Insulin therapy regimen

Insulin therapy
management
regimen

1. Insulin Therapy

2. Indications for insulin therapy
•Type 1 diabetes
•Women with gestational diabetes
•In type 2 diabetes, inadequately controlled on OADs
• type 2 diabetes in special situations-
–Pancreatitis
–DKA
–during surgery
–acute infections

3. Types of InsulinTypes of Insulin
1.Rapid-acting
(insulin Aspart)
2. Short-acting
humulin
3. Intermediate-acting
4. Premixed
5. Long-acting
lantus-(glargine).levemir(detemir)
(Analogs)
(Regular)
(NPH)
(70/30)

6. INSULIN
REGIMENS

7. Twice daily regimens
•Intermediate acting insulin(NPH)and
short acting (regular) insulin
•2/3 of insulin – morning(ratio 1:2)
•1/3 of insulin - evening

8. MULTIPLE –INJECTION REGIMENS
•Short acting- before meal
•Intermediate or long acting –once or twice
daily
•Advantage:-
–allows greater freedom with regard to meal timing
.
–More variable day to day physical activity

9. Dawns phenomenon
•Early morning hyperglycemia without nocturnal
hypoglycemia.
•It is due to counter regulatory hormones
•No need of insulin dose change.
–Solution
•Give long acting insulin not before 11 :00 p.m
•May need to increase dose of night time insulin

10. Continuous subcutaneous insulin infusion (CSII)
•Very effective insulin regimen for type 1 DM
•Sophisticated device
•requires education of the patient and frequent interactions with
diabetes management team
•Advantages:
– programmed dose
– basal infusion rates altered during exercise
– different doses of insulin can be matched based on meals
•Disadvantages---
– infection
–hyperglycemia
–DKA
•Short acting insulin analogues are used.
•SMBG

11. Insulin devices
•Insulin syringes—10ml insulin vials
30 unit—0.3 ml,50 unit-0.5 ml,100 unit-1ml
Needl es -8mm to 13mm
Use each syringe only once.
•Insulin pen-insulin catridge-3ml-300units fits into the
device
Disposable, reusable
•Insulin pumps-reservoir of insulin-infusion set
worn outside the body—abdomen
Only short or rapid acting insulin are used—mimics
physiological pattern
•Inhaled insulin

12. After injection

15. Side-effects of Insulin TherapySide-effects of Insulin Therapy
•Hypoglycemia(predominantly seen in type 1 patients)
•Weight gain
•Peripheral edema(salt and water retention in short term)
•Insulin antibodies(with animal insulin )
•Local allergy
•Lipohypertrophy
or lipoatrophy
at site of injection