Insulin Therapeutics 2 W3

Question 1

What do insulin regimens aim?

Answer 1

To mimic physiological insulin release
- Constant low level release (basal)
- Dramatic increase in insulin in response to rise in blood glucose after food intake (bolus)

Question 2

What are the insulin regimes that are used to try and achieve this type of response?

Answer 2

Multiple dosing of insulin

Twice daily dosing of insulin

Once daily dosing of insulin

Sliding scale

Question 3

Multiple dosing of insulin regime

Answer 3

Immediate/long acting basal once daily and at night and multiple short acting at meal times

Question 4

Multiple dosing of insulin regime advantages

Answer 4

Flexible if need to delay a meal/adjust to exercise and suitable for shift workers or people with busy jobs or the travel

Question 5

Multiple dosing of insulin regime disadvantages

Answer 5

More injections

Question 6

Twice daily dosing of insulin regime

Answer 6

Short and intermediate acting pre-mixed

Question 7

Twice daily dosing of insulin advantages

Answer 7

Simple and relatively good control

Less injections

Question 8

Twice daily dosing of insulin disadvantages

Answer 8

Inflexible/fixed time

Timed and constant food intake lifestyle, especially exercise

Question 9

Once daily dosing of insulin regime

Answer 9

Not really for type one diabetes

Intermediate/lung acting basal once daily at night

Often used in combination with oral hypoglycaemic

For example, in type two diabetes where maximal oral hypoglycaemic therapy does not give control

Question 10

Sliding scale therapy

Answer 10

Normally in hospital

IVs for medical emergencies (DKA), perioperatively, labour, unstable diabetes

Given by continuous IV fusion and rate is adjusted frequently according to blood glucose levels

Question 11

Bedside capillary blood glucose and the initial rate of insulin infusion per hour

Answer 11

<4.0 = 0.5

9.1-11.0 = 3

> 20 = see diabetes team or medical advice

Question 12

Starting insulin: what happens? when we start a patient on insulin?

Answer 12

Start with very low doses and increase very slow slowly to avoid hyperglycaemia

Often the honeymoon period when some recovery of indigenous insulin production - this is in the early stages of insulin administration

Twice daily: 6 to 10 units twice a day is a typical start regime

Normally multiple dosing regime of 60% short and 40% long

Patience can be taught to adjust dose according to preprandial blood glucose

Question 13

Adjusting doses

Answer 13

It’s most important to remember that pre-meal result is a result of the previous dose of insulin so don’t change until the next insulin dose

Usually adjust doses by 10% alloquots

Do you know what I meant doses if it’s too low manage this by increasing food intake

Question 14

Storage

Answer 14

Long-term storage is always in the fridge as there can be a loss of 5 to 10% potency at room temperature over 2 to 3 months

If currently using the wire or pen, then keep it out of the fridge as cold insulin takes longer to absorb and stings

Can only keep for one month out of the fridge

Avoid freezing as this will decrease activities significantly so keep in the salad container in the fridge

Question 15

Sick day rules

Answer 15

During illness, diabetics type one and type two should:
- Not stop taking tablets or insulin even if not eating went ill
- Test blood more often (four times daily or more) as they are at risk of DKA they do not do this
- Test for ketones as this will indicate DKA
- Drink plenty of fluids
- Replace normal meals to carbohydrate containing drink drinks if cannot eat