Insulin Therapy: Types, Administration, and Patient Care (Concise)

BERTIE

Training resources for Type 1 insulin and eating.

DESMOND

Diabetes education for Type 2 patients.

Describe rapid insulin

taken 3 times daily, good for acute hypoglycaemia and food cover, Humalog, Novorapid

Describe biphasic insulin

rapid+ intermediate, Novomix30, needs similar food and exercise, so hard to titrate

Describe intermediate insulin

good daily cover, lasts 12-18h, Humulin 1, good for diabetes type 2 and steroid induced hyperglycemia

Describe long acting insulin

good daytime cover lasts 20-24 h, Lantus

Describe ultralong insulin

lasts 40h, good for patients for compliance issues

what is HbA1c target and how often is it monitored for type 1

monitor every 3-6 months, aim for 48 mmol/L or 6.5%

How often should diabetic patients monitor glucose and what are the aims

4x, waking 5-7, before meal 4-7 and after meal 5-9

What is basal-bolus regime

rapid acting insulin analogue Lispro taken before meal TDS, intermediate Levemir taken BD or long acting Glargine OD

When is insulin indicated in type 2

acute hypoglycaemia, initial HbA1c > 75, symptoms like rapid weight loss, polyuria, nocturia, blood glucose is not controlled by dual oral therapy, oral drugs are contraindicated

Describe Subcutaneous insulin pump

plastic cannula terminates subcutaneously or patch pump omni pod 5

there is continuous micro basal insulin infusion and patient activated bolus doses at meal times

Which patients is subcutaneous pump suitable for

recurrent hypoglycaemia, uncontrolled hyperglycaemia

Describe continuous glucose monitoring CGM

device is on the arm or back and it constantly monitors your serum glucose, so doesn't require finger blood prick

describe hybrid closed loop HCL

sensor tells the pump what the blood glucose is and the pump administers insulin accordingly

Which patients is HCL given for

HbA1c > 58 or disabling hypoglycemia

What is the basal insulin used for type 2 diabetes

OD or BD isophane first line

When is bolus insulin introduced for type 2

BD biphasic insulin is started if HbA1c>75, hypoglycaemic, hyperglycaemic after meals or preference

What to educate the patient on

hypoglycaemia, driving, monitoring, employment, weight management, exercise, healthy eating, alcohol, travel, special occasions, injection technique

Describe injection technique

inject subcutaneous tissue at the back of arms, side of legs, stomach, butt, change injection sites and if lumpy fat develops stop using and monitor the site

describe the hypoglycaemia symptoms

below 4-anxious, sweating, pale, palpitations, hungry, shaking, tingling lips

below 2.5- aggressive, comatose, slurring the words

What could be the causes of hypoglycaemia

missing meals, taking insulin at the wrong time, injection technique, alcohol/drugs, not re-suspending intermediate insulin, exercise, renal failure

what could be the causes of lack of glucose control and what to do

diet, illness, stress, adherence increase or decrease the dose by 10%

if erratic then injection technique or site, monitoring issues, lifestyle, psychological issues, GI issues