What Is Insulin Therapy?

Types of Insulin

• Bolus insulin is released as a response to food intake to keep the glucose levels under control following a meal. Since people with diabetes cannot produce or utilize insulin effectively, a bolus dose of insulin is prescribed. Short-acting or rapid-acting insulins serve the purpose of keeping the blood glucose in check after a meal.

• Rapid-acting insulin - It is used to minimize the surge in blood sugar immediately after a meal or snack.

• Short-acting insulin - Also known as regular or neutral insulin, it controls postprandial blood glucose levels.

• Basal insulin, also called background insulin, regulates glucose levels between meals irrespective of food intake. It is released continuously throughout the day and night. A basal dose of insulin is required to act over a long period, and the types are intermediate, long-acting, or ultra-long-acting insulin. These help to regulate blood sugar levels throughout the day, between meals, and at night while fasting.

1. Onset: It is the time taken for insulin to enter the bloodstream and start lowering blood sugar.

2. Peak time: This refers to the period during which insulin works most effectively.

3. Duration: It is the period of time during which the insulin continues to act.

• Intermediate-acting insulin - Also referred to as isophane or NPH insulin, it is usually taken in conjunction with short-acting insulin. This is suitable for people who experience a spike in blood sugar during the night and morning.

• Long-acting insulin - It is active throughout the day and is suitable for people with high blood sugar during the day and overnight. It primarily functions to reduce the fasting blood glucose level.

• Ultra-long-acting insulin - It has a prolonged release and shows a glucose-lowering effect for up to 42 hours.

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  • Premixed insulins are preparations of rapid-acting insulin with either intermediate or long-acting insulin.

  • Inhaled insulin is rapid-acting insulin inhaled at the beginning of the meal, and this type is always used in combination with injectable long-acting insulin.

How insulin is used

• Once-daily insulin regimen: This is suitable for people with type 2 diabetes requiring assistance in taking injections. The regimen involves taking long-acting insulin or intermediate type insulin along with medications.

• Twice-daily regimen: Suitable for both type 1 and type 2 diabetes, this regimen involves taking a mixture of short-acting and intermediate-acting insulin. They can be mixed manually or taken as pre-mixed insulin.

• Basal-bolus regimen/multiple daily injection therapy: This regimen involves taking both basal and bolus insulins. Basal insulin is taken once or twice daily and separate bolus injections at each meal. It is commonly used in people with type 1 diabetes, and sometimes in type 2 diabetes. Basal-bolus regimen allows flexibility with mealtimes, and one can vary the dose based on the carbohydrate intake.

• Insulin pump therapy/continuous subcutaneous insulin infusion: An insulin pump is connected to the body to deliver insulin. It delivers basal insulin continuously throughout the day and bolus insulin on demand when food is consumed. It is generally used for type 1 diabetes in people unable to manage high blood sugar with multiple injections.

Calculation of insulin requirement

Tips for storing insulin

• Store all supplies in the refrigerator.

• Avoid storing insulin in extremely hot or cold temperatures.

• Store the opened insulin bottle at room temperature (up to one month) as injecting cold insulin can be painful.

• Never expose insulin to direct sunlight.

• Check the expiration date and never use expired insulin.

• Always check the bottle before each use and make sure the insulin looks normal without any particles, crystals, discolouration, or frosting.

Conclusion