Insulina

Farmacodinamia

Estructura química

• La insulina es una proteína pequeña que normalmente es creada y liberada por las células beta pancreáticas.
• Las formulaciones disponibles pueden ser:
  • Insulina humana: idéntica a la insulina producida de forma endógena
  • Análogo de la insulina: alterada para crear mayores ventajas farmacocinéticas

Mecanismo de acción

• La insulina actúa sobre las células para ↑ la captación de glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria tejidos, incluyendo:
  • Hígado
  • Músculo esquelético
  • Tejido Adiposo
• Esto ocurre a través de los LOS Neisseria transportadores de glucosa ( GLUT GLUT Tubular System):
  • GLUT4 → músculo y tejido adiposo
  • GLUT2 GLUT2 A glucose transport facilitator that is expressed primarily in pancreatic beta cells; liver; and kidneys. It may function as a glucose sensor to regulate insulin release and glucose homeostasis. Digestion and Absorption → hígado
• La insulina exógena se utiliza frecuentemente para superar la hiperglucemia causada por:
  • Deficiencia de insulina ( diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 1)
  • Resistencia a la insulina ( diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus tipo 2)

Efecto fisiológico

• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el hígado:
  • ↑ Síntesis de glucógeno
  • ↑ Glucólisis
  • ↑ Lipogénesis
  • ↑ Síntesis de proteínas
  • ↓ Glucogenólisis y gluconeogénesis
  • ↓ Conversión de ácidos grasos y aminoácidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cetonas
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el músculo:
  • ↑ Glucólisis
  • ↑ Síntesis de proteínas
  • ↑ Lipogénesis
  • ↑ Síntesis de glucógeno
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tejido adiposo:
  • ↑ Almacenamiento de triglicéridos
  • ↓ Lipólisis
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria niveles sanguíneos:
  • ↓ Glucosa
  • ↓ Ácidos grasos
  • ↓ Cetoácidos
  • ↓ Aminoácidos

Farmacocinética

Absorción

• La absorción y el inicio de acción dependen de:
  • Modo de administración
  • Sitio de administración
• Del más rápido al AL Amyloidosis más lento:
  • Intravenoso> intramuscular > subcutáneo
  • Abdomen > brazos > glúteos > muslo
• Otros factores que puedan causar un efecto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum su absorción:
  • Ejercicio
  • Temperatura
  • Irrigación sanguínea local

Excreción

• La insulina se elimina a través de los LOS Neisseria riñones.
• Es posible que sea necesario ajustar la dosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum personas con insuficiencia renal.

Clasificación

Los LOS Neisseria tipos de insulina se pueden clasificar según su farmacocinética:

• Acción rápida:
  • Rápida absorción
  • Efecto pico rápido
  • Ejemplos:
    • Insulina lispro Lispro Insulin that has been modified so that the b-chain contains a lysine at position 28 instead of a proline and a proline at position 29 instead of a lysine. It is used to manage blood glucose levels in patients with type 2 diabetes. Insulin
    • Aspart Aspart Insulin that has been modified to contain an aspartic acid instead of a proline at position 38 of the b-chain. Insulin
    • Glulisina
• Acción corta:
  • Todavía mantienen una absorción rápida
  • Efecto pico ligeramente más largo
  • Ejemplo: regular Regular Insulin
• Acción intermedia:
  • Absorción más lenta
  • Mayor duración
  • Ejemplo: protamina neutra Hagedorn ( NPH NPH Normal pressure hydrocephalus (NPH) is a neurodegenerative disorder characterized by the triad of gait abnormalities, dementia, and urinary urgency or incontinence. Normal pressure hydrocephalus can be either idiopathic or secondary to intraventricular or subarachnoid hemorrhage. Normal Pressure Hydrocephalus, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
• Acción prolongada:
  • Absorción lenta
  • Efecto pico mínimo (proporcionan un efecto de meseta estable)
  • Duran la mayor parte del día
  • Ejemplos:
    • Detemir Detemir A recombinant long-acting insulin and hypoglycemic agent in which a myristic acid is conjugated to a lysine at position b29. It is used to manage blood glucose levels in patients with diabetes mellitus. Insulin
    • Insulina glargina
    • Degludec Degludec Insulin

Indicaciones

Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus

Insulina subcutánea:

• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 1:
  • Las personas con diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 1 requieren un reemplazo de insulina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo momento.
  • Se pueden utilizar múltiples inyecciones diarias para simular la liberación fisiológica de insulina:
    • La insulina basal (de acción prolongada) se administra una o dos veces al AL Amyloidosis día.
    • Los LOS Neisseria bolos de insulina de acción rápida se administran con las comidas.
  • Una infusión continua de insulina (a través de una bomba de insulina) con bolos a la hora de las comidas también es una opción.
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus tipo 2:
  • Se agregan cuando la terapia oral no ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia logrado proporcionar un control adecuado de la glucemia
  • Generalmente, se utilizan junto con otros medicamentos antidiabéticos orales (e.g., metformina)
  • Indicados como terapia inicial cuando se observa una hiperglucemia severa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el momento del diagnóstico
• Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus gestacional: terapia de elección para la hiperglucemia no controlada a pesar de las modificaciones de la dieta y la actividad física

Insulina intravenosa:

• Cetoacidosis diabética
• Estado hiperglucémico hiperosmolar

Otras indicaciones

Además de la diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, la insulina intravenosa se puede utilizar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum otras varias condiciones (a menudo junto con la dextrosa para mantener la euglucemia).

• Hiperpotasemia:
  • Ingresa potasio (K) a las células
  • Tratamiento temporal utilizado para ↓ los LOS Neisseria niveles de K de forma aguda
• Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis aguda inducida por hipertrigliceridemia:
  • ↓ Liberación de ácidos grasos de los LOS Neisseria adipocitos
  • ↑ Almacenamiento de triglicéridos
  • ↓ Niveles de triglicéridos
• Toxicidad por betabloqueadores y bloqueadores de los LOS Neisseria canales de calcio:
  • Indicado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos hemodinámicamente inestables refractarios a otros tratamientos
  • ↑ Inotropía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum miocitos (afectados por la toxicidad por los LOS Neisseria bloqueadores de los LOS Neisseria canales de calcio) por ↑ captación de glucosa necesaria para el metabolismo aeróbico
  • Supera la deficiencia de insulina causada por el efecto de los LOS Neisseria betabloquedores en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el páncreas

Efectos Secundarios y Contraindicaciones

Efectos secundarios

• Hipoglucemia:
  • Confusión
  • Cefalea
  • Palpitaciones
  • Taquicardia
  • Diaforesis
• Aumento de peso posterior al AL Amyloidosis inicio del tratamiento
• Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Anafilaxia
• Sitio de inyección:
  • Eritema
  • Inflamación
  • Lipoatrofia

Contraindicaciones

• Hipopotasemia (la insulina impulsa el K+ al AL Amyloidosis interior de las células)
• Hipersensibilidad
• Hipoglucemia

Precauciones

Es posible que sea necesario realizar ajustes de dosis y un control estricto para las personas con:

• Deterioro hepático
• Deterioro renal

Interacciones medicamentosas

• ↑ Efecto hipoglucemiante con:
  • Otros agentes antidiabéticos
  • Alcohol
  • Andrógenos
  • Betabloqueadores
  • Agentes antivirales de acción directa para la hepatitis C Hepatitis C Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). The infection can be transmitted through infectious blood or body fluids and may be transmitted during childbirth or through IV drug use or sexual intercourse. Hepatitis C virus can cause both acute and chronic hepatitis, ranging from a mild to a serious, lifelong illness including liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis C Virus
  • Inhibidores de la monoamino oxidasa (IMAO)
  • Salicilatos
  • Antibióticos sulfa
• Puede ser necesario un ↑ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la dosificación de la insulina con:
  • Corticoesteroides
  • Estrógenos/anticonceptivos orales
  • Diuréticos tiazídicos
  • Antipsicóticos
  • Niacina

Comparación de las Insulinas