General
- Carbohydrate, fat, and protein metabolism are all affected by diabetes
- All people with type 1 diabetes require insulin for management of blood glucose
- People with type 2 diabetes require insulin when undergoing surgery, experiencing high levels of physiologic stress (e.g. infection), and during pregnancy.
- Insulin is classified two ways:
- Type – How it’s made
- Natural or regular
- Addition of protein to prolong duration (NPH)
- Insulin analogs
- Lispro and Aspart insulins have shorter durations than Regular insulin
- Glargine insulin has a longer duration than Regular
- Group – Time-course-of-action
- Oral hypoglycemics used for type 2 diabetes when diet/exercise are not enough
Insulin
| Type | Duration | Route | Time | Onset | Peak |
| Lispro
(Humalog) |
Short, Quick
(3 – 6 h) |
SC / Pump | 15 m ac | 15 – 30 m | ½ – 2½ hr |
| Aspart
(Novolog) |
Short, Quick
(3 – 5 h) |
SC / Pump | 5-10 m ac | 10 – 20 m | 1 – 3 hr |
| Regular
(Humulin R) |
Short, Slower
(6 – 10 h) |
SC / Pump / IH / IM / IV | 30 m ac | 30 – 60 m | 1 – 5 hr |
| NPH
(Humulin N) |
Intermediate
(16 – 24 h) |
SC | 2x/day
(same time) |
1 – 2 hr | 6 – 14 hr |
| Glargine
(Lantus) |
Long
(24 h) |
SC | 1x/day
(same time) |
70 min | None |
| · Insulin: promotes cellular GLC uptake // GLCGLYC // moves K+ into cells | |||||
| · Type 2 may need insulin: severe renal/liver disease // neuropathy // Severe stress | |||||
| · Insulin also used: Tx of hyperkalemia // Tx of DKA and HHNS. | |||||
Adverse Effects:
Hypoglycemia, Lipohypertrophy
Contraindications/Precautions:
Pregnancy (?), CAUTION: Only regular insulin by IV
Interactions:
Additive GLC ò effect with sulfonylurea, meglitinides, β-blocker, EtOHv
Thiazide diuretics, glucocorticoids ò glucose-reducing effects
Education:
When mixing short-acting and long-acting draw short-acting first and then longer-acting in order to keep longer-acting from contaminating shorter-acting.
Disperse particles in suspension before drawing insulin.
Glargine is never IV and should not be mixed
Use one general area to produce consistent results (rateñ thigharmabdomen)
GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
