Insulin and Metformin

It was developed in the 1920s and is used to treat diabetes by injection instead of natural insulin. Insulin is a peptide hormone that is produced by pancreatic beta cells and refined through crystallization. Insulin is essential for controlling the body's metabolic processes and maintaining a normal blood glucose level.

Mechanism of action

Insulin lowers the body's glucose level. Insulin interacts with specific receptors on the cell membranes of almost all cells. The insulin receptor's two alpha and two beta subunits are linked together by sulfide bonds. The alpha subunit has insulin binding sites, whereas the beta subunit has tyrosine kinase activity. Insulin transports glucose across cell membranes in an ATP-dependent manner. In the end, insulin aids in the transit of glucose into fat and muscle cells. Additionally, insulin boosted glycogen production. Insulin inhibits glucose synthesis. Insulin inhibits lipolysis while increasing triglyceride production. As a result, insulin is required for cell development.

Action of Insulin 

• It enhances glucose utilization.
• It promotes the conversion of glucose to glycogen, the storage form.
• It inhibits the process of gluconeogenesis, which results in the synthesis of glucose.
• It cannot be administered orally and must be administered via intravenous or subcutaneous injection. In an emergency, only soluble insulin can be administered via IV.

Dose

• Dose is variable depending on the condition and blood glucose level of the patient. IDDM patients normally require 0.4 - 0.8IU / k * g / d * ay

Indication

• Hypoglycemia (type I and sometimes type II or Emergency cases). Diabetes Mellitus. Diabetic coma (Diabetic ketoacidosis)

Contraindication

• Severe allergic reaction (insulin allergy), hypoglycemia

Side effects

• Hypoglycemia, rebound hypoglycemia lipodystrophy, lipohypertrophy. Urticaria, skin rashes, hypoglycemia, and Shock.

Nursing consideration (Insulin)

• Insulin should be stored in a refrigerator at a temperature of 20.8°C. Insulin should ideally be stored horizontally between 2 and 8 degrees Celsius.
• Insulin should be administered 15 to 30 minutes before eating. Remind the patient to eat after he or she has taken insulin. Because there are several types of insulin, read labels carefully.
• Stop taking the insulin preparation if the consistency or color changes in any way. Make certain that all blood tests are carried out in compliance with the criteria.
• Inform patients about the proper injection technique.
• Inform the patient to strictly follow the dose regimen and to take the medication exactly as prescribed by the doctor.
• Patients are recommended to contact with pharmacists or doctors before using other medications.
• Encourage patients to keep a source of sugar, such as sweets, on hand in case of hypoglycemic symptoms. Dextrose will be beneficial in the event of an insulin overdose.
• Insulin solution should not be used if the suspension cannot be properly resuspended due to clump/cake formation.

Metformin

Metformin was derived from natural compounds found in the plant Galega officinalis, also known as French lilac or goat's rue.

Mechanism of Action

• It lowers blood sugar via reducing hepatic glucose synthesis, lowering intestinal glucose absorption, and enhancing insulin sensitivity by increasing peripheral glucose uptake and utilization.

Dose

• Initially, 500mg with breakfast for at least 1 week, then 500mg with breakfast and evening meal for at least 1 week, then 500 mg with breakfast, lunch, and evening meal for at least 1 week, then 500 mg with breakfast, lunch, and evening meal for at least 1 week, then 500

Contraindication:

• Type-l diabetes mellitus, major surgery, diabetic coma, cross sensitivity with Sulphonamides, uncontrolled infection, severe hepatic or renal disease.

Side effects:

• Dizziness, confusion megaloblastic anaemia flatulence, metallic taste, anorexia, diarrhea Miscellaneous: lactic acidosis: decreases Vit. B12 absorption.

Nursing Consideration

• Metformin's main advantage is that it reduces hyperglycemia.
• Renal function testing on the patient should be done on a regular basis.
• Patients are encouraged to see a doctor if their glucose level does not improve after taking the prescription.
• taking the medication before or after eating
• If the patient develops a condition related to hypoxemia or dehydration, the medication should be discontinued immediately due to the risk of lactic acidosis associated with these disorders.
• Check the patient's blood sugar levels on a regular basis.
• Never take extra drugs without first visiting a doctor.
• Patients are encouraged to switch prescription brands as frequently as feasible.