| Abstract: |
This article brings dietitians and nutrition specialists up-to-date with advances in diabetes care. The author discusses the history of home blood glucose monitoring (SMBG) and insulin; the physiology and pharmacology of both old and new insulin analogues, including lispro, aspart, glulisine, detemir, and glargine insulins; exubera, the first inhaled insulin; and new therapies that mimic glucagon-like peptide (GLP-1) and amylin. The newer, rapid-acting insulin analogues (lispro, aspart, glusiline) have a structural difference that promotes rapid absorption. The longer-acting insulin analogues (detemir and glargine) are designed to produce a smooth, reliable basal insulin profile. Inhaled insulin (exubera) is a powdered form of insulin taken into the lungs via inhalers. Exubera has an onset of action similar to the rapid insulin analogues, with peak activity at 30 to 90 minutes after administration. Exenatide mimics the actions of native GLP-1 which controls blood glucose by stimulating insulin secretion, slowing gastric emptying, reducing glucagon release, and enhancing the sense of satiety. Pramlinitide is an amylin analogue that, when injected 15 minutes before a meal, slows gastric emptying, suppresses the release of glucagon, and improves satiety after a meal. |