Insulin Diabetes Outreach(June 2011)
Insulin Learning outcomes • Understand the difference between insulin therapy in type 1 diabetes as compared to type 2 diabetes. • State what is meant by basal and bolus insulin. • Understand the main groups of insulins. • Understand the basic principles regarding insulin administration.
Insulin action The action of insulin is to: • Help the movement of glucose into the cells. • Stimulate cells to take up glucose from the blood. • Facilitate the storage of glucose, amino acids and fatty acids. • Facilitate glycogen formation and storage in the liver.
Aim of insulin therapy • Exogenous insulin therapy aims to mimic the actions of endogenous insulin production so that blood glucose levels can be maintained as near to normal as possible • Type 1 diabetes: total insulin replacement for survival • Type 2 diabetes: insulin supplementation to improve glycaemic control when OHAs are no longer effective.
Natural insulin pattern bolus Blood insulin level basal Tea Breakfast Lunch
Insulin in type 1 diabetes • Insulin in type 1 diabetes is needed for survival. • No insulin is produced and so insulin must be administered to cover meal times (bolus) and between meals and overnight (basal). • Most people with type 1 diabetes are on an intensive regimen ie basal bolus or insulin pump therapy.
Insulin in type 2 diabetes • Over time people with type 2 diabetes start to produce less and less insulin and eventually require insulin therapy to reach target BGLs. • It is common for the person to start on one basal injection in combination with oral hypoglycaemic agents. • Over time their treatment will intensify as insulin secretion drops further.
Types of insulin's available Rapid (bolus) Short (bolus) Detemir (basal) Plasma Insulin Levels NPH (basal) Glargine (basal) 0 2 4 6 8 10 12 14 16 18 20 22 24 Hours
Rapid insulins (bolus insulins) Human analogue: Humalog/ Novo Rapid/ Apidra • onset 0.25 - 0.5 hrs • peak 1 - 3 hrs • lasts 3 - 5 hrs
Short acting insulins (bolus) • onset 0.5 - 1 hr • peak 2 - 4 hrs • lasts 5 - 8 hrs
NPH insulins (basal) Isophane: Protaphane/ Humulin NPH (cloudy) • onset 1 - 2 hrs • peak 4 - 12 hrs • lasts 16 - 24 hrs
Long acting analogue insulins (basal) Human analogue: • Glargine • onset 2 - 4 hrs • peak nil • lasts 24 hrs • Detemir • onset 1 - 2 hrs • peak 6 - 12 hrs • lasts 20 - 24 hrs
Premixed insulin - human Neutral plus Isophane mix: Mixtard 30/70, 50/50, Humulin 30/70 • human (cloudy) • mixture of intermediate and short Mixtard 30/70Humulin 30/70 Mixtard 50/50
Premixed insulin - analogue Biphasic insulin aspart plus protamine mix: NovoMix 30, Humalog Mix 25, Humalog Mix 50 • analogue (cloudy) • mixture of intermediate and rapid NovoMix 30 Humalog Mix 25
Self administration of insulin What are the important factors to consider when giving an insulin injection eg storage, sites for injection, preparing the injection, side effects, timing. window indicating dose plunger depressed to deliver dose dial rotated to deliver dose replaceable needle to deliver the dose
Insulin therapy in hospital What are the nurses responsibilities in the area of insulin administration whilst the person is in hospital?
Syringe disposal • Take care at all times • Store supplies in their original box • Use a sharps container • Do not recap needles/ pen needles/ lancets • For local arrangements about safe disposal of containers check council, public hospital or community health centre.
References • Diabetes Outreach (2009) Diabetes Manual, Section 10: Medication • MIMS product information sheet