Insulin

Definition of Insulin:

• Insulin therapy is indispensable for type 1 diabetes and may be required in advanced type 2 diabetes.

Physiology:

• Produced by β-cells of the pancreas; released in response to increased blood glucose.
• Lowers blood glucose by facilitating glucose uptake in muscle and adipose tissue and by inhibiting hepatic glucose production.

Types of Insulin:

1. Rapid-Acting (e.g., insulin lispro, aspart):

   • Onset: ~15 minutes.
   • Peak: 1 hour.
   • Duration: 2-4 hours.

2. Short-Acting (e.g., regular insulins):

   • Onset: ~30 minutes.
   • Peak: 2-3 hours.
   • Duration: 3-6 hours.

3. Intermediate-Acting (e.g., NPH):

   • Onset: 1-2 hours.
   • Peak: 4-12 hours.
   • Duration: 12-18 hours.

4. Long-Acting (e.g., glargine, detemir):

   • Onset: 1-2 hours.
   • Peak: Minimal or none.
   • Duration: Up to 24 hours.

Clinical Use:

1. Type 1 Diabetes: Basal and bolus insulins regimens.
2. Type 2 Diabetes: As insulins resistance progresses, insulins may be added to oral agents.
3. Hyperkalemia: Insulins (with glucose) shifts potassium intracellularly.

Side Effects:

• Hypoglycemia, weight gain, lipodystrophy at injection sites.

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