Insulin Therapy: Made Easy Sanjay Kalra, Binayak Sinha
INDEX
ABCDEFGHIKLMNOPRSTUVW
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Acetylcholine 7
Acute myocardial infarction 44
Alloxan 7
Alpha-adrenergic stimulators 7
Alpha-glucosidase inhibitor 47
American Association of Clinical Endocrinologists 49, 74
American College of Endocrinology 49, 74
American College of Obstetricians and Gynecologists 74
American Diabetes Association 1, 44, 45, 61, 74, 79, 88, 88t
Amino acid 2, 7, 15
Antidiabetic drugs 47f
Antioxidant 46
Anxiety 89
Arginine 7
B
Basal insulin 16, 28, 31, 74
pharmacology of 28t
regimen 49
secretion 3
therapy 72, 75
titration of 50t
use of 31t
Basal-bolus insulin therapy 73
Basal-bolus regimen 51, 54
action profile of 52f
dosing of 62
Basal-plus insulin 53
Basal-plus regimen 53
Beta-adrenergic blockers 7
Beta-adrenergic stimulators 7
Beta-cell rest 46
Beta-keto acids 7
Biphasic human insulin 56
Biphasic insulin
aspart 33, 34, 56
lispro 33, 35
Body weight 81
Bolus insulin 74
dose 64
C
Carbohydrate 88
metabolism 46
Cardioprotection 46
Cholecystokinin 7
Confusion 89
Continuous glucose monitoring 62, 64, 66f
Continuous subcutaneous insulin infusion 63, 93
devices 17
Conventional premix human insulin 32
Convulsions 89
C-reactive protein 46
Cyclic adenosine monophosphate 46
D
Degludec 31
Deoxyglucose 7
Detemir 31
Devices 98, 102
Diabetes in Pregnancy Study Group India 74
Diabetes 1, 70
adult-onset 43
mellitus 70, 91
gestational 73, 74
Diabetic ketoacidosis 44
Diazoxide 7
Dipeptidyl peptidase 4 47
Dizziness 89
Drowsiness 89
Durable pen device 99f
E
Endoplasmic reticulum-induced stress, and apoptosis 43
Endothelial nitric oxide synthase 46
Enuresis 89
Epinephrine 7
Escherichia coli 15
Estimated glomerular filtration rate 76
European Association for Study of Diabetes 44, 45
European Medicines Agency 24, 31
F
Fast-acting insulin aspart 19, 22, 24
Fasting plasma glucose 25, 45, 50, 74
Fatigue, chronic 89
Fatty acid 26
Flash glucose monitoring 66
Food and Drug Administration 24, 31, 36
G
Galanin 7
Gastric inhibitory polypeptide 7
Gastrin 7
Glomerular filtration rate 76
Glucagon 7
Glucagon-like peptide-1 7, 47, 53, 91
receptor agonist 16, 56
Gluconeogenesis 9
Glucose 7
levels, tracing of 66f
transporter type 4, translocation of 8
Glucotoxicity 43
Glycemia 61
Glycemic management during hindu fasts 79
Glycine, substitution of 26
Glycogen synthase 8
Glycogenesis, process of 8
Glycogenolysis 9
Golgi bodies 3
H
Headache 89
Hemoglobin, glycosylated 18, 45, 71, 73, 81
Hexamers 17
High postprandial glucose 43
High-mix insulin regimen 55
Human and analog premix insulin, time action profile of 32f
Hyperglycemia 9, 43
management of 81fc
Hyperglycemic hyperosmolar nonketotic coma 44
Hypertriglyceridemia 9
Hypoglycemia 51, 71, 73, 75, 77, 87–89, 89t
causes of 88
classification of 88t
prevention of 90t
signs of 88
symptomatic 88
I
Ideglira 16
Indian Insulin Guideline 54
Indian National Consensus Group 45
Guidelines 51
Injection
site 95
techniques 96
Insulin 3, 25
action of 8
allergy 93
analog 16, 17, 21, 72, 75–77
long-acting 29, 29f
aspart 16, 17, 19, 21, 24, 35, 56, 62, 72, 73, 79
co-formulation 33
and analog premix insulin, time action profile of 34f
deficiency 9
degludec 16, 28, 30, 35, 49, 56, 72, 73, 79
delivery devices 73
detemir 16, 26, 28, 29, 49, 56, 72, 79
development of 1
discovery of 2, 2f
dose adjustments during fasting conditions 79t
edema 87, 91
management of 92
effects of 46t
glargine 16, 26, 28–30, 49, 56, 72, 79, 91
glulisine 16, 17, 19, 20, 23, 24, 62, 72
history of 2
human 21
inhibitors 7
injection
storage of 102
technique 95
usage of 102
lispro 16, 17, 19, 20, 23, 24, 62, 72
management, principles of 61
metabolism of 3, 9, 10, 10fc
milestones in development of 3, 4, 4t, 6, 6t
needles 98
pens 99
physiology of 3, 10
preparations 56t
profile of 15
pump 101
advantages of 101t
therapy 64, 65, 65t, 101t
receptors 8
regimens 55, 62
regulation and action 9fc
secretion of 3, 7t
short-acting 17, 18f, 19, 21
side effects of 87
stimulators 7
storage 93
structure of 3, 7f
synthesis 3, 6f
therapy 43, 47, 61, 70, 71, 74–77, 80, 102
barriers to 47
benefits of 44, 46t
five M's of 90t
indications for 44, 45
initiation of 49
intensification of 52
management of 87
practical aspects of 87
types of 16, 16t, 19, 24, 26, 26t, 100
Intercellular adhesion molecule 1 46
International Diabetes Federation 1, 75
International Society for Pediatric and Adolescent Diabetes 61
Intestinal hormones 7
Isophane 25, 62
insulin 25, 75, 79
K
Kidney disease, chronic 24, 31, 36, 75, 76
L
Langerhans pancreatic islets 3
Leucine 7
Lipid metabolism 46
Lipoatrophy 87
Lipohypertrophy 87, 92, 92f, 93f
Lipotoxicity 43
Liver disease, chronic 24, 31, 36, 70, 76, 77
M
Mannoheptulose 7
Mannose 7
Maximum serum insulin concentration 18
Medical nutrition therapy 74
Metabolic memory 46
Microtubule inhibitors 7
Mitogen-activated protein-kinase 8
Monocyte chemoattractant protein-1 46
Mood changes 89
Morning headache 89
Multiple daily injection 61, 64, 65
regimen 62
action profile of 63
Myristic acid 26
N
National Institute for Health and Care Excellence 50, 75
Nausea 89
Neuroprotection 46
Neutral protamine Hagedorn 16, 25, 26, 28, 31, 49, 56, 91
Night sweats 89
Nitric oxide 46
Noninsulin-dependent diabetes 43
Norepinephrine 7
O
Oral antidiabetic
agents, properties of 70
drugs 1, 45, 61
P
Palpitation 89
Pen devices 97, 99, 100
advantages of 101t
disadvantages of 101t
Peripheral vascular diseases 45
Phenytoin 7
Phosphofructokinase 8
Phosphoinositide 3 kinase 46
Plasminogen activator inhibitor-1 46
Postprandial blood glucose 72, 74
Postprandial glucose 16, 45, 52, 62
Postprandial glycemic excursion 15
Potassium 7
Prandial insulin 16
pharmacology of 19t
titration of 52t
Premix insulin 16, 32, 33, 36, 72, 75
analogs 34
pharmacology of 33t
regimen 50, 54
titration of 51t
use of 36t
Propranolol 7
Protamine 26
zinc insulin 25
Protein metabolism 46
Protraction, mode of 18f
Pump therapy, dosing guidance on 64t
R
Random blood glucose 44
Rapid-acting insulin 17, 18f, 19
analogs 19
against regular human insulin, advantages of 18t
structure of 21
therapy 72, 75
Regular human insulin 19, 21, 24
Research Society for Study of Diabetes in India 45
Rough endoplasmic reticulum 3
S
Saccharomyces cerevisiae 19
Self-measured plasma glucose 52
Severe hypoglycemia 64, 90
Skin infections 87, 93
Sodium-glucose cotransporter-2 47, 91
Somatostatin 7
South Asian Federation of Endocrine Societies 78, 79
Split-mixed insulin regimen 55
Sulfonylurea 7, 47
Sweating 89
T
Theophylline 7
Thiazide diuretics 7
Thiazolidinedione 47
Type 1 diabetes mellitus 1, 15, 61, 62, 73, 91
Type 2 diabetes mellitus 1, 15, 43–45, 52, 53, 53fc, 57, 61, 72, 91
U
Ultra-fast acting insulin 19
analog 19
Unstable angina 44
V
Vision changes 89
W
Weakness 89
Weight gain 87, 91
×
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INSULIN THERAPY Made Easy
INSULIN THERAPY Made Easy
Editor Sanjay Kalra MBBS MD DM Consultant Endocrinologist and Head Department of Endocrinology Bharti Hospital Karnal, Haryana, India Co-Editor Binayak Sinha MBBS MRCP (UK) CCST (UK) Consultant Endocrinologist Department of Endocrinology and Diabetes AMRI Hospitals Kolkata, West Bengal, India Foreword AK Das
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Insulin Therapy: Made Easy/Sanjay Kalra, Binayak Sinha
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Contributors Foreword
It's been nearly 100 years when the lifesaving molecule “insulin” was discovered. Since then it has played a major role in helping people with diabetes to achieve good glycemic control, lower the risk diabetes-related complications, and thereby has saved millions of lives.
As per the IDF Atlas of 2019, India as a country ranks 2nd globally in terms of number of people living with diabetes. The burden of diabetes is truly huge. On top of it, people with diabetes in India do not have the desired good glycemic control which directly and indirectly results in vast healthcare cost for the country. There is no doubt that insulin offers the maximum glycemic control as compared to any other antidiabetic agent. Yet, majority of the people with diabetes as well as physicians have this inertia to consider insulin as a part of diabetes management. There is a need to overcome barriers to insulin initiation and optimization. The inadequate knowledge about insulin and its related concerns/myths needs to be dealt through capacity and confidence building when it comes to insulin therapy.
This book takes a step forward by covering major aspects of insulin therapy—types and profiles of different insulins, the indications: Which insulin to choose, when to choose, how to initiate, titrate and intensify therapy, considerations in special populations, and practical do's and don'ts when it comes to using insulin for managing both T2DM and T1DM.
What makes this book special and different is the inclusion of up to date, latest guidelines and recommendations. This book has a comprehensive coverage of insulin and I believe the reader will find all the useful necessary information in a simple and easy to grasp manner. It is a recommended read from my side for all general practitioners, postgraduate students, and other healthcare professionals.
AK Das
Professor of Medicine and Professor and Head of Endocrinology Pondicherry
Institute of Medical Sciences, Pondicherry, India Former Professor and Medical Superintendent, JIPMER Past President RSSDI and API
Preface
Insulin is a good friend to have. This seemingly simple polypeptide has transformed the lives of millions of people who use it, saving them from disability and death. It has rewarded its workers with at least four Nobel Prizes, and has facilitated the growth of the dynamic discipline of endocrinology.
Insulin is humility personified. It lends itself to use in various regimens, different preparations, and novel coformulations. It can be administered through a variety of delivery devices. The hormone can be coprescribed with virtually every other drug, and brooks no contraindication.
At the same time, insulin stands for strength. The pillar of treatment for type 1 diabetes mellitus, it is also integral to the management of all other forms of dysglycemia. In uncomplicated and complicated patients, in outdoor and indoor settings, insulin is able to achieve good glycemic control.
Insulin is a faithful friend, with high fidelity. Once we learn its physiology and biochemistry, it becomes easy to understand its basic pharmacology. This in turn allows us to use it effectively, and efficiently, in the clinical setting.
This fidelity and strength are underscored in our book, which we share with all humility. Leading experts from India describe the history and physiology, as well as basic and clinical pharmacology of insulin. This comprehensive coverage conveys the beauty, and brawn, of insulin therapy in a reader-friendly, relaxed manner.
Through this book, we hope to make Insulin Therapy easy. This will help improve diabetes care in general, and insulin usage in particular, across the world. We wish our readers success in their healing, and the patients in their care, wellness in their health.
Sanjay Kalra
Acknowledgment
We acknowledge the contribution of our patients and our colleagues in diabetes care.