# Insulin --- **Insulin** is the main [[metabolism|metabolic]] [[hormone]] in the body that regulates [[blood glucose]] levels--specifically it lowers it. It is produced in the [[pancreas]] when there is a lot of glucose (the best snack) in the blood. When the glucose levels fall back down, insulin falls with it (it is used up by the cells or reuptaken by the liver), corresponding to a rise in [[glucagon]] (which raises blood sugar levels). A few of the responses that insulin triggers are: - stimulating both liver and muscle cells to form [[glycogen]]. - stimulating adipose tissue to increase uptake of [[triglycerides]] - stimulating most cells (especially muscle cells) to increase amino acid uptake for protein synthesis >[!health] Normal Range for blood sugar >The normal range of blood sugar kind of varies, but *generally speaking* a normal range (that insulin is trying to get to) is 60-99 mg/dl. Your pancreas produces about 40-50 units a day of insulin to maintain that range. ## Insulin Resistance **Insulin resistance** is a condition where the cells of your body have an increased difficulty in taking in insulin. This can occur if blood sugar levels are continuously elevated, resulting in the constant production of insulin. Additionally if you have and increased body surface/area, your pancreas has to produce a lot more insulin to go around. Unmanaged insulin resistance can lead to [[type 2 diabetes mellitus|type 2 diabetes]]. ## Exogenous Insulin **Exogenous insulin** is insulin made in a lab and can be used as a [[medicine]] for those that cannot produce enough of their own (i.e. patients with [[diabetes mellitus]]). There's a bunch of different kinds, classified as long acting vs short acting. ![[insulin pharmacokinetics.png]] - **Rapid acting** insulin (like **Lispro**) has a very fast onset and also wears off quite quite quickly. Insulin pumps use fast-acting insulin. - Onset: 15 minutes - Peak: 1 hour - Duration: 2-4 hours - **Short acting** insulin (often called "regular" insulin, like **Humulin**) is the [[pharmacology|prototype drug]] for insulin. This type is also the best to give someone experiencing [[diabetic ketoacidosis]]. - Onset: 30 minutes - Peak: 2-3 hours - Duration: 3-6 hours - **Intermediate acting** insulin is sometimes used as a mix of different insulins such as **NPH**. - Onset: 2-4 hours - Peak: 4-12 hours - Duration: 12-18 hours - **Long-acting** insulin (like **Glargine**) is used to provide a baseline level of insulin throughout the day, which is similar to normal endogenous insulin secretion. - Onset: "several hours" - Peak: none, there is a fairly even distribution throughout the day - Duration: 24 hours ## IV Insulin Considerations ![[IV insulin protocol.png]] ## Problems with Insulin - [[type 1 diabetes mellitus|type 1 diabetes]] - [[type 2 diabetes mellitus|type 2 diabetes]] ___