Insulin

Diabetes Outreach(June 2011)

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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.

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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.

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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.

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Natural insulin pattern

basal

bolus

Breakfast

LunchTea

Blo

od

insu

lin le

vel

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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.

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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.

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Types of insulin's available

Short (bolus)

Rapid (bolus)

NPH (basal)Detemir (basal)

Glargine (basal)

Pla

sma

Insu

lin L

evel

s

Hours

0 2 4 6 8 10 12 14 16 18 20 22 24

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Timing of insulin

Bolus (meal time) Basal (background)

Timing Timing

Rapid immediately Glargine anytime (same time each day)

Short 30mins prior Detemir Breakfast

Bed time (2130 or ask person)

Pre-mix

- Rapid

- Short

immediately

30mins prior

NPH Breakfast

Bed time

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Human analogue: Humalog/ Novo Rapid/ Apidra> onset 0.25 - 0.5 hrs> peak 1 - 3 hrs> lasts 3 - 5 hrs

Rapid insulins (bolus insulins)

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> onset 0.5 - 1 hr

> peak 2 - 4 hrs

> lasts 5 - 8 hrs

Short acting insulins (bolus)

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NPH insulins (basal)

Isophane: Protaphane/ Humulin NPH (cloudy)> onset 1 - 2 hrs> peak 4 - 12 hrs> lasts 16 - 24 hrs

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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

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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 30/70Mixtard 50/50

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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

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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.

plunger depressed to deliver dose

replaceable needle to deliver the dose

window indicating dose

dial rotated to deliver dose

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Insulin therapy in hospital

What are the nurses responsibilities in the area of insulin administration whilst the person is in hospital?

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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.

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References

> Diabetes Outreach (2009) Diabetes Manual, Section 10: Medication

> MIMS product information sheet

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