Pharmacological and Molecular Perspectives on Diabetes

Madhukar Saxena

• Éditeur: Bentham Science Publishers
• Année: 2001
• ISBN:
  9789815040227
• Sujet: Medicine
• Sous-sujet: Pharmacology

Pharmacological and Molecular Perspectives on Diabetes is a compilation of reviews on clinical and scientific aspects of diabetes mellitus. It presents 11 contributions by eminent scholars that give the reader rational pharmacological and genetic perspectives of the disease and its treatment. The reviews approach diabetes from different angles, and highlight research that has been done to understand some questions about the molecular biology of diabetes in experimental settings. Topics of clinical significance such as the use of different hypoglycemic agents, and diabetic complications in clinical settings are also covered. Topics included in this book are: · Epigenetic alterations and type 2 diabetes mellitus · Responses to nutritional chromium supplements for type 2 diabetes mellitus · Endocrine role of osteocalcin in homeostatic regulation of glucose metabolism · Effect of diabetes on memory · Osteoarthritis in relation to type 2 diabetes mellitus: prevalence, etiology, symptoms and molecular mechanism · Infection of novel coronavirus in patients with diabetes mellitus · Role of an anti-inflammatory agent in the management of type 2 diabetes mellitus · Role of antidiabetic agents which helps regulates TCF7L2 variations in type 2 diabetes mellitus
· Relationship between type 2 diabetes mellitus, PCOD and neurological disorders: role of antidiabetic drugs · Comparison of different types of insulin available for type 1 diabetes treatment · Circadian rhythm disruption: special reference to type 2 diabetes mellitus · Type 2 diabetes mellitus and its complications: pharmacogenetics based correlations and circulating microRNA as biomarkers Pharmacological and Molecular Perspectives on Diabetes should prove to be of interest to all pharmaceutical and molecular biology scientists who are involved in research in anti-diabetic drug design and discovery, and practicing endocrinologists who wish to keep abreast of recent developments in the field.

Comparison of Different Types of Insulin Available for Type 1 Diabetes Mellitus Treatment

Jai Godheja^{1, *}

¹ School of Life and Allied Science, ITM University, Atal Nagar, Raipur, India

Abstract

A handful of pharmaceutical companies manufacture different types of insulin which treat type I diabetes mellitus. Insulin brands are grouped by the onset of their action and how long their blood glucose-lowering effects last. Insulin analogs were introduced way back in 1996; since then, there has been a lot of advancement in their production as well as the mechanism of action. Current insulin therapies more closely mimic the normal physiologic insulin secretion by the pancreas, which gives a better-glycosylated haemoglobin level in patients suffering from diabetes. This chapter focuses on the types of available insulins and their regimens, classification of types of insulin that are best for different age groups, diet to be followed, principles of dose adjustment, and a glimpse of insulin pump therapy.

Keywords: Diabetes mellitus, Type I, Insulin.

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^* Corresponding author Jai Godheja: School of Life and Allied Science, ITM University, Atal Nagar, Raipur, India; Tel:[phone]; E-mail: [email protected]

Introduction

Classification of diabetes mellitus is important for treatment strategies, which sometimes is complicated as these patients do not easily fit into a single class, especially children below 18 years [1^-4]. The classical classification of diabetes as proposed by the American Diabetes Association (ADA) in 1997 as type 1, type 2, other types, and gestational diabetes mellitus (GDM) is still the most accepted classification and adopted by ADA [1].

This chapter focuses only on people suffering from Type 1 diabetes mellitus who essentially take insulin which helps maintain the sugar levels [5, 6]. The market has various types of insulin that differ in terms of how quickly and how long they are effective and their chemical structure.

Short-acting insulin or rapid-acting insulin work very quickly (0-2 hrs), while long-acting or basal insulin only start to work after a certain amount of time (12-24 hrs), and ultra-long acting can even work over a longer time period (48 hrs).

Some years back insulin was easily extracted from the pancreatic cells of pigs or cattle and purified for human use. Currently, most people use genetically engineered insulin for the treatment of diabetes. These recombinant insulins are now available in the market with the names of human insulin or insulin analogues. Human insulin differs from insulin analogues in chemical structure, but the effect is the same.

Type 1 Diabetes: Types of Insulin Therapy

Maintaining the sugar level for a type 1 diabetic is the most important task because of the lack of insulin production in their body in order to prevent long-term complications. Diabetic patients all around the world follow either conventional or intensive or both of them to control their blood sugar levels.

Facts that regulate the blood glucose levels are the amount of insulin taken, diet, and the energy expended during physical activity. Other parameters that influence the blood glucose are the time of day when the injection is taken, inflammatory diseases, medications taken, and hormonal changes. Therefore, it becomes very important for a diabetic to know about one’s body and eating habits which can correctly adjust the insulin therapy to be given [7].

Pharmaceutical industries manufacture different types of insulin [8^-10], which differ only according to their time of action. The long-acting insulin works slowly and constantly over the whole day, and intermediate-acting insulin does the same for half a day. Short-acting insulin is generally taken just before the meals, whereas ultra-short acting insulins can be taken after the meals to maintain the sugar levels post-meal.

People with diabetes have the flexibility to choose between the types of insulin therapies, but most prefer following the intensive one in order to maintain their sugar levels as per their daily routine.

Conventional Insulin Therapy

Having a regular daily routine means that people inject their insulin at a fixed time every day, which is an older approach. Therapy involves injecting long-acting or intermediate-acting insulin as prescribed by the physician, and sometimes a short-acting shot is also preferred, which is effective in most people and helps maintain a sugar level in the blood. Most people use a standard mixture of short-acting and longer-acting insulin, which can be taken before breakfast and before dinner to overcome the problem of injecting two times at the same time. The disadvantage of following this therapy is that these people have to eat calculated amounts of food regularly over the day. Those who go through many exercises can balance their blood sugar level by eating between meals.

Only those people living a strict life can take full advantage of conventional insulin therapy, but as the lifestyle has become more complicated and with the advent of fast food, the therapy can be much less effective at preventing diabetic complications.

Intensive Insulin Therapy

Since most type I diabetic people acquire IDDM between the ages 2 – 18 years and due to the modern lifestyle, intensive insulin therapy becomes the therapy of choice as an individual’s blood sugar levels, diets, and physical fitness levels can be taken into account to adjust insulin doses flexibly and spontaneously. The treatment...