Topic: Antidiabetics
Question: Discuss the adverse effects of parenteral insulin.
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Hypoglycemia
– Most common adverse effect
– Results from excess insulin relative to carbohydrate intake and exercise
– Symptoms include sweating, palpitations, tremors, hunger, confusion, unconsciousness
– Can lead to seizures, coma, and even death in severe cases
– Higher risk in tight glycemic control protocols
Allergic reactions
– Local injection site reactions – pain, redness, itching
– Systemic reactions – generalized rash, angioedema
– Anaphylaxis – potentially life-threatening reaction involving airway swelling
– Due to insulin molecule itself or additives like protamine
– Can involve IgE-mediated or non-IgE mediated mechanisms
Lipodystrophy
– Localized subcutaneous fat atrophy or hypertrophy at injection sites
– Caused by repeat injections at same site
– Rotating injection sites helps prevent this
Hypokalemia
– Insulin promotes shift of potassium into cells
– Can significantly lower serum potassium concentration
– Of particular concern with intravenous insulin infusions
Weight gain
– Insulin is an anabolic hormone and increases adipose tissue
– Improved glycemic control after insulin therapy also contributes
Mitogenic effects
– Insulin has dose-dependent growth promoting effects
– Theoretically may increase risk of certain cancers
– Unclear if this risk outweighs the benefits of glycemic control
Immunogenicity
– Can stimulate formation of insulin antibodies after prolonged use
– Mostly a concern with non-human insulin preparations
– Insulin antibodies can affect pharmacokinetics of insulin
Other rare effects: sodium retention, hypertension, edema
