Hypoglycaemia and insulin treatment in diabetes Flashcards
What are the different types of insulins available?
Basal insulin:
NPH insulin
Insulin glargine
Insulin detemir
Insulin degludec
Prandial insulins:
Insulin lispro
Insulin glulisine
EDTA/citrate human insulin
Faster-acting insulin aspart
T1DM
Autoimmune condition (B-cell damage) with genetic component.
Profound insulin deficiency.
T2DM
Insulin resistance.
Impaired insulin secretion and progressive B-cell damage (initially continued insulin secretion).
Excessive hepatic glucose output.
Increased counter-regulatory hormones including glucagon.
Advantage of basal bolus insulin?
A much slower rise in circulating insulin levels following sc insulin injection a delayed and slower fall after eating which is seen most dramatically in the post-absorptive period just before the midday and evening meal and during the night.
Insulin therapy for T1DM
Basal bolus to mimic physiology.
Pre-meal rapid acting bolus adjusted according to pre-meal glucose and CHO content of food to cover meals.
Basal insulin should control…
Blood glucose between meal and particularly during the night.
Dosage of basal insulin?
Given as either twice daily insulin levemir (basal analogue)
OR
Once daily (degludec) adjusted to maintain fasting blood glucose between 4-7 mmol/L.
Do people with T2DM require insulin?
Many people with T2DM require insulin – particularly later in the disease course or in individuals with poor glycaemic control on other medications.
What is the insulin-regime for T2DM?
In general, basal insulin is initiated followed by addition of a prandial insulin where necessary
What type of insulin is give for T2DM?
Long-acting basal insulin analogues are associated with lower risk of symptomatic, overall and nocturnal hypoglycaemia.
Once daily basal insulin is used in
T2DM only
Twice daily mix insulin is used in
Both conditions
Basal-bolus therapy is used in
Mostly in T1DM but can be used in T2DM.
Advantages of basal insulin therapy in T2DM
Simple for the patient, adjusts insulin themselves, based on fasting glucose measurements .
Carries on with oral therapy, combination therapy is common.
Less risk of hypoglycaemia at night.
Disadvantages of basal insulin therapy in T2DM
Doesn’t cover meals.
Best used with long-acting insulin analogues which are considered expensive.
Advantages of pre-mixed insulin in diabetes
Both basal and prandial components in a single insulin preparation.
Can cover insulin requirements through most of the day.
Disadvantaged of pre-mixed insulin in diabetes
Not physiological.
Requires consistent meal and exercise pattern.
Cannot separately titrate individual insulin components.
Increased risk for nocturnal hypoglycaemia.
Increased risk for fasting hyperglycaemia if basal component does not last long enough.
Often requires accepting higher HbA1c goal of <7.5% or ≤8% (<58 or ≤64 mmol/mol).
When to begin insulin therapy in people with T2DM?
When HbA1c levels are equal to or greater than 9%.
Summary of T2DM treatment
Treatment approach in which basal insulin is added to oral therapy can improve glycaemic control and reduce hypoglycaemia but bolus insulin for one or two meals is often required.
