Abstract
Diabetes mellitus continues to be a disease that affects a good percentage of our population. The majority affected need insulin on a day-to-day basis. Before the invention of the first manufactured insulin in 1978, dealing with diabetes took a significant toll on patient's lives. As technology and human innovation prevail, significant advancements have taken place in managing this chronic disease. Patients have an option to decide their mode of insulin delivery. Intranasal insulin, one such form, has a rapid mode of action while effectively controlling postprandial hyperglycemia. It has also been proven to reduce hypoglycemia and insulin resistance problems, which seem to be the main adverse effects of using conventional insulin regularly. However, due to the large dosages needed and high incurring costs, Intranasal Insulin is currently being used as adjunctive therapy along with conventional insulin. We conducted a literature search in PubMed indexed journals using the medical terms "Intranasal insulin," "diabetes," and "cognitive impairment" to provide an overview of the mechanism of action of Intranasal Insulin, its distinctive cognitive benefits, and how it can be compared to the standard parenteral insulin therapy. One unique feature of intranasal insulin is its ability to directly affect the central nervous system, bypassing the blood-brain barrier. Not only does this help in reducing the peripheral side effects of insulin, but it has also proven to play a role in improving the cognitive function of diabetics, especially those who have Alzheimer's or mild cognitive impairment, as decreased levels of insulin in the brain has been shown to impact cognitive function negatively. However, it does come with its limitations of poor absorption through the nasal mucosa due to mucociliary clearance and proteolytic enzymes, our body's natural defence mechanisms. This review focuses on the efficacy of intranasal insulin, its potential benefits, limitations, and role in cognitive improvement in people with diabetes with pre-existing cognitive impairment.
Highlights
BackgroundInsulin is a peptide hormone secreted by the pancreas, by the β cells of Langerhans' islets that maintain normal blood glucose levels by mediating cellular glucose uptake and regulating carbohydrate, lipid, and protein metabolism [1]
This review focuses on the efficacy of intranasal insulin, its potential benefits, limitations, and role in cognitive improvement in people with diabetes with pre-existing cognitive impairment
In 1922, it was first used as a therapeutic alternative in patients with diabetes, and since it has become the cornerstone of treating patients with type 1 diabetes mellitus (T1DM)
Summary
Insulin is a peptide hormone secreted by the pancreas, by the β cells of Langerhans' islets that maintain normal blood glucose levels by mediating cellular glucose uptake and regulating carbohydrate, lipid, and protein metabolism [1]. One therapeutic strategy uses the intranasal route, which can deliver insulin directly to the brain bypassing the blood-brain barrier On these lines, Benedict et al in 2010 demonstrated through a systematic review the benefits of intranasal insulin in improving memory of healthy people as well as of those with impaired cognition (like Alzheimer's Disease), in the absence of adverse effects, and as a neuroprotective agent that may be used for prevention and treatment of insulin resistance and deficiency in the CNS as seen in Alzheimer's disease[32]. The effect of intranasally administered insulin on the CNS and the metabolic homeostasis of our body has been studied in a review conducted by Ott et al in 2012, wherein impaired insulin signalling in the brain was attributed to the development of type 2 diabetes and obesity, in which peripheral and possibly CNS insulin resistance is the hallmark, and Alzheimer's Disease, which has been associated with insulin resistance as a contributor to the cognitive decline accompanying it [16]. The risk of hypoglycemia which is a significant concern with insulin, is negligible with the intranasal route [59]
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