Diabetes and Insulin.pptx

Basics of diabetes management, types and appropriate use of Insulin.

1. Diabetes: Management and Insulin Dr. Amit Garg

2. These are based on individual knowledge and ideologies. Does not reflect views of the organisation.

3. Diabetes Mellitus DM – a group of heterogeneous disorders with reduced carbohydrate metabolism & increased protein & lipid metabolism Insulin deficiency or insulin resistance Hyperglycemia , glycosuria 3 ‘polys’ – polyuria, polydipsia & polyphagia 2 major types – Type 1 and Type 2

4. Complications of Diabetes Microvascular Macrovascular

5. Pancreas

6. How does insulin work

7. Banting & Best with Marjorie, the dog (University of Toronto)

8. Evolution of Insulin Beef Pork Biotechnology Human Insulin

9. Types of Insulin Each type of insulin has an onset, a peak, and a duration time. The onset is how soon the insulin starts to lower blood glucose after it is taken. The peak is the time the insulin is working the hardest to lower blood glucose. The duration is how long the insulin lasts—the length of time it keeps lowering blood glucose.

10. Action Profiles of Insulins 1 2 5 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Plasma I nsulin levels Regular 6 – 8 hours NPH 12 – 16 hours Ultralente 18 – 20 hours Glargine ~24 hours Aspart, glulisine, lispro 4 – 5 hours Detemir ~14 hours Hours

11. Basal vs premixed insulin regimens: Schematic representation Insulin action Basal Insulin injection basal human insulin basal analogue insulin Insulin action Breakfast Lunch Dinner Premixed injection Premixed injection Premixed human insulin Premixed analogue insulin

12. Insulin Analogues Rapid-acting Absorbed very rapidly, last only a few hours Aim to control postprandial glucose e.g. Glulisine - Apidra ® , Aspart - NovoRapid ® , Lispro - Humalog ® Long-acting More slowly absorbed Designed to provide a low level of insulin throughout day and night e.g. Glargine U100 - Lantus ® , Detemir - Levemir ® Ultra-long-acting Very slowly absorbed Designed to act for more than 24 hours e.g. Glargine U300 - Toujeo ® , Degludec - Tresiba ® Premixed Mixture of rapid- and intermediate/long-acting insulin e.g. Aspart mix - NovoMix ® 30, Lispro mix - Humalog ® Mix 25/75, IDegAsp - Ryzodeg ®

13. Insulin injection devices and sites Syringes - 100 U, 40 U with varying needle gauges and lengths Reusable insulin pens : e.g. HumaPen Ergo II Disposable pen: e.g. Humalog KwikPen

14. Insulin syringes U40 (RED) - Each ml consists of 40 IU* of insulin U100 (Orange) - Each ml consists of 100 IU* of insulin

15. Injecting Single Type of Insulin 1. 3. 4. 2.

16. Injecting Single Type of Insulin 5. 6. 8. 7.

17.     2. 1. 5 . 4. 3. Mixing Two Types of Insulin

18. How to inject

19. REMEMBER…. Stay within same site 2.5 cm. apart ( about the width of 2 fingers ) Do not use the 5 cm. radius around the navel 1 2 3 4 5 6 7 8 Abdominal Site Rotation Adapted from Am J Clin Dermatol 2003; 4 (10)

20. Injection Rotation Guide Abdomen

21. Injection Rotation Guide Right Thigh Left Thigh

22. Insulin Storage Never freeze (Frozen insulin should be thrown away.) Never expose insulin to direct heat or light. Inspect insulin prior to each use. Any insulin that has clumps or solid white particles should not be used. Unused insulin should be stored in a refrigerator (2–8°C) After opening, an insulin vial should be discarded after 3 months if kept at 2–8°C or after 1 month if kept at room temperature In hot climates where refrigeration is not available, cooling jars or a cool wet cloth around the insulin will help to preserve the insulin

23. Things to remember Right Insulin Right Dose Right Time Right Technique

24. REMEMBER….. Fear of the injection is more painful than the injection itself !