Insulin regimens for type I diabetes

The most commonly used insulin injection preparations are the 'artificial' human insulins. Insulins are classified according to their time course of action:

• rapid-acting and short duration—lispro insulin

• short-acting—neutral (regular, soluble)

• intermediate-acting—isophane (NPH) or lente

• long-acting—ultralente

• mixed short/intermediate—biphasic (neutral + isophane)

Starting insulin 2

It is important to use the simplest regimen for the patient and to provide optimal education about its administration and monitoring. Full replacement of insulin is achieved by using 2, 3 or 4 injections per day.

• The pre-mixed 2 injection system: Give twice daily, before breakfast and before evening meal. e.g. Mixtard 30/70, Humulin 30/70 (the most common)

Typical starting dose: 0.3 IU/kg/day—for a 70 kg person use 10 units bd

• 3 injections per day

Short-acting insulin before breakfast and lunch Intermediate- or long-acting insulin before evening meal

• 4 injections (basal-bolus) system:

Short-acting insulin before breakfast, lunch and dinner Intermediate-acting insulin at bedtime

Insulin requirements often vary significantly even in the same individual under different lifestyle conditions. The new rapid-acting analogues can be taken with meals.

Methods of giving insulin injections

When:

Get the patient to develop a set routine such as eating meals on time and giving the injection about 30 minutes before the meal.

Into subcutaneous tissue—the best place is the abdomen (Fig 17.2). It is advisable to keep to

Where' one area such as the abdomen and avoid injections into the arms, near joints and the groin. The injection should be given at a different place each time, keeping a distance of 3 cm or more from the previous injection. This reduces the risk of the development of lipodystrophy.

Pinch a large area of skin on the abdomen between the thumb and fingers and insert the How: needle straight in. After withdrawing the needle, press down firmly (do not rub or massage) over the injection site for 30 seconds.

Fig. 17.2 Method of giving insulin injections; use the abdomen
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