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  1. Non Diabetic use of insulin.
    1. Treatment of Hyperkalemia               
    2. To assess anterior pituitary function. 
    3. To assess completeness of truncal vagotomy. 
  2. Indications of use of insulin in diabetes (MCQ)
    1. Type I diabetes
    2. Diabetes in pregnancy
    3. Acute complications of DM (DKA)  
    4. Acute medical illness (MI, sepsis)
    5. Major surgery
    6. Primary and secondary failure of oral hypoglycemic drugs (OHA)
Pharmacology of Insulin (Ref. Hari.18th ed. , Pg- 2993, table 344.10)


  1. Ultra Short-acting
    1. Aspart
    2. Glulisine
    3. Lispro
  2. Short-acting

    1. Regular
  3. Intermediate acting
    1. NPH
    2. Lente
  4. Long acting
    1. Detemir
    2. Glargine

Recent Advances
Insulin Degludec

  1. It is a ultralong-acting basal insulin analogue
  2. It is injected subcutaneously three-times a week to help control the blood sugar level of those with diabetes.
  3. It has a duration of action that lasts up to 40 hours, unlike the 18 to 26 hours glargine and insulin detemir.(This is not given in Harrison 18th edition also).!!!
  1. Imeglimin is an oral anti-diabetic.
  2. It is an oxidative phosphorylation blocker that acts to inhibit hepatic gluconeogenesis, increase muscle glucose uptake, and restore normal insulin secretion. 
Degludec and Imeglimin are the new drugs. They are not given in Harrison 18th edition also. !!!


Extra Edge

Glulisine, Aspart, Glargine, detemir & Degludec are newer insulin. (PNQ)

  1. Newer emerging trend (Ref. Hari.18th ed. , Pg- 3000)
    1. Whole pancreas transplantation (performed concomitantly with a renal transplant) may normalize glucose tolerance
    2. Pancreatic islet transplantation has been plagued by limitations in pancreatic islet supply and graft survival.
      After Successful pancreatic transplantation
      1. Complication that may be reversed / healed
        1. Early diabetic nephropathy (microalbuminuria stage)
        2. Diabetic neuropathy
      2. Complications that do not appear to be reversed / healed.
        1. Diabetic retinopathy          
        2. Peripheral vascular disease
    3. Closed-loop pumps that infuse the appropriate amount of insulin in response to changing glucose levels.
    4. Bariatric surgery for markedly obese individuals with type 2 diabetes. The ADA clinical guidelines state that bariatric surgery should be considered in individuals with DM and a BMI >35 kg/m2.

Recent Advances: New therapies under development for type 2 diabetes include

  1. activators of glucokinase,         
  2. an inhibitor of 11 -hydroxysteroid dehydrogenase-1,        
  3. Salsalate.

Important Points: (Ref. Hari.18th ed. , Pg- 2990, table 344.8)


Goals of treatment in a diabetic patient: To achieve

  1. Pre prandial blood sugar 70 – 130 mg%
  2. PP blood sugar < 180 mg%
  3. HBA1C < 7
  4. BP < 130 / <80 mmHg. If the patient has associated renal disease than target is (<125 / <75 mmHg)
  5. LDL <100 mg%
  6. Tg <150 mg%
  7. HDL >40mg% in male, >50mg% in female
  1. Insulin Resistance
    When a patient needs more than 200 units of the insulin per day, he is said to have insulin resistance.

    Causes of insulin resistance
    1. Obesity.          
    2. Polycystic ovarian syndrome,      
    3. Renal failure.                  
    4. Pregnancy.
    5. Leprechaunism,      
    6. lipodystrophy syndrome,
    7. type A insulin resistance,   
    8. Werner syndrome,
    9. Ataxia telangiectasia.
Extra Edge

Insulin resistance in liver disease is due to steatosis  (AIIMS Nov 2013)

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