Insulin Flashcards
What is insulin?
Polypeptide hormone responsible for the metabolism of carbohydrates, fat and protein.
It regulates blood sugar levels by helping cells absorb glucose for energy or storage.
Rapid
- PRN
- Fast onset + short duration of action
- Injected immediately before or after eating
- Lower risk of hypo than soluble (short acting)
- Alternative to soluble in emergency
Examples of rapid acting
- Aspart (Novorapid)
- Lispro (Humalog)
- Glulisine (Apidra)
Short acting (neutral or soluble)
- PRN
- Longer duration of action
- Injected 30 mins before eating
- Do not eat within 30 minutes = risk of hypo
- Can be given in diabetic emergencies + surgery
Examples of short-acting
- Actrapid
- Humulin S
- Insuman rapid
Intermediate
- BD
- Given in conjunction with short acting
- Up to 16 hours duration
- Roll in hands before administration to resuspend zinc-insulin particulate
- Never use IV (may block capillary; thrombosis)
Examples of intermediate acting
- Isophane/NPH
- Insulatard
- Humulin I
- Insuman basal
Long acting
- OD
- Same time each day
- Roll in hands before administration to resuspend zinc-insulin particulate
- Never use IV (may block capillary; thrombosis)
- Dont mix with soluble insulin
Examples of long acting
- Detemir (Levemir)
- Glargine (Absaglar, Lantus)
- Degludec (Tresiba)
Biphasic insulin
- Combination of shorter and longer acting insulin
- More convientn
- Less control
- Resuspend before mixing
Examples of biphasic
- Novomix 30
- Humalog mix 25
- Humulin M3
When is insulin used?
Type 1
Type 2 if oral antidiabetic medication fails
Surgery
Hospitalisation for illness e.g. DKA
When do insulin requirements increase?
Infections or intercurrent illness
Stress or accidental surgical trauma
Puberty
Pregnancy - 2nd/3rd trimester
When do insulin requirements decrease?
Endocrine disorders
e.g. Addisons disease, hypopituitarism
Coeliac disease (gluten intolerance)
Administration
S/C injection to buttocks, upper arm, abdomen or thigh
IV reserved for urgent treatment
- DKA
- During surgery
- Serious illness for fine control
MIR
- Short/rapid acting insulin before meals
AND - Intermediate/long acting insulin OD/BD
Biphasic mixtures regimen
- Short/rapid acting insulin pre-mixed with intermediate/long acting insulin
- OD/BD before meal
Suitable for:
- Patients who have difficulty with/prefer not to use MIR
Not suitable for:
- Acutely ill patients as insulin requirements change
Long/intermediate acting regimen
- OD/BD
- With or without short/rapid acting before meals
- NOT suitable for Type 2 diabetes, unless in certain criteria
Continuous S/C infusion
Type 1 diabetes in certain criteria
Type 1 diabetes
Start with MIR
Type 2 diabetes
Isophane insulin (long-acting) OD/BD
AND
Short acting (soluble) insulin
- Biphasic or MIR
S/C infusion pump
- Basal insulin and patient activated bolus doses at meal times
- Must monitor blood glucose regularly
- NOT recommended in Type 2
S/C infusion pump give to…
- Unpredictable hypoglycaemia with MIR
- Glycaemic control >8.5% despite optimised MIR
- Children under 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
Insulin - SE
Hypoglycaemia
Lipodystrophy
- Rotate injection site
Local injection site reactions
- Check injection technique
Hypoglycaemia
Don’t miss melbas
Right insulin, Right dose, Right time, Right route
Do not do strenuous exercise before administration - increased absorption from limb used
Counselling - food
MIR
- Adjust dose according to carbohydrate intake
Biphasic
- Regulate and distribute carbohydrate intake throughout day to match regimen
Interactions - hypoglycaemia
- Oral antidiabetics
- ACEi
- MAOIs
- Salicylates
- Beta blockers (masks symptoms)
- Alcohol
Interactions - hyperglycaemia
- Corticosteroids
- Diuretics
- Sympathomimetics (epinephrine, salbutamol, terbutaline)
- Thyroid hormones
- Oral contraceptives (oestrogen, progesterone)
Warning
Recurrent hypoglycaemic episodes
- Sweating
- Palpitations
- Confusion
- Drowsiness
DKA
- N + v
- Drowsiness
Hepatotoxicity
Ulceration of foot tissue
