Diabetes Mellitus

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Diabetes Mellitus
Factors altering onset and duration of insulin
action
Dr. Sireen Shilbayeh
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Route Of administration
Factors altering clearance

• Renal Function

• Jet Injectors

• Insulin Antibodies

• Lipohypertophy

• Subcutaneous Enzyme

• Insulin preparation

Factors altering SQ absorption

• Insulin Mixtures

• Site of injection

• Insulin Concentration and Dose

• Exercise of Injected area

• Ambient Temperature

• Local Massage

• Smoking

Dr. Sireen Shilbayeh
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Route Of administration
Onset of action more rapid and duration of action
shorter for IV gt IM gt SQ.
Intranasal Insulin has more rapid onset and
shorter duration than SQ insulin, resembling IV
Pharmacokinetics.
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Dr. Sireen Shilbayeh
4
Renal Function
Renal failure decreases insulin clearance. May
Prolong and intensify action of exogenous and
endogenous insulin.
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Dr. Sireen Shilbayeh
5
Insulin Antibodies
IgG antibodies bind insulin as it is absorbed
and release it slowly, thereby delaying and/or
prolonging its effect.
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Dr. Sireen Shilbayeh
6
Subcutaneous Enzyme
Rare. Patients with SQ insulin degrading enzymes
are resistant to SQ administration, but are
responsive to IV and other routes of
administration.
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Dr. Sireen Shilbayeh
7
Factors altering SQ absorption
Factors that increase SQ Blood flow increase
absorption rates of regular insulin. The effect
on intermediate and long-acting insulin's is
minimal.
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Dr. Sireen Shilbayeh
8
Site of injection
Rate of absorption is fastest from the
abdomen, intermediate from the arm, and slowest
from the thigh
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Dr. Sireen Shilbayeh
9
Exercise of Injected area
Strenuous exercise of an injected area within one
hour of injection can increase absorption rate.
Increase rate of absorption of regular insulin.
Has little effect on intermediate-acting
insulin.
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Dr. Sireen Shilbayeh
10
Ambient Temperature
Heat (e.g. hot weather, hot bath, sauna)
increases absorption rate, cold has opposite
effect.
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Dr. Sireen Shilbayeh
11
Local Massage
Messaging the injected area for 30 minutes
substantially increases the absorption rate
of regular insulin as well as longer-acting
insulin's.
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Dr. Sireen Shilbayeh
12
Smoking
Controversial. Vasoconstriction may decrease
absorption rate.
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Dr. Sireen Shilbayeh
13
Jet Injectors
Insulin absorption more rapid, probably
secondary to increased surface area for
absorption.
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Dr. Sireen Shilbayeh
14
Lipohypertophy
Insulin absorption is delayed from
Lipohypertophic sites.
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Dr. Sireen Shilbayeh
15
Insulin preparation
More soluble forms of insulin are more rapidly
absorbed and have shorter duration of action.
Human insulin may have shorter action than
animal species.
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Dr. Sireen Shilbayeh
16
Insulin Mixtures
The short-acting properties of regular insulin
may be lost if mixed with PZI or lente
insulin's.
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Dr. Sireen Shilbayeh
17
Insulin Concentration and Dose
More dilute solutions (e.g., U-40,U-10) and
lower doses are absorbed more rapidly than more
concentrated forms (U-100, U-500) and higher
doses.
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Dr. Sireen Shilbayeh
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