Insulin

• Types of insulin


  • Short acting
  • Rapid acting
  • Intermediate acting
  • Biphasic (short and intermediate mix)
  • Long-acting (2 T's and 2 L's)
• Administration


  How insulin is administered
• Subcutaneous


  • Route of insulin administration
• IV for emergencies


  • Such as DKA/hyperkalaemia
• Abdomen


  • Fastest absorption rate
• Outer thighs/buttocks


  • Slower absorption rate
• Insulin regimens


  • Basal-bolus - Long acting x1 (BD detemir) and Rapid-acting x3
  • Twice daily - Intermediate
  • Biphasic
• Side effects


  • Oedema
  • Hypoglycaemia
• Pregnancy


  • Increase normally in second and third trimesters
  • Isophane recommended and insulin detemir
• Breastfeeding


  • Altered requirements
• Blood glucose monitoring


  • 5-7 on waking
  • 4-7 before meals
  • 5-9 at least 90 mins after meals
  • At least 5 when driving (check every 2 hours)
• HbA1c


  48 (6.5%)
• Brand prescribing/dispensing
• Short acting


  • Soluble
  • 15-30 minutes before meals
  • Rapid onset 30-60 minutes
  • Peak 1-4 hours
  • Duration 9 hours
• IV


  • Immediate onset and short half-life
• Rapid-acting


  • Immediately before meals
  • Onset within 15 minutes
  • Short duration 2-5 hours
• Intermediate


  • Onset 1-2 hours
  • Maximum effect at 3-12 hours
  • Duration 11-24 hours
• Long acting


  • Duration 36 hours
  • Steady state after 2-4 days
• Indications


  • Type 1/2 diabetes mellitus
  • Hyperkalaemia with IV glucose
  • IV soluble in DKA/HHS/perioperative
• Interactions


  • Hypoglycaemia
  • Clarithromycin
  • Fibrates
  • Oral antidiabetics
  • AC
  • Sulfonamides
  • MAOIs/fluoxetine
• Opposing


  • Corticosteroids
  • Diuretics
  • Isoniazid
  • Oestrogen/progestogens
  • Salbutamol
  • Clozapine/olanzapine
• MHRA warnings


  • Severe harm and death due to withdrawing from pen devices (NOT to withdraw from pen/pen refill)
  • Not to abbreviate unit/international units
  • Risk of cutaneous amyloidosis at injection site
  • Inappropriate dosing when switching tresiba products (no dose conversion necessary)
• Patient factors


  • Decreased requirements
  • Hepatic impairment
  • Renal impairment
• Rapid acting

  • Aspart
  • Fiasp
  • Novorapid
  • Trurapi
• Rapid acting

  • Glulisine
  • Apidra
• Rapid acting

  • Lispro
  • Admelog
  • Humalog
  • Lyumjev
• • Soluble
  • Actrapid
  • Humulin S
• Intermediate acting

  • Isophane (insulin + protamine)
  • Mix with short acting or give alongside mealtime insulins
  • Humulin I
  • Hypurin porcine
  • Insulatard
  • Biphasic (short and intermediate mix)
  • Isophane
  • Humulin M3
  • Hypurin porcine mix
  • Aspart
  • Novomix
  • Lispro
  • Humalog mix
• Long-acting (2 T's and 2 L's)

  • Determir
  • OD/BD
  • Levemir
  • Degludec
  • OD
  • Tresiba
  • Glargine
  • OD
  • Adasglar
  • Lantus
  • Semglee
  • Toujeo