insulin regimes

Question 1

who is insulin used in

Answer 1

• 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

Question 2

types of insulin

Answer 2

• rapid acting
• short acting
• intermediate acting
• long acting

Question 3

rapid acting insulin timescale

Answer 3

begins to work within 15 minutes and peaks between 30-90 minutes its duration is between 3-5 hours

Question 4

when should rapid acting insulin be injected

Answer 4

before meals times

Question 5

examples on rapid acting insulin

Answer 5

• insulin aspart (novorapid)
• insulin lispsro (humalog)
• insulin apidra (glusiline)

Question 6

remember that with rapid acting insulin

Answer 6

doses may need to be reduced 1 hour before planned exercise

Question 7

short acting insulin timescale

Answer 7

begins to work within 30-60 minutes and peaks between 2-4 hours, its duration is between 6-8 hours

Question 8

examples

Answer 8

analogues of human insulin:

• actrapid
• humulin S
• inhuman rapid

Question 9

remember with short acting insulin

Answer 9

there is a risk of hypos late in the morning or early hours of night depending on the time of the dose

Question 10

intermediate acting insulin timescale

Answer 10

begins to work within 2-4 hours and peaks between 4-8 hours its duration is about 16 hours

Question 11

examples of intermediate acting insulin

Answer 11

isophane insulin:

• humulin I
• insuman basal
• insulatard

Question 12

what is intermediate insulin usually used in combination with

Answer 12

a short acting insulin

Question 13

long acting insulin timescale

Answer 13

begins to work within 2 hours and provides a continuous level of insulin with no peaks its duration is between 24 and 36 hours

Question 14

examples of long acting insulin

Answer 14

• insulin glargine (lantus)
• insulin detemir (levemir)
• insulin deludec (tresiba)

Question 15

basal insulin regime can be

Answer 15

once daily or twice daily

Question 16

once daily basal regime

Answer 16

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

Question 17

twice daily basal regime

Answer 17

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

Question 18

short and intermediate acting pre-mixture

Answer 18

humulin M3, inhumar comb 15,25,50 (15% short acting 85% intermediate, 25% short acting, 75% intermediate…)

Question 19

rapid and intermediate acting pre-mixture

Answer 19

humalog mix 25/50 or novomix 30

Question 20

basal bolus (prandial regime)

Answer 20

patients take a long acting insulin in the morning or evening and a rapid acting insulin before each main meal (breakfast, lunch and dinner)

Question 21

before the rapid acting glucose is injected

Answer 21

blood glucose levels must be checked

Question 22

general dosage in basal bolus insulin

Answer 22

10 units of long acting insulin

0.1-0.3 units/kg of rapid acting insulin 15 minutes before each meal

Question 23

target blood glucose levels for basal bolus insulin

Answer 23

pre-meal: 4-7 mol/l

1-2 hours after beginning of a meal: less than 10mmol/l

Question 24

advanced carbohydrate counting

Answer 24

synchronises the amount of insulin injected with the carbohydrate consumed

Question 25

advanced carbohydrate counting used for

Answer 25

people who take multiple daily insulin injections and those on a subcutaneous insulin pump

Question 26

1 unit of insulin per

Answer 26

10g of carbohydrates

Question 27

insulin pump

Answer 27

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

Question 28

factors affecting insult absorption

Answer 28

temperature, injection depth, exercise, lipohypertrophy

Question 29

regime of choice for type 1 diabetes

Answer 29

twice daily insulin detemir regime