Insulin Therapy Flashcards
Types of human insulin
-Short acting (eg actrapid, Humulin S)
-Intermediate acting (eg Humulin I, insulatard)
Describe short-acting human insulin
-Onset within 30-60 mins
-Peak action 2-3h
-Lasts 6-8h
Describe intermediate acting human insulin
-Onset ½-2 hours
-Peak action 4-6h
-Duration 10-16h
Describe intermediate acting human insulin
-Onset ½-2 hours
-Peak action 4-6h
-Duration 10-16h
Describe rapid acting human analogue insulin
-Novorapid, Humalog, Apidra
-Onset 10-20 mins
-Peak 1.5-2.5h
-Duration 4.5-6h
Describe long acting human analogue insulin
-Levemir, lantus, deglugec
-Onset 1-2 hours
-Minimal peak at around 6-10h
-Duration 18-26 hours
-Degludec: last up to 36 hours with nearly no peak
Describe mixed insulins
-Mixed insulins have a biphasic profile, as they usually contain between 25-30% short acting insulin, and the rest is intermediate acting
-Top curve = analogue insulin
Eg novomix 30, Humalog mix 25
-Lower curve = Human insulin
Eg Humulin M3
Describe the regular insulin profile for T1DM
-Patient try to replicate their normal physiology as much as possible
-Typical daily dose is 0.5units/kg of insulin
-Approx 40-50% will be basal insulin
-The remainder, prandial/ mealtime insulin
Describe carb counting in T1DM
-Calculate the grams of CHO in a meal
=Food labels
=Weigh food
=Apps eg Carbs and Cals
-Work out the amount of insulin for that amount of carbs:
=1 unit for 10g
=1 unit for 7g etc
What are correction doses?
-If high before a meal, blood glucose should be corrected with extra insulin, as well as the meal insulin
-1 unit of rapid acting insulin will reduce blood glucose in an insulin sensitive person by 2-3mmol/l
Describe insulin regimes in T2DM
-Insulin is used in T2DM only when blood glucose not to target despite tablets and lifestyle modification
-Patients are insulin resistant, so may require large doses
-Typical regimes are once daily intermediate insulin, once daily long acting insulin or pre-mixed insulin
Indications for Variable Rate IV Insulin Infusion (VR111)
-Perioperatively
-Nil by mouth and missing more than 1 meal
-Vomiting
-Severely unwell with the need for good glucose control (eg sepsis)
-As well as insulin, there is a separate iv line for dextrose
What is lipohypertrophy?
Dense tissue forms in an area repeatedly injected with insulin due to the anabolic effect of insulin causing local fat cells to enlarge and proliferate
Describe Insulin pumps
-Contains rapid acting insulin
-Still need to calculate a bolus for a meal, snack or to correct a high blood glucose
-Can reduce the basal rate to avoid hypos overnight or around exercise
Describe closed loop systems
Continuous glucose monitor “talks” to an insulin pump which automatically adjusts insulin to blood glucose
