Insulin Degludec; a New Long-Acting Insulin
Diabetes mellitus is an ever common and increasing in prevalence, disease process afflicting many. Proper treatment, management and ultimately control of diabetes, is a complex and difficult task. Many factors contribute to the complexity of diabetes treatment. These factors play a role in the large occurrence of non-compliance in diabetic treatment therapies. Identifying, understanding and finally, addressing these issues will help alleviate these obstacles in diabetes management.
Factors Contributing to Insulin Therapy Non-adherence According to Stockley (2014), consistently following an insulin therapy schedule will better control blood glucose levels and will decrease and help prevent
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16). Stockley affirms that the pharmacokinetic studies done on insulin degludec have shown a therapeutic effect lasting more than 42 hours with a maintained glucose lowering action (2014 p. 16). This increased sustained release far exceeds the current 24 hour duration of action that both insulin glargine and insulin determir possess.
Clinical Evidence
In a 52 week randomized clinical study, patients with either type 1 diabetes or type 2 diabetes were treated using insulin glargine or insulin degludec. The study focus was on the effectiveness, safety and how well the patients tolerated the insulin degludec. One area of the study that was of particular interest was the occurrence of hypoglycemic events and mainly nocturnal hypoglycemia. The results of this study were then analyzed and the findings interpreted to compare insulin glargine and insulin degludec.
The clinical study outcome showed that insulin degludec compared similarly with insulin glargine in both type 1 and type 2 diabetic patients on the reductions of both HbA1c and fasting plasma glucose levels. However, when the amount of episodes of hypoglycemia were compared, the patients taking insulin degludec showed an increased reduction of hypoglycemic events, anywhere from 18% to 25% fewer incidences (Stockley, 2014, p. 18). This finding is extremely important and beneficial because the main reason cited for
The study showed that the benefits of glucose reduction did not accrue for several years, and despite achieving statistical significance, the absolute risk reduction from intensive glycaemic control was small, with a reduction of 5 events over 10 years, and a small differential HbA1c between the conventional and intensive groups. Furthermore, due to the progressive nature of the disease, increasing combinations of oral and insulin drug therapy were introduced over to time to maintain the tight glycaemic control, therefore providing greater variability and a limited scope of comparison for statistical data on the efficacy of individual agents used amongst the patient cohorts.(King, Peacock, and Donnelly, 1999). This has raised further questions for clinicians in assessing how worthwhile are the benefits achieved with tighter glycaemic control, and how can targets be achieved in routine practice? It is not always clinically acceptable to maintain intensive glycaemic control, for example with the frail and elderly, or those with existing severe co-morbidities or complications. The Diabetes Control and Complications Trial follow up study reported that patients who achieved an average HbA1c value of 53mmol/mol had better outcomes after 20 years of follow-up than the control group (who had an average HbA1c of 75 mmol/mol), irrespective of
Diabetes can be treated in three basic ways: by diet, by diet in conjunction with tablets, or diet in conjunction with insulin. Diet serves as an initial control for non-urgent patients. If a person’s diet will have a major effect on glycaemic control, it does so reasonably quickly, within a few weeks of changing
Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.
The mechanism of action of dulaglutide involves activation of GLP-1 receptor; a membrane-bound cell surface receptor coupled to adenyl cyclase in β cells. Increase in intracellular cells leads to a glucose-dependent release of insulin. Reduction in the secretion of glucagon and slow gastric emptying is done by Dulaglutide (K). Continued administration of dulaglutide increases fasting insulin and C-peptide concentrations, thus reducing fasting glucagon concentrations. Healthy patients as well as adults with type 2 diabetes have similar dulaglutide pharmacokinetics. It occurs slowly, but is well absorbed into the systemic circulation, thus reaching a maximum plasma concentration.
Answer: The combination of Insulin as well as oral hyperglycaemic drugs may be prescribed for Diabetes because they help in lowering the blood glucose levels. However the primary treatment doesn’t consist of these drugs. The primary treatment comprises of Diet control, Physical activity and Weight control. If after following the primary treatment strictly, no improvement in the blood glucose level is achieved then medication is suggested for the same. Insulin helps in maintaining the blood sugar levels. Note that insulin is not to be taken orally because the acids and digestive juices in the stomach destroy it. It has to be injected under the skin only. Taking insulin leads patient to experience Hyperglycaemic condition. The Hyperglycaemic drugs helps our body to react appropriately with the insulin so that the insulin hormone is able to help transfer glucose from blood to the cells successfully.
Everybody knows that obesity is a big factor in developing type-2 diabetes, and that part of coping with this metabolic disorder is lifestyle change. If blood glucose does not go down, then medicines are introduced. Some type-2 diabetics even have to administer insulin in order to keep their blood glucose levels
First and foremost, Dr. Frederick Banting was able to isolate insulin and use it to treat the metabolic disorder diabetes which has benefited Canada. As a result, numerous individuals have been able to receive treatment which has reduced the number of deaths. This decrease in mortalities has also lowered the number of debilitating conditions resulting from diabetes. In fact, the mortality rate for diabetes over the past forty-five years has dropped by over fifty percent (Center for Disease Control and Prevention). This decrease clearly indicates that the death rates for diabetes is gradually declining. This trend can be followed from the time insulin was discovered and has increased the prognosis and quality of life for many people. In addition, the number of diabetes cases in Canada has risen by almost thirty percent over the past twenty years (Public Health Agency of Canada 2). Although, the number of people living with diabetes is significantly
2. “Among adults with diagnosed diabetes (type 1 or type 2), 12% take insulin only, 14% take both insulin and oral medication, 58% take oral
Treatment of diabetes is important to minimize the harm that is done to the body by diabetes. In addition to exercise and a special diet, type 1 diabetes patients need regular insulin injections to lower the blood sugar levels, while people with type 2 diabetes usually don’t need insulin shots, most of them require insulin tablets in addition to healthy diets and regular exercise and a few don’t even need the insulin tablets. (2, 7)
Insulin glargine 10 units subcutaneous; This medication is used at bedtime. It is a hormone that lowers your blood sugar that is circulating in your blood. It is long acting and starts to working a few hours after the subcutaneous injection and will continue to work steadily for 24 hours. You should avoid drinking alcohol because it can lower your blood sugar and interfere with your treatment. Some of the side effects of Insulin glargine are redness, swelling, itching, or rash over the site where the injection was given. If you develop trouble breathing, palpations or fast heart rate, feel dizzy of have swelling in your throat or tongue.
On my last week visit with the client, I was glad and satisfied with the outcome of my teaching with the client about her self-administration of degludec insulin and other medications. The patient reported of remembering to administer subcutaneous insulin in the morning and feel so much better and have more energy when she gets up in the morning and had better result of daily glucose monitoring instead of being so low which causing her to be weak and shaky. The patient reported that she does not feel any shaky or weakness upon waking up in the morning and have more energy playing with her dog and more energy throughout the day. The patient also included in her weekly schedule of going to the community swimming pool 3 times per week and
Treatments that elevate insulin in the blood independent of the ambient glucose unavoidably bring danger of recurring hypoglycemia. Episodes of hypoglycemia are traumatic, because of the modification in human brain
Lispro (Humalog), Aspart (Novolog), and Glulisine (Apidra) are rapid-acting insulin. Their onset of action is 5 to 15 minutes. The peak of the action occurs at 1 to 2 hour. The effect can sustain for 4 to 5 hours. Some precautions need to be noted for the patients who taking rapid acting insulin. Even the blood sugar level is well controlled, the insulin dose have to be continue. The rapid-acting insulin should take 15 minutes before meal except Apidra can be taken immediately after a meal. So, after taking rapid-acting insulin, the patient should take his or her meal within the 15 minutes.
Pharmacological interventions used to improve glucose control include both oral glucose lowering agents and injectables including glucose like peptide & insulin. Apart from insulin the choice of available pharmacological interventions to treat diabetics has expanded rapidly over the past decade. Till date, the efficacy & safety of these therapies have not been well documented in people with diabetics & CKD.
Diabetes is a systemic disease caused by a decrease in the secretion of insulin or reduced sensitivity or responsiveness to insulin by target tissue. (Beale, et al., 2011) The incidence of diabetes is growing rapidly in the United States and worldwide. An estimated 347 million people around the world are afflicted with diabetes. (Whalen, et al., 2012) According to World Health Organization (WHO), Diabetes prevalence among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It is the major cause of blindness, kidney failure, heart attack, stroke and limbic amputation. World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death in 2030. It is a complex and costly disease that can affect nearly every organ in the body and result in devastating consequences. The leading cause of non-traumatic lower extremity amputations, renal failure, and blindness in working-age adults, diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal mortality, and disability. (Cefalu, 2000) Insulin therapy and oral hypoglycemic agents have demonstrated improvement in glycaemic control. However, Insulin therapy has some disadvantages such as ineffectiveness following oral administration, short shelf life, of the need for constant refrigeration, and fatal hypoglycaemia, in the event of excess dosage.