Insulin Administration

T1DM

within the normal range or underweight

T1DM

insulin deficiency as a result of ß-cells damage

T1DM

anti-GAD, ICA, IA2, IAA, ZnT8

T1DM

acute with accompanying diabetic ketoacidosis

T1DM

basic pharmacotherapy: insulin

T2DM

overweight or obese

T2DM

insulin resistance

T2DM

not found presense of antibodies

T2DM

mild onset

T2DM

pharmacotherapy: initially metformin and other orally administered medications, in some cases insulin

1921

Animal insulin is discovered

1922

1st shot was given to Leonard Thompson

Leonard Thompson

1st shot was given to who?

1923

Banting and Macleod won the Nobel Prize

Banting and Macleod

won the Nobel Prize

1930s – 1950s

Newer animal insulins

1970s

• Purification

1980s

• “human” insulin

rapid-acting

How Fast It Starts to Work (onset): 15 minutes

When It Peaks: 1 hour

How Long It Lasts (duration): 2 to 4 hours

ultra rapid-acting

How Fast It Starts to Work (onset): 15 minutes

When It Peaks: 1 hour

How Long It Lasts (duration): 5 to 7 hours

rapid-acting, inhaled

How Fast It Starts to Work (onset): 10 to 15 minutes

When It Peaks: 30 minutes

How Long It Lasts (duration): 3 hours

regular, also called short-acting

How Fast It Starts to Work (onset): 30 minutes

When It Peaks: 2 to 3 hours

How Long It Lasts (duration): 3 to 6 hours

How Fast It Starts to Work (onset): 2 to 4 hours

When It Peaks: 4 to 12 hours

How Long It Lasts (duration): 12 to 18 hours

long-acting

How Fast It Starts to Work (onset): 2 hours

When It Peaks: does not peak

How Long It Lasts (duration): 24 hours

ultra long-acting

How Fast It Starts to Work (onset): 6 hours

When It Peaks: does not peak

How Long It Lasts (duration): 36 hours or longer

Orally inhaled rapid-acting insulin

indicated to improve glycemic control

Insulin Preparation (Syringe)

• most common insulin delivery method

• plastic, disposable syringes

• available in three sizes can hold up to 30, 50 or 100 units of insulin.

• needles are fine (up to 31 gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults.

Insulin pumps

deliver insulin continuously subcutaneously as per preset infusion rates.

Infusion Pump

delivers predetermined basal rates to meet nonprandial insulin requirements.

insulin pump

contains an insulin filled cartridge or a syringe connected to a catheter that is inserted into the subcutaneous tissue.

abdomen

Absorption is fastest in the

lipodystrophy

Rotating injection site areas prevents

lag time

The interval between premeal injections and eating, known as ___ affects blood glucose levels after meals

45-degree angle

is advised for frail older adults and cachexic

frail older adults and cachexic

a 45-degree angle is advised for

4 mm or 5 mm

Patients with high body mass index (BMI) levels can use _____ needles to inject insulin at a 90-degree angle without pinching a skinfold before injection.

Intensified regimens

include a basal dose of intermediate- or long-acting insulin and a bolus dose of short- or rapid-acting insulin designed to bring the next blood glucose value into the target range.

Multiple-component insulin therapy

combines short- and intermediateacting insulin injected twice daily.

Single daily injection

protocols require insulin injection only once daily

• Anabolic steroids,

• salicylates, alcohol,

• and monoamine oxidase inhibitors (MAOIs)

may increase the hypoglycemic effect of insulin.

• orticosteroids,

• sympathomimetic drugs,

• thiazide diuretics,

• dextrothyroxine sodium

may reduce the effects of insulin, resulting in hyperglycemia.

Beta-adrenergic blockers

may prolong the hypoglycemic effect of insulin and may mask signs and symptoms of hypoglycemia.

Rebound Hyperglycemia

Dawn phenomenon results from a nighttime release of growth hormone that causes release of liver glucose resulting in blood glucose elevations at about 5 to 6 am.

Somogyi phenomenon

is morning hyperglycemia from the counterregulatory response to nighttime hypoglycemia resulting in release of liver glucose.