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    Insulin New

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    Sheik
    This document provides information on insulin therapy, including indications for insulin use, administration, dosing, insulin profiles, regimens, dose calculation, and factors influencing effectiveness. It discusses the principles of insulin therapy and notes that dosage depends on individual factors and needs frequent monitoring. Insulin can be started at 0.3-0.7 U/kg/day for type 1 diabetes and 0.1-0.4 U/kg/day for type 2 diabetes. Various regimens like basal-bolus, premixed twice daily, and basal are described. Practical aspects of timing, storage, and injection technique are also covered. Adverse effects like hypoglycemia, weight gain, and lipohypert

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    Insulin New

    Uploaded by

    Sheik
    22 views41 pages
    This document provides information on insulin therapy, including indications for insulin use, administration, dosing, insulin profiles, regimens, dose calculation, and factors influencing effectiveness. It discusses the principles of insulin therapy and notes that dosage depends on individual factors and needs frequent monitoring. Insulin can be started at 0.3-0.7 U/kg/day for type 1 diabetes and 0.1-0.4 U/kg/day for type 2 diabetes. Various regimens like basal-bolus, premixed twice daily, and basal are described. Practical aspects of timing, storage, and injection technique are also covered. Adverse effects like hypoglycemia, weight gain, and lipohypert

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    This document provides information on insulin therapy, including indications for insulin use, administration, dosing, insulin profiles, regimens, dose calculation, and factors influencing effectiveness. It discusses the principles of insulin therapy and notes that dosage depends on individual factors and needs frequent monitoring. Insulin can be started at 0.3-0.7 U/kg/day for type 1 diabetes and 0.1-0.4 U/kg/day for type 2 diabetes. Various regimens like basal-bolus, premixed twice daily, and basal are described. Practical aspects of timing, storage, and injection technique are also covered. Adverse effects like hypoglycemia, weight gain, and lipohypert

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    22 views41 pages

    Insulin New

    Uploaded by

    Sheik
    This document provides information on insulin therapy, including indications for insulin use, administration, dosing, insulin profiles, regimens, dose calculation, and factors influencing effectiveness. It discusses the principles of insulin therapy and notes that dosage depends on individual factors and needs frequent monitoring. Insulin can be started at 0.3-0.7 U/kg/day for type 1 diabetes and 0.1-0.4 U/kg/day for type 2 diabetes. Various regimens like basal-bolus, premixed twice daily, and basal are described. Practical aspects of timing, storage, and injection technique are also covered. Adverse effects like hypoglycemia, weight gain, and lipohypert

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 41

    INSULIN

    UNIT 2

    CHIEF
    DR. N.D.SOJI MD GEN MED

    PRESENTER
    DR SIVANATHAN.PG
    INDICATION OF INSULIN THERAPY

    • Type I diabetes mellitus


    • Type II diabetes mellitus not controlled with maximum doses of OHA
    • Type II DM patients during the period of stress
    Acute infection
    Severe weight loss
    Major surgery
    Acute myocardial infarction, stroke
    Acute emergency like DKA, HHS
    • Pregnancy with diabetes
    • Renal failure, liver failure, CCF
    • Hyperkalemia
    ADMINISTRATION

    • Principles of insulin therapy

    • Varies between individuals and changes over time

    • The correct dose of insulin is the dose that achieves the best glycemic
    control without causing obvious hypoglycemia problems and achieving
    normal growth(height and weight)
    • Dosage depends on,
    • Age, weight, stage of puberty, duration and phase of diabetes, state
    of injection sites, nutritional intake and distribution, exercise
    pattern, daily routine
    INSULIN DOSE

    •Individualize dose based on metabolic needs and frequent monitoring of blood


    glucose
    •In Type 1 DM Insulin can be started at dose of 0.3 – 0.7 U/kg/day
    •In type 2 DM insulin can be started at dose of 0.1-0.4 U/Kg/day
    •Prepubertal children usually require 0.2-0.6 U/kg/day
    (Honeymoon phase)
    •During puberty due to hormonal changes, requirements may rise even up to
    2 U/kg/day
    CARBOHYDRATE TO INSULIN RATIO

    •The carbohydrate-to-insulin ratio (CIR) is the number of grams of carbohydrate that


    are covered by 1 unit of insulin.
    •The CIR is calculated by dividing the constant 450 by the Total Daily Dose (TDD).
    The CIR may be different for different meals of the day.
    •CIR = 450 / TDD
    Example:
    TDD= 50 units Regular insulin
    CIR= 450 /50 = 9 grams/unit
    INSULIN SENSITIVITY FACTOR

    •The amount blood glucose is lowered by the injection of 1 unit of insulin is called the
    insulin sensitivity factor
    •Calculated by dividing the constant 1700 by the Total Daily Dose (TDD) of rapid acting
    insulin Or
    Dividing the constant 1500 by the Total Daily Dose of insulin (TDD) of
    short acting insulin.
    Example:
    TDD= 50 units Regular insulin
    ISF= 1500 /50 = 30 mg/dL
    •Insulin sensitivity factor can only be effectively assessed for people with type 1 diabetes
    CORRECTION DOSE:

    • Can be used to lower their blood glucose levels in Diabetics, when they are out of their
    target range
    • The current premeal blood sugar is 210 mg/dL
    • The target premeal blood sugar is 120 mg/dL
    • Correction dose =(Current blood sugar -Target blood sugar) / ISF
    • Example
    Correction Dose = (210-120)/ 30
    = 90/30
    = 3 units
    INSULIN PROFILES
    INSULIN PROFILES (ANALOG)
    INSULIN REGIMENS

    • Basal Bolus ( 3 Prandial And One/Two NPH or Basal Analog)

    • Only Basal (NPH or Basal Analog)

    • Premixed Twice a day (30/70 Conventional or Analog)

    • One Regular or short acting analogue to control PPG


    INSULIN REGIMENS
    PRE MIXED TWICE DAILY REGIMEN
    • Contains Intermediate acting (NPH) – 70%
    and Regular (R) Insulin – 30%

    • 2/3 dose in Morning and 1/3 dose in evening

    • Suboptimal to control post-lunch and/or pre-dinner hyperglycaemia in


    some patients
    BASAL INSULIN

    • Usually given at night


    • Long acting, peak less insulin given
    BASAL PLUS

    • Basal insulin at night


    • Any rapid acting insulin given at premeal
    • May be useful during early years of T2DM and in uncomplicated well
    motivated patients
    • May be needed to shifted to basal bolus regimen
    BASAL BOLUS REGIMEN

    • 50 Percent of Total daily dose as Basal (once or twice)


    • Remaining 50 Percent of Total dose as Prandial divided over 3 Meals
    • Administer according to CIR and titrate with correction dose.
    • More physiological and Flexible
    INSULIN DOSE CALCULATION

    • Calculate total daily insulin


    • 0.5*weight/ sum of current dose
    • Example- 60kg-30U

    • Total meal time insulin- lispro, aspart, regular


    • 60% of TDI
    • 18U—three divided doses—prebreakfast, prelunch, predinner
    • Total basal insulin—NPH, glargine, ultralente
    • 40% of TDI
    • 12U—bed time
    INSULIN PREFERENCE AND ADJUSTMENT
    Blood glucose Insulin to be changed

    Fasting Bedtime intermediate- or long-acting

    Pre-lunch Morning intermediate-acting or short- or rapid-acting insulin

    Pre-dinner Morning intermediate-acting insulin or lunchtime short- or


    rapid-acting insulin

    During the night Supper-time or bedtime intermediate-acting or long-acting


    insulin
    EFFECTIVENESS OF INSULIN
    FACTORS INFUENCING INSULIN THERAPY
    FACTOR EFFECTS
    Site of injection Abdominal Injection (particularly if above the umbilicus)
    results in the quickest absorption;.
    Depth of injection Intramuscular injections are absorbed more rapidly than
    subcutaneous injections.
    Insulin concentration U-40 insulin (40 units per mL) is absorbed more rapidly than U-
    100 insulin (100 units per mL).
    Insulin mixing Regular insulin mixed with NPH insulin is compatable ;
    however, mixing regular insulin with lente or ultralente insulin
    slows absorption and blunts the activity of regular insulin.
    Exercise increases the rate of insulin absorption.
    Heat application or increases the rate of insulin absorption
    massage
    SOMOGYI EFFECT

    • It is due to over insulin


    • Hyperglycemia proceeded by insulin induced hypoglycemia particularly
    NPH
    • Hypoglycemia causes an increase in the secretion of counter regulatory
    hormones(glucogan, epinephrine, cortisol, growth hormone), which inhibit
    insulin secretion and increase glucose output by the liver(by
    glycogenolysis and gluconeogenesis)
    • Treatment –3.00am RBS and gradual reduction of insulin dose
    DAWNS PHENOMENON

    • Fasting hyperglycemia without nocturnal hypoglycemia


    • Due to low dose administration of insulin, overnight realise of hormones,
    carbohydrate snack consumption at bedtime
    PRACTICALS

    Timing
    • Soluble insulin: 30-45 minutes pre-meal
    • Intermediate- 30 minutes before meal
    • Long-acting insulins (with No Peak) do not have to be given in relation to a
    meal
    • Insulin analogues- along with food.
    PRACTICALS

    STORAGE
    • One month in fridge 2-8degree or at room temperature once the vial has been opened
    • Must never be frozen
    • Store away from source of heat
    • If refrigeration not available – Frio bags available
    • May be damaged by direct sunlight or vigorous shaking
    • Excess agitation avoided
    • If used for more than one month may lost the potency
    INCREASING REQUIREMENTS

    • Infection
    • Stress
    • puberty, pregnancy,
    • Acromegaly
    • cushing syndrome
    • Lipohypertrophy
    • Malignancy
    DECREASING REQUIREMENTS

    • Impending renal failure


    • Honeymoon phase of type I DM
    • Hypothyroidism
    • Addisons disease
    • Hypopituitarism
    • Remission of diabetes
    IN RENAL DISEASE

    • Dose of the insulin has to be reduced because of insulinase enzyme does


    not function
    • Insulin excreted slowly and half life of insulin increases
    • The duration of insulin action increased
    • Risk of hypoglycemia more
    INJECTION TECHNIQUE

    © 2004 BD
    INJECTION TECHNIQUE

    © 2004 BD
    ADVERSE EFFECTS OF INSULIN

    o HYPOGLYCEMIA
    o WEIGHT GAIN
    o CHANGE IN VISION
    o INSULIN ALLERGY
    o INSULIN OEDEMA
    o INSULIN RESISTANCE
    o LIPOATROPHY/ LIPOHYPERTROPHY
    HYPOGLYCEMIA

    • This is due to
    Inaccurate self monitoring
    Variability in timing and composition of meals, amount of exercise, Insulin
    absorption
    Acute illness – If nausea and vomiting are absent
    CONTD..
    Hypoglycaemic unawareness due to drugs, tight glycemic control, autonomic
    neuropathy,recent hypoglycaemic episodes
    Defective counter regulatory hormone response to hypoglycaemia
    Pregnancy
    Gastroparesis
    Critical illness – reducing insulin requirements( renal, liver , adrenal, pituitary
    failure)
    Weight loss
    Alcohol intake
    INSULIN ALLERGY

    • Local allergy at injection site: Redness, pruritus, swelling


    • and heat occurs. It usually occurs within the first few
    • weeks of therapy and is self-limiting. This is IgG
    • mediated.
    • Systemic allergy: Urticaria, angioneurotic oedema and
    • anaphylaxis can occur but rare, this is related to prior
    • intermittent use of insulin. This reaction is IgE mediated.
    INSULIN OEDEMA:

    Patients who have been having poor glycaemic control in the past, may
    develop peripheral oedema when their glucose is rapidly brought down. CCF
    is also common.

    It is a self-limiting condition clearing in about one week unless the patient


    has a renal or cardiac problem.
    LIPOHYPERTROPHY

    • This is due to insulin like growth factor 1 action on adipose tissues


    • This causes delayed insulin absorption causing inadequate glycemic
    control
    • Prevented by alternating the injection site of insulin
    THANK YOU

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