what is insulin ?

Insulin is a hormone produced by beta cells of pancreatic islets of Langerhans glands. Insulin stimulates amino acid entry into cells and then increases protein synthesis. Insulin increases fat storage and prevent the use of fat as energy materials. Insulin stimulates glucose entry into cells for use as an energy source and help glycogen storage in muscle and liver cells. Endogenous insulin is the insulin produced by the pancreas, exogenous insulin is being injected insulin and a pharmaceutical product.

Indication of therapy with insulin:

All people with type I diabetes require exogenous insulin because insulin production by beta cells absent or nearly absent.
Persons with type II diabetes may require insulin when certain other types of therapy can not control blood glucose levels.
State of severe stress, such as severe infections, surgery, acute myocardial infarction or stroke.
Gestational diabetes and pregnant persons with DM who require insulin when diet alone can not control blood glucose levels.

Diabetic ketoacidosis.
Hyperglycemic hyperosmolar non ketotik.
Persons with diabetes who received parenteral nutrition or who require high-calorie supplements, to meet increasing energy needs, will gradually require exogenous insulin to maintain near normal blood glucose levels over a period of insulin resistance or when there is an increase in insulin requirements.
Impaired renal function or severe liver.
Contraindications or allergy to oral hypoglycemic drugs.

Based on his long, insulin is divided into 4 types, namely:

1. Short-acting insulin
Included here are the regular insulin (Crystal Zinc Insulin / CZI). Currently known two kinds of insulin CZI, namely in the form of acidic and neutral. Preparations that exist include: Actrapid, Velosulin, Semilente. This type of insulin administered 30 minutes before eating, Reaching the peak after the 1-3 range and the effect can last up to 8 hours.

2. Intermediate-acting insulin
Used today is Hegedorn Neutral protamine (NPH), MonotardÒ, InsulatardÒ. This type of early works is 1.5 - 2.5 hours. The climax is reached in 4-15 hours and the effect can last up to 24 hours.

3. Long-acting insulin
Is a mixture of insulin and protamine, diabsorsi slowly from the injection site so that the effects felt quite deep, which is about 24-36 hours. Preparations: protamine zinc insulin (PZI), Ultratard

4. Insulin infasik (mixture)
Insulin is a combination of short and medium type. Preparations: Mixtard 30/40

Sliding scale insulin administration is intended to be more efficient and appropriate gift because it is based on patients' blood sugar levels at that time. Blood sugar checked every 6 hours.

The dose of insulin depends on blood sugar levels, namely:

Blood glucose <60 mg% = 0 units Blood glucose <200 mg% = 5-8 units Blood sugar 200-250 mg% = 10 - 12 units Blood sugar 250-300 mg% = 15-16 units Blood sugar 300-350 mg% = 20 units Blood glucose> 350 mg% = 20 - 24 units

Metabolic effects of insulin therapy:

Lowering blood sugar levels fasting and post fasting.
Suppression of glucose production by the liver.
Stimulation of peripheral glucose utilization.
Glucose oxidation / storage in muscle.
Fix abnormal lipoprotein composition.
Reducing glucose toxicity.
Improve the ability of endogenous secretion.
Reduce Glicosilated end product.

Route of administration of insulin:
Short-acting insulin:

IV, IM, SC
Infusion (AA / glucose / electrolyte)
Do not be shared blood (containing enzymes destroy insulin)

Intermediate-acting insulin / length:

Do IV because of the danger embolism.
Currently, he also provided a mixture of insulin (premixed) work fast and medium work.

How to insulin injections:
Insulin is usually given by injection under the skin (subcutaneous). In special circumstances are given intramuscularly or intravenously as a bolus or drip. Insulin can be given a single (one kind of rapid-acting insulin, intermediate or long-acting work) but can also be given a combination of fast acting insulin and intermediate employment, according to the individual's response to insulin, which judging from the results of daily blood glucose levels.

Injection location must also be considered correct, as well as the injection site rotation. If necessary, as far as storage is assured sterility, insulin syringes and needles can be used more than once by the same patient. It should be noted the suitability of insulin concentration (U40, U100) with a syringe that is used. It is advisable to keep the concentration used.

Most rapid absorption occurs in the abdominal area which is then followed by the arm, upper thigh buttocks. When injected intramuscularly in the absorption will occur more quickly and working period will be shorter. Carried out physical activities IMMEDIATELY after the injectionWill Accelerate the onset of action and also shorten the period ofemployment.

Indications pemberiaan insulin in elderly diabetic patients as in non-elderly, uyaitu the ADO therapy failure, ketoacidosis, hyperosmolar coma, the presence of infection (stress) etc.. It is advisable to use a mixed intermediate-acting insulin with rapid-acting insulin work, can be administered once or twice a day.

Difficulties of insulin in elderly Patients Is that Patients do not want to inject Himself Because the issue in his eyes, tremors, or the physical state of disturbed and the presence of dementia. In Such circumstances it would have been much needed help from his family.

Side effect of insulin:

Hypoglycemia
Lipoatrophy
Lipohipertrofi
Systemic or local allergic
Insulin resistance
Edema insulin
Sepsis

Hypoglycemia is the most dangerous complication and can occur when there is a mismatch between diet, physical activity and the amount of insulin. In 25-75% of patients given conventional insulin lipoatrophy can occur that is happening indentation under the skin injection site due to atrophy of fat tissue. This is thought to be caused by immune reactions and are more common in young women is especially true in countries that use the insulin is not so pure. Lipohipertrofi namely the collection of subcutaneous fat tissue at the injection site due to lipogenik insulin. More prevalent in countries that use pure insulin. Regression occurs when insulin is no longer injected at the site.

Local allergic reaction occurs 10x more often than systemic reactions especially in the use of less pure preparations. Local reactions in the form of erythematous and induration at the injection site that occurs within minutes or hours and beberpa berlagsung.

Over the past few days. This reaction usually occurs several weeks after starting insulin treatment. Local inflammation or infection of the skin easily occur when the cleaning is not good, the use of antiseptics which cause sensitization or the injection intrakutan, these reactions will disappear spontaneously. The general reaction may include hives, skin eruptions, angioudem, gastrointestinal disorders, respiratory disorders and is very rarely hypotension and shock ending death.

Interaction

Some hormones counteract the effects of insulin hypoglycaemia eg growth hormone, corticosteroids, glucocorticoids, thyroid, estrogen, progestin, and glucagon. Adrenaline inhibits insulin secretion and stimulates glycogenolysis. Increasing these hormones need to be taken into account in the treatment of insulin.

Guanetidin lowers blood sugar and insulin doses need to be adjusted when these drugs are added / removed in treatment. Some antibiotics (eg chloramphenicol, tetracycline), salicylates and fenilbutason increase in plasma insulin levels and may exhibit hypoglycemic effects.

Hypoglycemia tends to occur in patients who received ß adrenoceptors inhibitors, these drugs also obscures tachycardia due to hypoglycemia. Hypoglycemic effect of insulin potentiation occurs with MAO inhibitors, anabolic steroids and fenfluramin.? p