Because of the complex and interacting factors, it is, in principle, impossible to know for certain how much insulin (and which type) is needed to 'cover' a particular meal to achieve a reasonable blood glucose level within an hour or two after eating. Non-diabetics' beta cells routinely and automatically manage this by continual glucose level monitoring and insulin release. All such decisions by a diabetic must be based on experience and training (., at the direction of a physician, PA, or in some places a specialist diabetic educator) and, further, specifically based on the individual experience of the patient. But it is not straightforward and should never be done by habit or routine. With some care however, it can be done reasonably well in clinical practice. For example, some people with diabetes require more insulin after drinking skim milk than they do after taking an equivalent amount of fat, protein, carbohydrate, and fluid in some other form. Their particular reaction to skimmed milk is different from other people with diabetes, but the same amount of whole milk is likely to cause a still different reaction even in that person. Whole milk contains considerable fat while skimmed milk has much less. It is a continual balancing act for all people with diabetes, especially for those taking insulin.
The images show a normal dog white blood cell: the important anatomy is of the cell is indicated (cell membrane, nucleus and cytoplasm).
When the parainfluenza virus or adenovirus enters the body of a dog, it attaches to the cell membrane of a particular body-cell-type that it has been specially 'designed' to invade. The virus has specific surface proteins, called attachment proteins, that allow itto recognize, bind to and access certain cell types. For example, in canine cough, the cells that the virus prefers to invade are the cells of the upper respiratory tract and mucous membranes (conjunctiva of the eye and lining of the mouth and nose). When a kennel cough virus attaches to the right kind of cell, one of two things may happen:
1) the virus outer membrane fuses with the cell membrane (in the case of paramyxovirus), resulting in the virus capsid and RNA being released into the cytoplasm of the cell OR
2) the cell membrane reaches outwards, surrounding the adenovirus or parainfluenza 2 virus inside a 'bubble' of cell membrane (the process is termed endocytosis ). This bubble gets released into the cell's cytoplasm where the virus fuses with it, resulting in the release of the viral RNA or DNA into the cytoplasm.
Either way, the genetic material of the virus (RNA or DNA) ends up within the cytoplasm of the host cell.
Due to the inherent risks in handling pandemic influenza strains for the production of vaccines where an uncontrolled release could have a significant public health impact, a detailed risk assessment for pandemic influenza production strains and the biosafety precautions needed in manufacturing environments. WHO issued a biosafety risk assessment and guidelines for the production and quality control of human influenza pandemic vaccines in 2005. These guidelines cover biosafety aspects of pandemic influenza vaccines produced from wild strains, attenuated (reassortment) strains, and live attenuated strains. The document was updated to include the pandemic influenza A (H1N1) virus in 2009. This update is relevant to both vaccine development and production activities.