Diabetes mellitus is perceived as a complex syndrome that is a direct result of the alteration in the secretion of insulin at the level of the pancreas or by the resistance of peripheral cells to the action of this hormone. The most common effect of these disorders is an increase in blood glucose levels above normal limits- hyperglycemia.
Type 1 diabetes mellitus is defined as the etiological process characterized by the destruction of pancreatic beta cells (cells that are implicated in the secretion of insulin), leading to complete insulin deficiency with progression to ketoacidosis and fatal outcome if not corrected by insulin replacement therapy. These patients have a vital dependence on insulin treatment, without which they cannot survive. Type 1 diabetes mellitus can occur at all ages but is most common in patients whose onset of the disease is under the age of 30. Below this age, almost all patients are insulin-dependent. The factors involved in the development of type 1 diabetes are twofold: genetic and environmental (viral and nutritional) (DiMeglio et al.,2018).
Impact on the body
The pancreas stimulates the production of a hormone known as insulin, which has the role of helping the tissues use glucose and through this, lowers the amount of glucose available in the bloodstream. So, after meals, blood glucose rises due to food intake, and the healthy pancreas responds by enhancing insulin secretion, which will bring blood glucose back within normal limits. Diabetes occurs when there is not enough insulin in the body (pancreas deficiency) or the body cannot use insulin efficiently (insulin resistance). The latter is most associated with obesity, but can also occur in other situations.
Only about a third of patients with diabetes show the characteristic symptoms of the disease (intense thirst, passing large amounts of urine, etc.), the others being discovered by chance in ophthalmology (where they come for visual disorders – diabetic ophthalmopathy), neurology (because of signs of diabetic neuropathy or strokes), gynecology (where patients present for genital itching), cardiology, dermatology, nephrology, surgery, etc., where patients end up because of the complications that diabetes gives to the respective organ (Subramanian, Baidal,2021).
Medication mechanism of action
Insulin is a form of peptide hormone that is released by the beta-cells located at the level of the islets of Langerhans in the pancreas. Its main purpose is to regulate blood glucose levels. In the case of patients with diabetes type 1, due to the inadequate production of insulin, the medication of choice is presented by exogenous administration of insulin. The mechanism of action relies on insulin adhering to the insulin receptors, where they initiate tyrosine kinase activity. This process will stimulate the translocation of the glucose transporters from the level of the cytoplasm to the surface of the cells and thus influencing the influx of glucose from the bloodstream to the interior of the cell (Thota, Akbar, 2021).
Insulin does not have any oral bioavailability when it comes to absorption. Currently, the method of choice for administration is the subcutaneous one. Studies point out that this hormone It does not pass through the lymphatics and is absorbed directly into the bloodstream, whether it is injected in an amorphous, dissolved, or crystalline state. The absorption rate is dependent on the volume of the injected substance, the blood flow, and the concentration of insulin. The apparent volume of distribution for this hormone tends to be almost equal to that specific to the extracellular space. Even so, absorption of insulin at the level of the subcutaneous tissue tends to be slow and different based on what type of insulin is used. It is close to 0.5-2.6 hours for fast-acting insulin, 6-13 for intermediate-acting insulin, and nevertheless 15-48 hours for long-acting insulin. The metabolization of insulin tends to be multi-site as it occurs A vascular endothelium surrounds the heart, muscle tissue, and liver. Even so, in terms of excretion, it is believed that the liver and kidney are the primary organs when it comes to insulin degradation. More precisely, 50 to 60% of the insulin is degraded at the level of the liver, while the remaining 30-40% is at the level of the kidneys. Even so, in the case of exogenous insulin administration, this report is modified as the kidney will have a great role in the excretion process (Munguia, Correa,2021).
Corticosteroids represent a medication that interacts with insulin. These drugs tend to disrupt the glucose control process, which can eventually lead to acute decompensation. Another medication is represented by isoniazid, frequently used to treat pulmonary tuberculosis, which tends to reduce the effectiveness of insulin isophane (acronym of NPH) together with other medications used to control hyperglycemia. The last medication mentioned is niacin, which seems to decrease adipocyte insulin responsiveness. Due to that, this medication is contraindicated in patients who received insulin therapy due to the high risk of insulin resistance, even though studies pointed out that this is more evident in the case of long-term usage (Donner, Sarkar,2019).
Among insulin’s side effects, hypoglycemia is the most serious. One of the most serious insulin side effects is hypoglycemia. This also represents one of the most important barriers when it comes to achieving the required glycemic target for Diabetes type 1 patients. Second, there is a negative impact is weight gain, which is mostly related to the frequent hypoglycemic episodes, or Adipose tissue is responsible for fatty acid uptake. The third side effect is a rare one and is represented by local allergic reactions expressed through pruritus or erythema. Even so, systemic reactions such as anaphylaxis are rarely a cause of the issue in the case of insulin analogs and human insulin. For these patients, the usage of Lispro-insulin seems to be more effective as it tends to be less allergenic (Donner, Sarkar,2019).
As this paper was able to demonstrate, in Diabetes type 1 patients, the recommended treatment is represented by exogenous administration of insulin. The side effects and pharmacodynamics tend to be different based on the type of insulin which is administered (as some of them tend to be short-acting while others are long-acting). Neglected diabetes mellitus can lead over time to chronic complications such as diabetic neuropathy (damage to the peripheral nerves and/or vegetative nervous system), diabetic retinopathy (damage to the retina which, if left untreated, can lead to blindness), diabetic nephropathy (damage to the kidneys, which can lead to kidney failure and dialysis), diabetic arteriopathy (this, together with peripheral neuropathy, can lead to diabetic gangrene which may require amputation of the lower limbs). Due to that, it is mandatory that patients maintain a normal value of blood glucose level; even so, as this paper demonstrates, that can be difficult, especially due to the potential side effects which are associated with the usage of this medication.