Transcript Insulin_therapy

INSULIN THERAPY
WHAT IS INSULIN ?
A hormone secreted in the beta cells of the
islets of Langerhans in the pancreas.
 Normal pancreas has about 1 million islets and
each contains between 80 and 100 beta cells
 Cells are capable of measuring the blood glucose
level every 10 seconds
 Endogenous Insulin
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FACTS
ABOUT
ENDOGENOUS INSULIN ……..
Beta cells produce
proinsulin – chain of
81 amino acids
 Transferred to Golgi
apparatus
 broken down into 2
units 51 amino acids =
insulin, 30 = c peptide
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EXOGENOUS INSULIN (HUMAN INSULIN)
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All exogenous insulin in NZ
is Human Insulin
Identical in structure to
the naturally occurring
hormone produced by the
healthy human pancreas
CHARACTERISTICS
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Concentration
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Type
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purity
CONCENTRATION ……..
Measured in units
world-wide
 U-100 = concentration
of 1 milliliter of
insulin fluid contains
100 units
 NZ no longer uses
U-40 and U-80
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TYPES OF INSULIN………
USUALLY CLASSIFIED ACCORDING TO PEAK EFFECT AND DURATION OF ACTION
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Rapid - acting
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Short – acting
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Intermediate – acting
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Long – acting
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premixed
RAPID
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ACTING INSULIN (BOLUS)
Act very quickly –only last
an hour or 2
Injected within 15 minutes
of eating
Start working in 5- 15
minutes
Lower blood sugar most in
45 -90 minutes (peak)
Duration – 3-4hrs
Easy to coordinate eating
Clear
SMBG –immediately
before meals and 2hrs
after. Before bed
SHORT-ACTING INSULIN ……
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Takes effect after 30 min
to an hour
Also called regular insulin
Peaks at 2-4 hrs
Lasts 3-8hrs
Injected before meals
Clear
SMBG -30-40 min. before
meals and before bed
INTERMEDIATE-ACTING
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Starts working 1-4 hrs
Peaks 4-12 hrs
Designed to last “all day”
Lasts 12-24 hrs
Usually taken before
breakfast or bed
Cloudy
SMBG – before injecting
and 3hrs after meal.
Before bedtime
INSULIN (BASAL)
LONG-ACTING
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INSULIN
Takes several hours to
work
Provides insulin at a
steady level for at least
24 hrs
Peaks at about 6-18 hrs
Usually taken at bedtime
Cloudy
SMBG – before breakfast
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PREMIXED INSULIN ………….
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A mixture of bolus and
basal
Offers convenience of
fixed, precise and
consistent dosing.
SMBG –depends on
combination
Easier to use in elderly
patients ? safer
Doses of individual
components cannot be
altered
Used mostly for type 2
diabetics
CARE OF INSULIN
Only 30 days supply at a time from pharmacy
 Vial or cartridge in current use may be kept at
room temperature up to 28 days
 Other stock stored in refrigerator - do not
freeze
 Note expiry date – discard after expiry date
whether or not in refrigerator
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INSULIN OVERVIEW
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http://www.youtube.com/watch?v=SA7yCKxzzr0&feature=related