Insulin

Purpose of Insulin:

  • Regulation of Blood Sugar: Human insulin is a hormone that regulates blood sugar levels by facilitating the uptake of glucose from the bloodstream into cells, where it is used for energy production or stored for later use.

Types of Human Insulin:

  • Short-Acting Insulin (Regular Insulin): This type of insulin begins to work within 30 minutes after injection, peaks in about 2 to 3 hours, and lasts for about 3 to 6 hours.
  • Intermediate-Acting Insulin (NPH Insulin): NPH insulin starts working within 1 to 2 hours after injection, peaks in about 4 to 8 hours, and lasts for about 12 to 18 hours.
  • Long-Acting Insulin (Basal Insulin): Long-acting insulin analogs provide a steady level of insulin over a longer period, usually up to 24 hours. These include insulin glargine and insulin detemir.

Dosage and Administration:

  • Dosage: The dosage of human insulin varies depending on factors such as blood sugar levels, meal size, physical activity, and individual insulin sensitivity.
  • Frequency: Human insulin is typically administered subcutaneously (under the skin) once or twice daily, depending on the type of insulin and the individual’s treatment plan.

Mechanism of Action (MOA):

  • Human insulin binds to insulin receptors on the surface of cells, leading to a series of intracellular signaling events that promote the uptake of glucose from the bloodstream into cells.
  • Inside the cell, glucose is metabolized to produce energy or stored as glycogen in the liver and muscles.

Pharmacokinetics (PK):

  • Absorption: Subcutaneously injected insulin is absorbed into the bloodstream at a rate that depends on factors such as injection site, insulin formulation, and blood flow.
  • Distribution: Insulin is distributed throughout the body, with higher concentrations in tissues such as the liver, muscle, and fat.
  • Metabolism: Insulin is metabolized primarily in the liver and kidneys.
  • Elimination: Insulin is cleared from the bloodstream by the liver and kidneys.

Pathophysiology:

  • In individuals with diabetes mellitus, the body either does not produce enough insulin (Type 1 diabetes) or is unable to effectively use the insulin it produces (Type 2 diabetes), leading to elevated blood sugar levels and various metabolic abnormalities.

Indications:

  • Human insulin is indicated for the treatment of diabetes mellitus to control blood sugar levels and prevent complications associated with hyperglycemia.

Contraindications:

  • Known hypersensitivity to human insulin or any of its components.
  • Hypoglycemia (low blood sugar) or diabetic ketoacidosis (DKA) in certain situations.

Drug Interactions:

  • Certain medications, such as oral hypoglycemic agents, beta-blockers, corticosteroids, and certain antibiotics, may interact with human insulin, affecting blood sugar levels and insulin requirements.

Precautions:

  • Hypoglycemia: Patients should be educated about the signs and symptoms of hypoglycemia and how to manage low blood sugar levels.
  • Hyperglycemia: Regular monitoring of blood sugar levels is essential to adjust insulin dosage and prevent hyperglycemia.
  • Injection Site Rotation: Rotating injection sites helps prevent lipodystrophy (changes in fat tissue) and ensures consistent insulin absorption.

Monitoring and Laboratory Tests:

  • Blood Glucose Monitoring: Regular self-monitoring of blood glucose levels helps patients adjust insulin dosage and detect hyperglycemia or hypoglycemia.
  • Glycated Hemoglobin (HbA1c): This test provides information about average blood sugar levels over the past 2 to 3 months and helps assess long-term diabetes management.
  • Liver and Kidney Function Tests: These tests help assess the metabolic effects of insulin therapy on liver and kidney function.

Storage and Disposal:

  • Insulin should be stored in a refrigerator at a temperature between 36°F and 46°F (2°C and 8°C) until the expiration date.
  • Insulin vials or pens in use may be kept at room temperature (59°F to 86°F or 15°C to 30°C) for up to 28 days.
  • Unused insulin should be disposed of properly according to local regulations or guidelines for biomedical waste disposal.