Description
THERAPEUTIC ACTION – Pancreatic hormone, antidiabetic CLASSFICATION – There are 3 main types of insulin preparations, differing in onset and duration of action: – Duration of action is indicated for each preparation by the manufacturer. For each preparation, onset and duration vary greatly according to the patient and route of administration. – The type of insulin used depends on the type of diabetes, patient’s age and blood glucose levels. INDICATION – Insulin-dependent diabetes – Diabetes during pregnancy – Degenerative complications of diabetes : retinopathy, neuropathy, etc. – Non-insulin-dependent diabetics during periods of severe infection, trauma, surgery. DOSAGE – Dosage must be individualised. Frequency of administration depends on the type of insulin and the patient’s response. There is no standardized protocol. Never exceed 200 Iu/day, whatever the type of insulin. DURATION – Insulin-dependent diabetics : life-time treatment – Other cases: according to clinical response and laboratory tests PRECAUTIONS – Do not administer in patients with allergy to insulin (rare). – May cause : • hypoglycaemia due to overdosage or inadequate diet. Treat mild hypoglycaemia with intake of oral sugar and IV injection of hypertonic glucose solution if severe; • local reactions: pain, erythema at the injection site, lipodystrophy. Rotate injection sites systematically and use all available sites (upper arm, thighs, abdomen, upper back). – Patient monitoring: blood and urine glucose concentrations, urine ketone tests. Blood glucose concentrations should be maintained within the range of 4.4 to 8 mmol/litre under fasting (8 mmol = 1.4 g). CONTROL DIABETES • there are no glucose and ketones in urine; • before-meal blood glucose levels are < 1.2 g/litre (< 6.67 mmol/litre); • postprandial blood glucose levels are ? 1.4 g/litre (< 7.78 mmol/litre). – Treatment of diabetes must be initiated in hospital under close supervision. TREATMENTS includes: insulin administration, specific diet, education and counselling under medical supervision (self-monitoring of blood glucose, self-administration of insulin, knowledge about signs of hypoglycaemia and hyperglycaemia). – Closely monitor combination with: • drugs enhancing hypoglycaemic effect: acetylsalicylic acid, angiotensin-converting enzyme inhibitors, beta-blockers (which in addition, may mask symptoms of hypoglycaemia); • drugs increasing blood glucose levels: glucocorticoids, salbutamol, chlorpromazine, oral contraceptives. – Avoid alcohol: enhances and prolongs hypoglycaemic effect of insulin. – use sterile technique. – Pregnancy: no contra-indication – Breast-feeding : no contra-indication REMARKS – Insulin is obtained by extraction from bovine or porcine pancreases. The term mono component insulin is used for highly purified insulin. – Insulin of human sequence is prepared either semisynthetically by modification of porcine material or biosynthetically. – Preparations of human or animal origin have the same hypoglycemic effect. There is generally no significant difference. – Insulin cannot be administered by mouth since it is inactivated in the gastro-intestinal tract.
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