulin with NPH insulin (70units NPH and 30 units regular insulin per milliliter) The different categories of insulin’s are: 1. Short-acting insulin types: regular insulin (crystalline zinc insulin), semilente insulin (prompt insulin zinc suspension), insulin lipsor; 2. Intermediate – acting insulin types: NPH (isophane insulin suspension) and linte insulin (insulin zinc suspension); 3.
Long-acting insulin types: PZI (protamine zinc insulin suspension) and ultralente insulin (extended insulin zinc suspension). Administration Insulin is injection instead of giving orally because it is destroyed in the gastrointestinal tract. Also, the molecule is too large to be absorbed by the intestinal membrane. Therefore, injection of soluble crystalline insulin is given by subcutaneous injection which is quickly absorbed. Peak effects of insulin are achieved quickly and also excreted quickly within a few hours. However some insulin such as simelente is absorbed slowly. The peak is reached slowly and is sustained.
This type of insulin excretion is also very slow and sometimes partly destroyed by insulinase enzyme in the liver. Controlling glucose level with insulin injections is a complex task since: a) Glucose concentrations fluctuate based on food ingestion. b) Cell sensitivity to insulin changes. Exercise increases sensitivity while stress, pregnancy, and some drug decrease insulin sensitivity. As a result some diabetic patients take multiple injections for a short-acting insulin preparation to produce peaks in insulin concentrations and a long acting formulation to establish a baseline concentration.
Variable rate infusion pumps are also used. Patients who use insulin need to be instructed on the rotation method of taking their medication. Insulin is absorbed more rapidly with administration in the arm or thigh, especially with exercise. The abdomen is used for more consistent absorption. Glucose levels should be checked as per physician orders. All insulin must be checked for expiration date and clarity of the solution. Insulin should not be given if it appears cloudy. Vials should not be shaken but rotated in between the hands to mix contents.
If regular insulin is to be mixed with NPH or lente insulin, the regular insulin should be drawn into the syringe first. Unopened vials should be stored in the refrigerator, and freezing should be avoided. The vial in use can be stored at room temperature. Vials should not be put in glove compartments, suitcase, or trunks. Humulin is a new type of insulin and is often the patient’s preference because it can be taken orally. It is imperative that the physician be called if any adverse reactions to the medications are observed. (Jahangir Moini, P 150-154).