Fluctuating blood glucose after switch to insulin aspart Sanofi

This case report concerns a patient with poor glycaemic control on oral antidiabetic drugs who initiated biphasic insulin aspart 30 (BIAsp 30), and reviews supporting clinical literature, alternative treatment choices and the options for intensification. During the six-month follow-up after initiation of BIAsp 30, glycosylated haemoglobin (HbA1c) was reduced from 10.2 % to 6.4 %, mean fasting blood glucose (FBG) was reduced from 9.0 mmol/l to 6.8 mmol/l and mean postprandial glucose (PPG) was reduced from 15.3 mmol/l to 8.8 mmol/l. Body weight increased by 4 kg. The patient experienced eight episodes of hypoglycaemia over the six-month period (four pre-lunch, one at bedtime and three nocturnal). The patient had six episodes with blood glucose (BG) <4.0 mmol/l but no episodes with BG <2.8 mmol/l. Insulin initiation with a premix insulin analogue offers a simple and convenient regimen of once- or twice-daily dosing and provides effective glycaemic control by providing coverage of both FBG and PPG.

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Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient

CJEM ◽

10.1017/cem.2017.422 ◽

2017 ◽

Vol 20 (4) ◽

pp. 643-647 ◽

Cited By ~ 1

Author(s):

Catherine M. Dewaal ◽

Eric McGillis ◽

Matt Mink ◽

Scott Lucyk

Keyword(s):

Blood Glucose ◽

Diabetic Patient ◽

Insulin Aspart ◽

Blood Glucose Concentration ◽

Somatostatin Analogue ◽

Peripheral Edema ◽

Endogenous Insulin ◽

Intravenous Dextrose ◽

Initial Blood ◽

Insulin Overdose

AbstractIntentional insulin overdose may lead to severe and refractory hypoglycemia. Exogenous dextrose administration is the mainstay of therapy for these patients and is effective in most cases. However, in patients with a functional pancreas, exogenous dextrose administration may precipitate endogenous insulin release leading to rebound hypoglycemia. We describe a case report of a 41-year-old woman who injected 300 units of insulin aspart with suicidal intent. Her initial blood glucose was 2.3 mmol/L (41 mg/dL). Over the next 12 hours, she experienced recurrent hypoglycemic episodes despite 10% dextrose infusions and 14 ampoules of 50% dextrose. Our patient experienced complications, including peripheral edema, related to the large volumes of intravenous dextrose required to attempt to maintain euglycemia. Octreotide, a somatostatin analogue, may help prevent dextrose-induced hypoglycemia and improve the management in select insulin overdose patients; large infusion volumes resulted in significant peripheral edema. Treatment with octreotide was initiated 12.5 hours post-injection and was followed by a stabilization of blood glucose concentration in this non-diabetic patient.

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Antihyperglycemic Effectiveness Test of 96% Ethanol Extract of Soursop Leaves on Mus musculus Induced by Streptozotocin

Majalah Kedokteran Bandung ◽

10.15395/mkb.v52n3.2042 ◽

2020 ◽

Vol 52 (3) ◽

pp. 131-138

Author(s):

Nur Fadhillah Khalid ◽

Peter Kabo ◽

Natsir Djide

Keyword(s):

Blood Glucose ◽

Mus Musculus ◽

Insulin Aspart ◽

Fasting Blood Glucose ◽

Ethanol Extract ◽

Positive Control ◽

Control Group ◽

P Value ◽

Annona Muricata ◽

Cross Sectional

Annona muricata L. is widely known throughout Indonesia as having great potentials as an antidiabetic agent. This study aimed to evaluate the antihyperglycemic effectiveness of ethanol extract 96% from soursop leaves and to compare its effects to metformin and insulin aspart injection as antidiabetic agents. This was a cross-sectional experimental study with random sampling approach which was performed at Phytochemistry and Biopharmacy Laboratory, Faculty of Pharmacy, Hasannudin University, Indonesia, from February 17 to March 3, 2020. Twenty-four Mus musculus subjects induced by streptozotocin were divided into six groups, which received 96% ethanol extract from Annona muricata in various doses. The extract was produced using the maceration process. The fasting blood sugar level was measured using the point of care testing (POCT) method, and data collected were then analyzed using a univariate approach. Results showed that the average fasting blood glucose level (FBG) was decreasing with increasing doses (5 g/kgBW=127 mg/dL, 10 g/kgBW =114 mg/dL, and 15 g/kg BW=97.75 mg/dl with a p-value of 0.000 based on repeated ANOVA. When compared to the positive control 1 (metformin), the decrease in FBG level in this control group (70.67 mg/dL) was better than in the group that received ethanol extract from Annona muricata L. In subjects in positive control 2 (insulin aspart), the average FBG level remained high, which was 473 mg/dL. Hence, 96% ethanol extract of Annona muricata L. can effectively lower fasting blood glucose in Mus musculus.

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Insulin-Loaded Barium Salt Particles Facilitate Oral Delivery of Insulin in Diabetic Rats

Pharmaceutics ◽

10.3390/pharmaceutics12080710 ◽

2020 ◽

Vol 12 (8) ◽

pp. 710

Author(s):

Rahela Zaman ◽

Md. Emranul Karim ◽

Iekhsan Othman ◽

Anuar Zaini ◽

Ezharul Hoque Chowdhury

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Insulin Aspart ◽

Oral Delivery ◽

Diabetic Rats ◽

Duration Of Action ◽

Wide Range ◽

Ft Ir

Oral delivery is considered as the most preferred and yet most challenging mode of drug administration; especially a fragile and sensitive peptide like insulin that shows extremely low bioavailability through the gastro-intestinal (GIT) route. To address this problem, we have designed a novel drug delivery system (DDS) using precipitation-induced Barium (Ba) salt particles. The DDS can load insulin molecules and transport them through the GIT route. There were several in vitro simulation tests carried out to prove the efficiency of Ba salt particles as oral delivery candidates. All three Ba salt particles (BaSO4, BaSO3, and BaCO3) showed very good loading of insulin (>70% in all formulations) and a degree of resistance throughout a wide range of pHs from basic to acidic conditions when assessed by spectrophotometry. Particles and insulin-associated particles were morphologically assessed and characterized using FE-SEM and FT-IR. A set of tests were designed and carried out with mucin to predict whether the particles are potentially capable of overcoming one of the barriers for crossing intestinal epithelium. The mucin binding experiment demonstrated 60–100% of mucin adhesion to the three different particles. FT-IR identifies the characteristic peaks for mucin protein, particles, and particle-mucin complex re-confirming mucin adhesion to the particles. Finally, the effectiveness of nano-insulin was tested on streptozotocin (STZ) induced diabetic rats. A short acting human insulin analog, insulin aspart, was loaded into Ba salt particles at a dose of 100 IU/Kg prior to oral administration. Among the three formulations, insulin aspart-loaded BaSO4 and BaCO3 particles dramatically reduced the existing hyperglycemia. BaSO4 with loaded Insulin showed an onset of glucose-lowering action within 1 hr, with blood glucose level measured significantly lower compared to the 2nd and 3rd h (p < 0.05). Insulin-loaded BaCO3 particles showed a significant decrease in blood glucose level at 1–2 h, although the glucose level started to show a slight rise at 3rd h and by 4th h, it was back to baseline level. However, although BaSO3 particles with loaded insulin showed a trend of reduction in blood glucose level, the reduction was not found to be significant (p < 0.05) at any point in time. Therefore, oral formulations of insulin/BaSO4 and insulin/BaCO3 particles were observed as effective as native insulin aspart subcutaneous formulation in terms of onset and duration of action. Further investigation will be needed to reveal bioavailability and mechanism of action of this novel Nano-Insulin formulations.

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