insulin therapy

Question 1

Indications of insulin

Answer 1

diabetes mellitus

Question 2

Contraindications of insulin

Answer 2

none

Question 3

First and second line treatment with insulin

Answer 3

first line for adults and children - multiple daily injection basal-bolus insulin regimens. this is injections of short/rapid acting before meals, with one or more separate daily injections of intermediate/long acting insulin as well

second line for children - insulin pump therapy (continuous subcutaneous insulin infusion). a programmable pump and insulin storage device that gives regular or continuous amounts of rapid/short acting insulin by subcutaneous needle or cannula

second line for adults - twice daily mixed insulin regimens

Question 4

Mechanism of action of insulin

Answer 4

the body cannot produce insulin so it is provided. it binds with receptors on cells (mostly liver, fat and muscle), insulin-receptor binding causes cells to become permeable to glucose so it can go out of the blood into the cells. fatty acids, amino acids and electrolytes also enter the cells, this enables anabolism and inhibits catabolism.

carbohydrate metabolism - regulates glucose metabolism to produce energy for cellular functions

fat metabolism - promotes the storage of fat by promoting glucose to turn into fat when it is broken down, when insulin is lacking fat is released into the bloodstream as free fatty acids

protein metabolism - insulin increases the total amount of body protein by increasing transport of amino acids into cells and synthesising proteins within the cells

Question 5

Common side effects of insulin

Answer 5

transient oedema, fat hypertrophy/local injection site reactions

Question 6

Monitoring requirements for insulin

Answer 6

blood plasma glucose concentrations between 4-9mmol/l (4-7 before meals, less than 9 after) for adults and 4-10mmol/l (4-8 before meals, less than 10 after) for children.

Question 7

Treatment cessation for insulin

Answer 7

hyperglycaemia, very dangerous can be fatal

Question 8

Patient and carer advice for insulin

Answer 8

hypoglycaemia is a potential risk for all insulin therapy. all patients must be instructed on how to advise it, this involves appropriate adjustment of insulin type, dose, and frequency together with suitable quantity and timing of meals and snacks

Question 9

Peak, onset and duration of rapid acting insulin

Answer 9

peak - 1-3 hours
onset - 15 mins
duration - 3-5 hours

Question 10

Peak, onset and duration of short acting insulin

Answer 10

peak - 2-3 hours
onset - 0.5-1 hour
duration - 5-7 hours

Question 11

Peak, onset and duration of intermediate acting insulin

Answer 11

peak - 8-12 hours
onset - 1-1.5 hours
duration - 18-24 hours

Question 12

Peak, onset and duration of long acting and mixed insulin

Answer 12

peak - 10-30 hours
onset - 4-8 hours
duration - 36+ hours

Question 13

Peak, onset and duration of analogue insulin

Answer 13

peak - none
onset - 1.1 hours
duration - 24 hours