Insulin Therapy Flashcards
Briefly describe the Basal-Bolus insulin regime
Multiple daily injection basal-bolus insulin regimens- the person has injections of short-acting insulin or rapid-acting insulin analogue before meals, together with one or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue to cover the basal requirement
Briefly describe the mixed (bisphasic) insulin regime
One, two or three insulin injections per day of short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin
Briefly describe the continuous subcutaneous insulin infusion (insulin pump) therapy
Programmable pump and insulin storage reservoir that gives a regular or continuous amount of insulin (usually in the form of a rapid-acting insulin analogue or short-acting insulin) by a subcutaneous needle or cannula
What is the first-line insulin regime for treating type 1 diabetes?
Basal-Bolus regime
What are the broad categories of insulin therapy?
- Rapid- and short-acting insulins have a quick onset of action and a short duration of action
- They are used to replicate the insulin normally produced by the body in response to glucose absorbed from a meal or sugary drink
- Intermediate- and long-acting insulins have a slow onset of action and a long duration of action
- They mimic the effect of endogenous basal insulin (insulin that is secreted continuously throughout the day)
Rapid-acting insulins:
- Onset of action
- Duration of action
- Examples
- 15 minutes
- 2–5 hours
- Humalog® (insulin lispro) and Novorapid® (insulin aspart)
Short-acting insulins:
- Onset of action
- Duration of action
- Examples
- 0–60 minutes
- 8 hours
- Actrapid® and Humulin S®
Intermediate-acting insulins:
- Onset of action
- Maximal effects
- Duration of action
- Examples
- 1–2 hours
- 3–12 hours
- 11–24 hours
- Humulin I®, Insuman Basal® and Insulatard®
Long-acting insulins:
- Duration of action
- Steady state level achieved
- Examples
- Up to 24 hours
- 2–4 days
- Lantus® (insulin glargine), Levemir® (insulin detemir) and Tresiba® (insulin degludec)
What accessories are needed for a patient on insulin therapy?
- Insulin injection device
- Needles for pen injectors
- Blood glucose meter, test strips and lancets for self-monitoring of blood glucose
- Ketone meter, test strips and lancets
- Glucose and/or glucagon kit
- Accessories for sharps disposal
How is insulin administered?
Insulin preparations are usually given by subcutaneous injection because insulin is destroyed by gastric acid and is not absorbed across the gut mucosa. For some people, insulin is given by subcutaneous infusion via an insulin pump.
Give advice on injection sites of insulin therapy
To choose a body area that has plenty of subcutaneous fat, ensuring that the site and hands are clean. The main injection sites are:
- Abdomen- fastest absorption rate compared with other sites
- Outer thigh
- Buttocks
- Arm (not usually recommended due to the difficulty in injecting at this site)
If necessary, the skin should be ‘pinched up’ to avoid injecting into the muscle.
The injection site should be:
- Checked regularly for lumps (lipohypertrophy) and other injection site problems
- Rotated to prevent lipohypertrophy
Give advice on target blood glucose self-monitoring levels for adults with type 1 diabetes
Advise routine self-monitoring of blood glucose levels at least 4 times a day (including before meals and before bed).
Discuss optimal targets for glucose self-monitoring.
The optimal targets for glucose self-monitoring in adults with type 1 diabetes are:
- Fasting plasma glucose level of 5–7 mmol/L on waking;
- Plasma glucose level of 4–7 mmol/L before meals at other times of the day;
- For adults who choose to test after meals, plasma glucose level of 5–9 mmol/L at least 90 minutes after eating.
According to NICE, is continuous glucose monitoring currently recommended in type 1 diabetics?
No
At what blood glucose level is hypoglycaemia defined as?
Levels fall to less than 3.5 mmol/L
