1. Insulin Diabetes Outreach (June 2011)

2. 2 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.

3. 3 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.

4. 4 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.

5. 5 Natural insulin pattern basal bolus Breakfast Lunch Tea Blood insulin level

6. 6 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.

7. 7 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.

8. 8 Types of insulin's available Short (bolus) Rapid (bolus) NPH (basal) Detemir (basal) Glargine (basal) Plasma Insulin Levels Hours 0 2 4 6 8 10 12 14 16 18 20 22 24

9. 9 Timing of insulin Bolus (meal time)Basal (background) Timing RapidimmediatelyGlargineanytime (same time each day) Short30mins priorDetemirBreakfast Bed time (2130 or ask person) Pre-mix - Rapid - Short immediately 30mins prior NPHBreakfast Bed time

10. 10 Human analogue: Humalog/ Novo Rapid/ Apidra >onset 0.25 - 0.5 hrs >peak 1 - 3 hrs >lasts 3 - 5 hrs Rapid insulins (bolus insulins)

11. 11 >onset 0.5 - 1 hr >peak 2 - 4 hrs >lasts 5 - 8 hrs Short acting insulins (bolus)

12. 12 NPH insulins (basal) Isophane: Protaphane/ Humulin NPH (cloudy) >onset 1 - 2 hrs >peak4 - 12 hrs >lasts16 - 24 hrs

13. 13 Long acting analogue insulins (basal) Human analogue: >Glargine –onset2 - 4 hrs –peaknil –lasts24 hrs >Detemir –onset1 - 2 hrs –peak6 - 12 hrs –lasts20 - 24 hrs

14. 14 Premixed insulin - human Neutral plus Isophane mix: Mixtard 30 / 70, 50 / 50, Humulin 30 / 70 >human (cloudy) >mixture of intermediate and short Mixtard 30/70 Humulin 30/70 Mixtard 50/50

15. 15 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

16. 16 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

17. 17 Insulin therapy in hospital What are the nurses responsibilities in the area of insulin administration whilst the person is in hospital?

18. 18 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.

19. 19 References >Diabetes Outreach (2009) Diabetes Manual, Section 10: Medication >MIMS product information sheet

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