[Insulins]
[Injectors]
[Oral
Medications]
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When initiating insulin treatment, most physicians use human insulins
instead of animal-derived insulins due to their less antigenic effects.
Insulins should be refrigerated during storage, but most are stable for
periods of time at room temperature. Many patients use combinations
of the 3 classes of insulins listed below in
their treatment.
1) Fast-Acting
The insulins lispro (Humalog)
and aspart (Novolog) are injected under the skin 15 minutes prior
to eating and lower the blood sugar levels very quickly. These are
actually genetically modified forms of regular insulin, and contain zinc
insulin microcrystals for rapid absorbance.
2) Rapid-Acting
Regular insulin is still
considered fast, though it lowers blood sugar levels in 2 to 5 hours.
These insulin preparation are made of course zinc insulin crystals
3) Long-Acting
Some insulins that are more slowly
acting are NPH (N) and Lente (L). These usually lower
the blood sugar the most within 6 to 12 hours after administration.
To see insulin receptor mechanisms, click here.
Insulin pens (NovolinPens) are similar in shape and size to ink pens, and offer a more discrete way of administering insulin. There is a dial to select the dosage and a short needle with a plunger attached for dispensing.
Insulin jet injectors use a high-pressure air mechanism to emit a fine spray of insulin throug the skin in order to avoid the use of needles. These units are more expensive and require more maintainance than traditional methods.
Insulin pumps can be worn
on a belt or in a pocket. These inject insulin through a narrow plastic
tube into a small needle which is inserted just beneath the skin of the
abdomen. Insulin pumps can be adjusted to administer a steady "trickle"
flow with increases at meals, providing the patient with extra convenience.
However, these pumps are also expensive and require much maintainance.
In general, oral medications are ineffective for Type I patients, since they cannot prevent symptomatic hyperglycemia or DKA, and are only taken by Type II patients.
Sulfonylureas- Until 1994, these were the exclusive form of medications in the United States. They work by causing the pancreas to produce more insulin and are usually taken once or twice a day. Common side effects include hypoglycemia, upset stomach, skin rash, and weight gain.
Amaryl (glimepiride) is an insulin-sparing sulfonylurea agent used for Type II diabetes when oral medication by itself is insufficient. It increases insulin secretion and is administered in tablets of 1 to 2 mg strengths daily with the first meal.Initial Treatment- The shorter-acting sulfonylureas are preferred for beginning treatment and are administered in low doses. The dosage levels are slowly increased over a period of days to reach a point where they become effective. Over 4% of patients hospitalized after developing hypoglycemia from this treatment die, so it is important that patients using this therapeutic procedure should be wary of any signs of hypoglcemia.
Biguanides- Also known generically as metformin, it causes the liver to make less sugar and lowers the amount of insulin in the body. Biguanides have been used in most of the world for over 30 years, but just recently became apporoved withing the United States. The side affects of this drug are numerous and can depend on specific lifestyles.
Alpha-glucosidase inhibitors- The two inhibitors that fall under this category are called acarbose and miglitol. These block the enymes for digestion of starches in order to prevent blood sugar levels from rising too much and too quickly. The medication is usually taken 3 times per day at meals. Some side effects include gas, bloating, and diarrhea.
Thiazolidinediones- Also known as pioglitazone and troglitazone, these increase the production of cells sensitive to insulin, allowing more glucose to be obtained from the blood stream. They are usually taken once or twice per day. Side effects include weight gain, anemia, swelling in legs and ankles, and other combined with concurrent prescriptions.
Meglitinides-
The generic name for this new treatment is repaglinide, and it works by
causing the pancreas to increase insulin production right after meals.
Patients typically take this medication only before meals, and it is most
effective one hour after administration. Two possible side effects
are weight gain and hypoglycemia.
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page by Jeff Klomp