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Introduction of insulin regime

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Some regimens which might be useful in the introduction of insulin to the therapaeutic regimen include (1):

  • basal insulin
    • adding a basal regimen to the current oral hypoglycaemic agents will result in suppressing the hepatic output of glucose and also a reduction in fasting glucose levels (1)
      • examples of insulin regimens which can be used with oral hypoglycaemics:
        • once daily intermediate acting insulin at bed time - useful in patients with high overnight and morning blood glucose which reduces once they start their normal daily work (2)
        • long acting insulin (taken at the same time, any time of the day, at 24-hour intervals) - useful in patients with high blood glucose during the day and night who otherwise will require twice daily basal insulin injections (2)
        • not useful in controlling post prandial glucose increase (1)
    • basal insulin together with oral hypoglycaemias is useful in the following:
      • obese and insulin resistant patients
      • people who hesitate to start insulin e.g - due to needle phobia
      • people who are unable to inject themselves
      • in people whom hypoglycaemia is unacceptable but optimal control is not very important e.g - elderly people without any complications or undue symptoms
  • premix insulin
    • the aim of premix insulin regimen is to mimic the normal insulin secretion which consists of basal insulin and meal-time bolus insulin
    • aims to control both fasting and post-prandial hyperglycaemia (1)
    • is useful in patients who:
      • have a fairly routine lifestyle who have similar amounts of food at same time each day
      • are becoming insulin depleted and oral hypoglycaemics are no longer effective (2)
  • basal bolus insulin
    • closely match the physiological insulin release, requires basal insulin with bolus or prandial rapid-acting insulin (generally requires four daily injections - a basal insulin injection plus rapid-acting insulin injections at meal-times)
    • it gives more flexibility since patients do not need to be on a strict meal time and the doses of insulin can be adjusted according to the content and quantity of the meal
    • is suitable for - young adults who require insulin, active sportsmen and pregnant women (1)
    • is useful in patients who:
      • needs flexibility e.g. - shiftwork, regular traveling across time zones
      • needs optimal control due to complications, illness or a wound (2)

Reference:


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