University Research Resource Journal Jayoti Vidyapeeth Women’s University

University Research Resource Journal
Jayoti Vidyapeeth Women’s University, Jaipur
To the study on insulin level in diabetes mellitus on one patient
MANSI SAXENA, SANA SAGHIR
JAYOTI VIDYAPEETH WOMEN’S UNIVERSITY, JAIPUR (RAJASTHAN)
FACULTY OF PHYSIOTHERAPY AND DIAGNOSTIC
TITLE
To review studies regarding the study on insulin level in diabetes mellitus on one patient
ABSTRACT
Recent research has shown that diabetes mellitus is a harmful disease. This condition requires a patient’s life program adjustment on the disease and for everyday restriction. In diabetes mellitus patient suffer with most common disease is mental problem. 5% of the population has been till diagnosed with diabetes mellitus. 9% of them are suffering from type 2 diabetes, majorly in older people. 5% diabetes occur from insulin dependent type 1 diabetes. It occurs mainly in childhood1stage. The most common pain in type 2 diabetes mellitus is Comorbid chronic and the presence of diabetic neuropathy with porolonged hyperglycemia. To current study will help us to examine the prevalence, characteristics and security of comorbid pain condition using interveins and self-report questionnaires in a sample of adults with type 2 diabetes mellitus. The most common type of comorbid pain is neuropathy pain that is not in much attention. This would help to access psychosocial variable related to pain which would be useful in the examination of:- in impact of neuropathic and musculoskeletal pain in patient with type 2 diabetes mellitus in terms of life, disability, physical activity, and other self care activities. It would also regard the study to relate between the symptoms of depression, anxiety and pain2.

INTRODUCTION
Previously determined reported reduction in hypogylcemia related with insulin glargin 300 u/ml GLa-300 which is compared to insulin glargin 100 u/ml GLa100 and are impacted by patient risk category in the type 2 diabetes, the clinical performance which are measured based on the healthcare effectiveness data and information that are set HEDIS are then applied to patient level data from the EDITION 2 and EDITION 3. clinical trials are then used to compare GLa-300 and GLa-100. Type 2 diabetes mellitus is on the line of verage of becoming a pandemic in india. In Type 2 diabetes mellitus risk of corobid artery disease increase 2 to 4 times in a patient3.insulin secretion and insulin sensitivity can be defined from this. When dysfunction occurs in Beta-cell it generally involve problems in pulsatility or in kinetics of secretions of insulin, Beta-cell are lossed. A recent evaluation which is using the computerized generic formal disease model has revealed that excess of global mortality occuring in the diabetes in the year 2000 was equivalent to 5.2%in all the deaths and most of the deaths are likely to be caused because of diabetes. The diabetes in today’s generation has been raised from 171 million in 2000 to 366 million in 2030, india, china and USA are reported top 3 countries in which people suffer the most from diabetes4

NEED
Diet control in diabetes mellitus has following two roles, The first role is to supply adequate nutrition for the diabetic patient to lead their daily lives in the same ways as healthy people. It is important to avoid excessive caloric intake. Since the amount of insulin required is reduced, the metabolism glucose of other substance occurs smoothly and function of the pancreatic beta-cell preserved, The second role is to supply nutrient in good balance for maintaining a healthy body. The three major type of nutrient, as well as vitamins and minerals should risk factors for complication such as hyperlipidemia and hypertension are corrected5. In diabetic mellitus patient should be avoid:- Table sugar, honey, molasses and syrup, Regular soft drinks, fruit drink(or concentrated) and drink mixes with sugar added, Milk cakes, chocolate milk, hot, coca milk, Canned fruits with heavy syrup6
IMPORTANCE
Diabetes mellitus can be defined as a metabolic disorder which is characterised by the relative or absolute insufficiency of the insulin due to improper carbohydrates metabolism. Insulin plays a major function in countering the role in maintaining action of a number of hyperglycemia generating hormones and maintain low blood glucose level. Diabetes is caused either due to the pancreas which are not producing sufficient insulin or the cells of the body are not responding properly to the insulin, and it is determined by the transport of glucose from the blood into neighbouring cells. Without the insulin, glucose transported into the cells will be less and with lack of glucose in the cells have to increase protein and fat metabolism for energy. Also, when enough insulin is not formed than also excess glucose cannot be stored in the liver and muscle tissue. Depending on their level of insulin resistance. insulin injections in type 2 diabetes patients are necessary to manage blood sugar levels.

RELEVANCY
INSULIN is a hormones made obviously in the body by the pancreas. This hormone controls the level of sugar (glucose) in the blood. When people who have type 2 diabetes may also want to have insulin injection help to manage the blood sugar level. Insulin is regularly inject under the skin between 2-4 day

INSULIN RESISTANCE one of the most prominent metabolic features of type 2 diabetes mellitus is the lack of reaction of peripheral tissue of insulin, mainly of the skeletal muscle and liver. In particular, is strong associated with insulin resistance and hence type 2 diabetes mellitus. The insulin syndrome is a complex of clinical features occurring from insulin resistance and its resultant metabolic derangement that include hyperglycaemia and compensatory hyperinsulinaemia
IMPARIED INSULIN SERECTION insulin resistance and insulin secretion are interlinked. And it response to insulin resistance there is compensatory increased secretion of insulin in an attempt to maintain normal blood sugar. In case of diabetes mellitus have gentle to moderate insufficiency of insulin but not its total absence.
INCREASED HEPATIC GLUCOSE SYNTHESIS
One of the normal roles play by insulin is to help hepatic storage of glucose as glycogen and suppress gluconeogenesis. In the type 2 diabetes mellitus, as a part of insulin resistance by peripheral tissues, the liver also shows insulin resistance7
INSULIN ARE AVAILABLE TO BE PERSCRIBED
They can also be obtained from the pancreas of pigs and cows but this is rarely used nowadays. There is a large number of insulin available in the UK and they come in various brand names. There are different types of insulin available which are classify according to how rapidly and for how long work. Biphasic insulin products include both a short-acting and an intermediate or long-acting insulin. The six major types of insulin are:-
RAPID-ACTING ANALOGUE: can be injected just before, with or after food. It tend to last between 2 and 5 hours only lasts long enough for the meal at which it is taken
LONG-ACTING ANALOGUE: is usually injected once a day to provide conditions of insulin lasting approximately 24 hours.

SHORT-ACTING INSULIN: should be injected 15-30 minutes before a meal, to cover the increase in blood sugar (glucose) levels that occurs after eating. It has a height action of 2-6 hours and can last for up to 8 hours.

MEDIUM-ACTING AND LONG-ACING INSULIN: are taken once or twice a day to provide locale insulin or in mixture with short-acting insulin/rapid-acting analogues. Their tip activity is between 4 and 12 hours and can last up to 300 hours.:
MIXED INSULIN: is a mixture of medium-acting and short-action insulin
MIXED ANALOGUE: is a mixture of medium-acting insulin and rapid-acting analogue8
COMPLETE ELABORATION
Insulin therapy remainder the effective method of reducing hyperglycaemia. There is no upper limit dosing for therapeutic effect, so it can be used to take any high HbA1c level down to near normal. Other benefits of insulin contain its effects on dropping triglycerides levels and increasing HDL
Hypoglycaemia is a concern, though the actual risk of severe episodes is small. Studies have exposed that insulin contain hypoglycaemic episodes require therapy happen in 1 to 3 per 100,000 patient-years. Weight increase can occur after beginning and is typically about 2 to 4 kg
Insulin Formulations
Insulin (Brand) Onset Peak Effective Duration
Rapid-acting
Aspart (Novolog) 5-15 min 30-90 min <5 hr
Lispro (Humalog) 5-15 min 30-90 min <5 hr
Glulisine (Apidra) 5-15 min 30-90 min <5 hr
Short-acting
Regular insulin (Humulin R, Novolin R) 30-60 min 2-3 hr 5-8 hr
Intermediate, basal
Insulin NPH 2-4 hr 4-10 hr 10-16 hr
Long-acting, basal
Insulin glargine (Lantus, Toujeo, Basaglar) 2-4 hr No peak 20-24 hr
Insulin detemir (Levemir) 3-8 hr No peak 17-24 hr
Insulin degludec (Tresiba) 1 hr >25 hr
Premixed
75% Insulin lispro protamine/25% insulin lispro (Humalog mix 75/25) 5-15 min Dual 10-16 hr
50% Insulin lispro protamine/50% insulin lispro (Humalog mix 50/50) 5-15 min Dual 10-16 hr
70% Insulin lispro protamine/30% insulin aspart (Novolog mix 70/30) 5-15 min Dual 10-16 hr
70% NPH insulin/30% regular 30-60 min Dual 10-16 hr
Inhaled
Technosphere insulin-inhalation system (Afrezza))9
REFERANCE
(1) HYPERLINK “http://www.dspace.cuni.cz/bisttream/Handle/20.500.119.56/IPBE-2011-2 0-368358-0-104984.pdf?sequence=3&isAlloweb=y” http://www.dspace.cuni.cz/bisttream/Handle/20.500.119.56/IPBE-2011-2 0-368358-0-104984.pdf?sequence=3&isAlloweb=y (2)https://www.ohio.edu/gss/grants/original/work/upload/GSS-GRANT-PROPOSAL-Example-pdf(3) HYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/28467113” https://www.ncbi.nlm.nih.gov/pubmed/28467113
(4)Textbook of pathology, harsh mohan, seventh edition, page no.-812, ISBN- 978-93-5152-369-7
(5) http://www.med.or.jp/english/pdf/2001_02/057_063.pdf(6)HYPERLINK “http://www.upmc.com/patients-visitors/education/diabetes/pages/basic-diabetes-meal-plan.aspx”http://www.upmc.com/patients-visitors/education/diabetes/pages/basic-diabetes-meal-plan.aspx
(7)Textbook of pathology, harsh mohan, seventh edition, page no.-812, ISBN- 978-93-5152-369-7
(8)HYPERLINK “http://www.fedoa.unina.it/2275/1/Lupoli_Patologia_Fisiopatologia_Molecolare.pdf”http://www.fedoa.unina.it/2275/1/Lupoli_Patologia_Fisiopatologia_Molecolare.pdf
(9)http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/diabetes-mellitus-treatment/