insulin regimes Flashcards
who is insulin used in
- all patients with type 1 diabetes
- patients with type 2 diabetes who have a HbA1c greater than 9% and have diabetic complications
- patients with type 2 diabetes where you cannot establish glycemic control with anti-hyperglycaemic drugs
types of insulin
- rapid acting
- short acting
- intermediate acting
- long acting
rapid acting insulin timescale
begins to work within 15 minutes and peaks between 30-90 minutes its duration is between 3-5 hours
when should rapid acting insulin be injected
before meals times
examples on rapid acting insulin
- insulin aspart (novorapid)
- insulin lispsro (humalog)
- insulin apidra (glusiline)
remember that with rapid acting insulin
doses may need to be reduced 1 hour before planned exercise
short acting insulin timescale
begins to work within 30-60 minutes and peaks between 2-4 hours, its duration is between 6-8 hours
examples
analogues of human insulin:
- actrapid
- humulin S
- inhuman rapid
remember with short acting insulin
there is a risk of hypos late in the morning or early hours of night depending on the time of the dose
intermediate acting insulin timescale
begins to work within 2-4 hours and peaks between 4-8 hours its duration is about 16 hours
examples of intermediate acting insulin
isophane insulin:
- humulin I
- insuman basal
- insulatard
what is intermediate insulin usually used in combination with
a short acting insulin
long acting insulin timescale
begins to work within 2 hours and provides a continuous level of insulin with no peaks its duration is between 24 and 36 hours
examples of long acting insulin
- insulin glargine (lantus)
- insulin detemir (levemir)
- insulin deludec (tresiba)
basal insulin regime can be
once daily or twice daily
once daily basal regime
injection one daily in the morning or evening using a long acting insulin of 10 units, mostly used in those with type 2 diabetes mellitus who also take a anti-hyperglycaemic medication
twice daily basal regime
injection in the morning and the evening with either a mixture of a short and intermediate acting insulin or a rapid acting and intermediate insulin mixture
short and intermediate acting pre-mixture
humulin M3, inhumar comb 15,25,50 (15% short acting 85% intermediate, 25% short acting, 75% intermediate…)
rapid and intermediate acting pre-mixture
humalog mix 25/50 or novomix 30
basal bolus (prandial regime)
patients take a long acting insulin in the morning or evening and a rapid acting insulin before each main meal (breakfast, lunch and dinner)
before the rapid acting glucose is injected
blood glucose levels must be checked
general dosage in basal bolus insulin
10 units of long acting insulin
0.1-0.3 units/kg of rapid acting insulin 15 minutes before each meal
target blood glucose levels for basal bolus insulin
pre-meal: 4-7 mol/l
1-2 hours after beginning of a meal: less than 10mmol/l
advanced carbohydrate counting
synchronises the amount of insulin injected with the carbohydrate consumed
advanced carbohydrate counting used for
people who take multiple daily insulin injections and those on a subcutaneous insulin pump
1 unit of insulin per
10g of carbohydrates
insulin pump
continuos administration of short acting insulin sub- cutaneously and delivers background insulin dictated by basal rate, using advanced carbohydrate counting a manual activated insulin can be delivered to cover meal times
factors affecting insult absorption
temperature, injection depth, exercise, lipohypertrophy
regime of choice for type 1 diabetes
twice daily insulin detemir regime
