HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

[Insulin substitution: new insulins, new modes of delivery].

Abstract
The demonstrated role of the tight control of hyperglycaemia for the prevention of long-term diabetic complications has reoriented the goals of insulin supply toward the search for restoration of the effects of physiological insulin secretion rather than the simple survival of insulin deficient patients and the reduction in the number of daily insulin injections to be performed. Normal blood glucose control requires the availability of a fast-acting insulin therapy at meal time in order to reduce hyperglycaemic excursions and a basal insulin therapy able to stabilize blood glucose between meals. Reduction of induced hypoglycaemic risk represents the secondary objective beside the main goal of avoiding hyperglycaemia. Fast-acting analogues, by a faster dissociation of their hexameric conformation after their injection or infusion in subcutaneous tissue, reduce post-meal hyperglycaemia, while their shortened duration of action versus regular insulin minimizes late post-absorptive risk of hypoglycaemia. Long-acting analogues, by their precipitation in subcutaneous tissue or their slowly reversible binding to albumin, provide a benefit on blood glucose stability versus NPH or zinc insulins. Continuous insulin therapy using pumps offers both a better blood glucose stability than multiple daily injections and a broader flexibility in life mode. Using the peritoneal route by implantable pumps is a mean to improve blood glucose stability in poorly controlled patients in spite of optimized subcutaneous insulin therapy. The development of glucose sensors provides reinforced information on blood glucose, versus self-monitoring by capillary blood measurements, that contributes to a better adaptation of insulin therapy. First trials of connections between blood glucose data and insulin delivery open a perspective toward glucose-modulated insulin therapy, at least in periods outside meals, leading to first models of semi-automated artificial endocrine pancreas. The alternative of a cellular insulin supply by pancreas or islet transplantation looked promising during recent years, but lack of transplants and adverse events related to immune suppression limit their use to very specific cases where benefit/risk ratio is positive.
AuthorsEric Renard
JournalJournal de la Societe de biologie (J Soc Biol) Vol. 201 Issue 2 Pg. 141-8 ( 2007) ISSN: 1295-0661 [Print] France
Vernacular TitleLa Suppléance Insulinique: nouvelles insulines, nouveaux procédés d'administration.
PMID17978746 (Publication Type: English Abstract, Journal Article, Review)
Chemical References
  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
Topics
  • Administration, Inhalation
  • Blood Glucose (drug effects, metabolism)
  • Diabetes Mellitus, Type 1 (complications, drug therapy)
  • Drug Administration Schedule
  • Humans
  • Hyperglycemia (prevention & control)
  • Hypoglycemic Agents (administration & dosage, therapeutic use)
  • Injections, Subcutaneous
  • Insulin (administration & dosage, pharmacokinetics, therapeutic use)
  • Insulin Infusion Systems

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: