How Insulin Reduces Blood Glucose Level; Indication of Insulin

Insulin reduce blood glucose level by –

1. Increase glycogenesis by increase glucose uptake & increase deposition of glycogen.
2. Decrease glycogenolysis by decrease phosphorylase & decrease cAMP.
3. Decrease neoglucogenesis by decrease enzymes concerned with neoglucogenesis

Indications of insulin

1. Insulin dependent diabetes mellitus (IDDM-Type I).
2.  Non -insulin dependent diabetes mellitus (NIDDM- Type II) when oral hypoglycemic drug failed.
3. Diabetes with complication such as -
•    Diabetic keto acidosis
•    Diabetic retinopathy
•    Diabetic nephropathy
•    Diabetic neuropathy
•    Diabetic acidosis.
These are emergency condition. Here we use short acting insulin & it is administered in I/V route.

4. Diabetes with acute infection & acute MI.
5. Diabetes with surgery. Before surgery, during surgery & after surgery insulin is required.
6. Diabetes with pregnancy (gestational diabetes). During pregnancy diabetes is controlled by insulin, here oral hypoglycaemic drug should not be used because it can cross-placental barrier & have teratogenic effect.
Insulin has large molecular weight & does not cross placenta & have no teratogenic effect.
7. Diabetes with pancreatectomy.