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Who uses insulin?
- Type 1 diabetics
- Type 2 diabetics who cannot control sugars with lifestyle and oral anti-hyperglycemics
- Any severe hyperglycemia where rapid blood sugar reduction is required
Types of insulin – brand name (generic)
Rapid acting (manufacturer + log)
- Novolog or Novorapid (aspart)
- Humalog (lispro)
- Apidra (glulisine)
Short acting
- Humulin R (regular insulin)
- Novolin ge Toronto (regular insulin)
Intermediate acting
- Humulin N (NPH)
- Novolin ge NPH (NPH)
Long acting
- Lantus (glargine)
- Levemir (detemir)
Ultra-long acting
What is premixed insulin?
- Typically used in conventional insulin therapy in type II diabetics who need insulin
- Used twice daily with no other insulin, and can be used with oral hypoglycemics
- Used for patients who want to avoid more than 2 injections (to start), easier to use and more convenient
- Consists of a mixture of long and short acting insulin
- Rapid acting insulin + rapid acting insulin that has been crystallized with protamine in order to make it more like NPH insulin
- Options
- LISPRO + LISPRO PROTAMINE SUSPENSION (rapid + intermediate)
- Humalog Mix25 – short:long is 25:75
- Humalog Mix50 – short:long is 50:50
- ASPART + ASPART PROTAMINE SUSPENSION (rapid + intermediate)
- NovoMix 30 – short:long is 30:70
- Short acting + intermediate premixed insulin injections are also available but are not used as common
- How to administer dose?
- 2/3 of dose in the morning injection
- 1/3 of dose in the evening injection
Insulin regimens
- Depends on whether the patient is type I or type II diabetic (type I requires stricter sugar control)
- Type I diabetic insulin regimen
- Multiple daily injections
- Basal insulin 1-2x / day
- Bolus insulin 3 times daily
- DO NOT use premixed insulin for type I diabetic insulin regimens as it does not allow for modification to the ratio of the insulins which may be required
- Start with 0.3 – 0.5 units/kg per day
- Ranges from 0.5 units to 1 unit / kg per day
- Type II diabetic insulin regimen
- Existing anti-hyperglyemic agents, except for sulfonylureas are continued when insulin is started
- Progression of disease from top to bottom
- Bedtime basal insulin
- NPH, glargine (lantus), detemir (levimir)
- Premixed insulin (basal + bolus insulin)
- Commonly twice daily (pre-breakfast + pre-dinner)
- Multiple daily injections
- Basal insulin 1-2x / day
- Bolus insulin 3 times daily
- Discontinue all anti-hyperglycemics except for metformin
- Start with 0.3 – 0.5 units/kg per day
- Ranges from 0.5 to 1 unit / kg per day (more than 1 unit may be required in obese + insulin resistant patients
- Characterizing regimens in a different way – by number of injections
- 2 injection regimen
- 1 pre-breakfast premixed insulin injection (66 % of dose)
- 1 pre-dinner premixed insulin injection (33 % of dose)
- 3 injection regimen
- 3 premixed insulin injections (66 % + 17 % + 17 %)
- 4 injection regimen (split 50/50 between basal and bolus doses)
- 1 rapid-acting insulin injection before breakfast (17 % of dose)
- 1 rapid-acting insulin injection before lunch (17 % of dose)
- 1 rapid-acting insulin injection before dinner (17 % of dose)
- 1 long-acting insulin injection before sleep (50 % of dose)
- 5 injection regimen (rarely used by type II diabetics)
- 1 rapid-acting insulin injection before breakfast (17 % of dose)
- 1 rapid-acting insulin injection before lunch (17 % of dose)
- 1 rapid-acting insulin injection before dinner (17 % of dose)
- 1 long-acting insulin injection before sleep (25 % of dose)
- 1 long-acting insulin injection in the morning (25 % of dose)