INSULIN REGIMEN (T1) Flashcards
When is insulin used?
- Type 1
- Type 2 if oral antidiabetic medication fails
- Surgery
- Hospitalisation for illness e.g. DKA
T1DM - first line treatment
Basal bolus regime
- Insulin determir bd
- Insulin aspart before meals
Types of insulin regimens
1.Basal-bolus insulin regimens
2. Biphasic regimen
3. Continuous subcutaneous insulin infusion (insulin pump)
Multiple daily injection basal-bolus insulin regimens (FIRST LINE)
- 3 bolus injections of rapid acting insulin for meals
- Once-twice daily background long acting insulin
Basal
Long/ intermediate acting insulin
OD or BD
- detemir BD
- second line = glargine OD
Examples of long acting
Detemir (Levemir)
Glargine (Abasglar, Lantus)
Degludec (Tresiba)
Bolus
Short/rapid acting before meals
Biphasic mixture
Short-acting mixed with intermediate injection
1-3 times a day
Which insulin regimens should NOT be recommended to patients newly
diagnosed with type 1 diabetes?
Non-basal-bolus regimens:
- Biphasic
- Basal-only
- Bolus-only
Continuous subcutaneous insulin infusion (insulin pump)
Regular or continuous amount of insulin (usually rapid acting insulin analogue or soluble insulin) delivered by a programmed pump and insulin storage reservoir via SC needle or cannula
When would you give continuous subcutaneous insulin infusion (insulin pump)
- Disabling hypoglycaemia
- Glycaemic control >8.5% despite optimised MIR
- Children over 12 (MIR is impractical) BUT they must undergo MIR trial between 12-18
What factors require pt to increase insulin administration?
Infection
Stress
Trauma
What factors require pt to decrease insulin administration?
Physical activity
Intercurrent illness
Reduced food intake
Impaired renal function
Certain endocrine disorders (thyroid, coeliac, Addison’s)
Why is insulin give s/c
It is a protein which would be digested very quickly and inactivated by GI enzymes
Where is insulin administrated?
Injected into a body area with plenty of subcutaneous fat
- abdomen (fastest absorption rate)
- outer thighs/buttocks (slower absorption rate)
Why should you rotate the injection site?
Lipohypertrophy can occur due to repeated injection into the same area
leads to erratic absorption of insulin
What are the types of short acting insulin?
Soluble (short-acting) insulin
Rapid-acting insulin
Examples of soluble (short-acting insulin)
Animal: Hypurin porcine neutral
Human: Actrapid, Humulin S, Insuman Rapid
Soluble (short-acting) insulin
Inject: 15-30 mins before meals
Onset: 30-60 mins
Peak action: 1-4 hours
Duration: up to 9 hours
Soluble (short-acting) insulin counselling points
Must consume food within 30mins of injecting to avoid hypo
Can be given in diabetic emergencies + surgery
Soluble (short-acting) insulin: side effects
- Increased risk of hypo
- Local reaction and fat hypertrophy at injection site can occur
Rapid-acting insulin
Inject: immediately before meal
Onset: < 15 mins
Duration: 2-5 hours
Lower risk of hypo than soluble (short acting)
Alternative to soluble in emergency
Examples of rapid-acting insulin
Lispro (Humalog)
Aspart (NovoRapid)
Glulisine (Apidra)
LAG - doesn’t lag
Examples of Intermediate-acting insulin
Biphasic isophane, biphasic aspart / lispro (isophane insulin mixed with SA insulin)
Animal: Porcine isophane
Human: Insulatard, Humulin I, Insuman Basal