Insulin inhalation for diabetic patients: Nursing considerations

Evaluation of hypoglycemic therapeutics and nutritional supplementation for type 2 diabetes mellitus management: An insight on molecular approaches

OBJECTIVE

This review aims to summarize the current management of type 2 diabetes principles, including oral hypoglycemic agents, types of insulin administration, diet maintenance, and various molecular approaches.

METHODS

A literature search was conducted in different databases such as Scopus, ScienceDirect, Google Scholar, and Web of Science by using the following keywords: type-2 diabetes mellitus (T2DM), first-line and second-line treatment, oral hypoglycemic agents, insulin administration, diet/nutritional therapy, gene and stem cell therapy, and diabetic complications.

RESULTS

The first-line treatment of T2DM includes administering oral hypoglycemic agents (OHAs) and second-line treatment by insulin therapy and some OHAs like Sulfonylurea's (SU). The oral hypoglycemic or oral antidiabetic drugs have the function of lowering glucose in the blood. Insulin therapy is recommended for people with A1C levels > 7.0, and insulin administration is evolved drastically from the syringe, pump, pen, inhalation, insulin jet, and patch. The use of OHAs and insulin therapy during glycemic control has a severe effect on weight gain and other side effects. Hence, diet maintenance (macro and micronutrients) and nutritional therapy guidelines were also reviewed/recommended for safe T2DM management. Besides, the recent progress in molecular approaches that focuses on identifying new targets for T2DM (i.e.) consisting of gene therapy, stem cell therapy, and the modulation of insulin signaling pathways for the regulation of glucose storage and uptake also discussed.

CONCLUSION

The analysis of all these key factors is necessary to develop a potential agent to cure T2DM and suggest that a combination of therapies will pave the way for advanced management of T2DM.

High-throughput macromolecular polymorph screening via an NMR and X-ray powder diffraction synergistic approach: the case of human insulin co-crystallized with resorcinol derivatives

Regular injections of insulin provide life-saving benefits to millions of diabetics. Apart from native insulin and insulin analogue formulations, microcrystalline insulin suspensions are also commercially available. The onset of action of the currently available basal insulins relies on the slow dissociation of insulin hexamers in the subcutaneous space due to the strong binding of small organic ligands. With the aim of identifying insulin–ligand complexes with enhanced pharmacokinetic and pharmacodynamic profiles, the binding affinity of two resorcinol-based molecules (4-chlororesorcinol and 4-bromoresorcinol) and the structural characteristics of insulin upon co-crystallization with them were investigated in the present study. `In solution' measurements were performed via saturation transfer difference (STD) NMR. Co-crystallization upon pH variation resulted in the production of polycrystalline precipitates, whose structural characteristics (i.e. unit-cell symmetry and dimension) were assessed. In both cases, different polymorphs (four and three, respectively) of monoclinic symmetry (P21 and C2 space groups) were identified via X-ray powder diffraction. The results demonstrate the efficiency of a new approach that combines spectroscopy and diffraction techniques and provides an innovative alternative for high-throughput examination of insulin and other therapeutic proteins.

A Review of the Impact of Smoking on Inhaled Insulin: Would You Stop Smoking if Insulin Can Be Inhaled?

High prevalence of diabetes and the need for tight glycemic control have been well established. With the invention of inhaled insulin, an alternate route has been explored and shows great promise. Inhaled insulin shows a similar physiologic response to subcutaneous insulin, with a faster onset of action, making it suitable for post-prandial hyperglycemia. This comes as a great relief, especially to those who are hesitant to use multiple injections in a day. Many factors affect insulin absorption, including device, particle size, airway patency. Another essential factor is smoking, which is prevalent among people with diabetes, as is in the non-diabetic population. Smoking increases the absorption of inhaled insulin, but it is not a straight fact, since acute smoking, passive smoking, chronic smoking - all have different effects on inhaled insulin. Furthermore, inhaled insulin is also affected by lung diseases. Most studies that have been conducted have included limited populations, thus questioning their generalisability. The studies from inception till 2020 have shown increased permeability of epithelial with acute smoking, change of epithelial layer back to normal after few weeks of smoking cessation, and reverting to chronic smoker levels with just one to two days of start in smoking. Data also suggests that smoking causes a reduction in insulin sensitivity, which could compensate for its increased absorption. Nicotine causes a decrease in the absorption of subcutaneous insulin, but its effect has not been seen on inhaled insulin. More studies, including diabetic smoker patients, need to be performed to give a specific set of variables. This would also add another reason to encourage smokers to quit smoking.