ALL ABOUT INSULIN

1. INSULIN
BY AMINKUMAR DHULE
NURSE PRACTITIONER IN CRITICAL CARE
RESIDENT 2DT YEAR

2. INSULIN
INSULIN IS A HORMONE THAT IS RESPONSIBLE FOR ALLOWING GLUCOSE IN
THE BLOOD TO ENTER CELLS, PROVIDING THEM WITH THE ENERGY TO
FUNCTION.
INSULIN ALSO ASSISTS IN BREAKING DOWN FATS OR PROTEINS FOR ENERGY.

3. STRUCTURE
OF
INSULIN

4. INSULIN
- INSULIN IS THE MAINSTAY IN THE TREATMENT OF TYPE I DIABETES MELLITUS.
- IT ACTS PRIMARILY IN THE LIVER, MUSCLE, AND ADIPOSE TISSUE BY ATTACHING TO
RECEPTORS ON CELLULAR MEMBRANES AND FACILITATING THE PASSAGE OF
GLUCOSE, POTASSIUM AND MAGNESIUM.
- THE ONSET, PEAK, DURATION OF ACTION DEPENDS ON THE INSULIN TYPE.
- INSULIN IS PRESENT ONLY EXTRACELLULARLY.

5. .• In the beta cells in islets of Langerhans of the pancreas. The glucose enters in the
beta cells by GLUT2 receptors which is present of beta cells. Which then goes
into mitochondria to produce energy (ATP). APT bind with the ATP sensitive
potassium channel which causes depolarization and hence k+ cannot move out
of beta cells which causes ca++ opens. Ca++ influx into beta cells which binds
with insulin and then releases out of cells

6. .
• Mechanism of action;
• Insulin binds with alpha subunit of insulin receptors on cell membrane. Beta
subunits of receptors become phosphorylate, phosphorylation of beta cells
activates local tyrosine kinase which then causes phosphorylation of multiple
other intracellular enzymes including insulin-receptor substrates [IRS]. IRS
stimulates Glucose transporter 4. glucose transporter acts as a channel and influx
of glucose from extracellular to intracellular.

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8. Insulin injection sites,
• Abdomen, arms (posterior surface)
Insulin injected into the abdomen
may absorb more evenly and
rapidly than at other sites.
• Thighs (anterior surface) and hips.

9. .
• NOTE;
• Systematic rotation within 1 anatomical area is recommended to prevent
lipodystrophy and to promote more even absorption; clients should not use the
same site more than once in a 2 to 3-week period
• Heat, massage and exercise of the injected area can increase absorption rates and
may result to hypoglycaemia.
• Injection into tissue scar may delay absorption of insulin.

10. Different site for
each dose

11. Insulin regimen
• How many doses and what preparations to be given?
• The standard treatment: standard twice daily dose.
• Intensive or tight control: insulin is given 3-4 times a day
• Calculate the daily required dose first:
• 2/3rd of the required dose is given before breakfast
• 1/3rd of the dose is given before dinner
• It is assumed that breakfast would be heavy and the largest meal of
the day.

12. SHORT DURATION • :
• The body absorbs this type into the bloodstream from the subcutaneous tissue extremely quickly.
People use fast-acting insulin to correct hyperglycemia, or high blood sugar, as well as control blood sugar
spikes after eating.
This type includes:
• Rapid-acting insulin analogs: These take between 5 and 15 minutes to have an effect. However, the size of
the dose impacts the duration of the effect. Assuming that rapid-acting insulin
analogs last for 4 hours is a safe general rule.
Example ; Insulin lispro 15-30 min , 3-6 hr
Insulin Aspart 10-20 min , 3-5 hr

13. .
• Regular human insulin: The onset of regular human insulin is between 30
minutes and an hour, and its effects on blood sugar last
around 8 hours. A larger dose speeds up the onset but also
delay the peak effect of regular human insulin.
Example ; Regular Insulin 30-60 min 1-5 hr 6-10 hr

14. INTERMIDIATE DURATION
THIS TYPE ENTERS THE BLOODSTREAM AT A SLOWER RATE BUT HAS A LONGER-LASTING
EFFECT. IT IS MOST EFFECTIVE AT MANAGING BLOOD SUGAR OVERNIGHT, AS WELL AS
BETWEEN MEALS.
OPTIONS FOR INTERMEDIATE-ACTING INSULIN INCLUDE:
NPH HUMAN INSULIN: [NEUTRAL PROTAMINE HEGEDORN ]
THIS TAKES BETWEEN 1 AND 2 HOURS TO ONSET, AND
REACHES ITS PEAK WITHIN 4 TO 6 HOURS. IT CAN LAST OVER 12 HOURS
IN SOME CASES. A VERY SMALL DOSE WILL BRING FORWARD THE PEAK
EFFECT, AND A HIGH DOSE WILL INCREASE
THE TIME NPH TAKES TO REACH ITS PEAK AND THE OVERALL DURATION
OF ITS EFFECT.

15. .

16. .
• Pre-mixed insulin ; This is a mixture of NPH with a fast-acting insulin, and its
effects are a combination of the intermediate- and
rapid-acting insulins.
Examples ; NPH Isophane insulin 60-120 min 6-14 hr 16-24 hr

17. LONG DURATION
• While long-acting insulin is slow to reach the bloodstream and has a relatively low
peak, it has a stabilizing "plateau" effect on blood sugar that can last for most of the
day.
• It is useful overnight, between meals, and during fasts.
• Long-acting insulin analogs are the only available type, and these have an onset of
between 1.5 and 2 hours. While different brands have different durations, they range
between 12 and 24 hours in total.
• Example ; Insulin glargine 70 min 18-24 hours.
- Insulin deter 60-120 min 12-24 hours varies

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20. Storage of Insulin
• Avoid exposing insulin to extremes in temperature.
• Insulin should not be frozen or kept in direct sunlight or hot car.
• Before injection, insulin should be at room temperature.
• If a vial of insulin will be used up to 1 month, it may be kept at room
temperature; otherwise the vial should be refrigerated.

21. .

22. Administering insulin
• To prevent dosage errors, be certain that there is a match between the insulin
concentration noted on the vial and calibration of unison the insulin syringe; the usual
concentration of insulin is U-100 (100 units/ml).
• Most insulin syringes have a 27 to 29 Gauge needles that is about 1/2 Inch (1.3 cm)
• NPH insulin is an insulin suspension; the appearance is cloudy. All other insulin
types are solutions; the appearance of all other insulin products is clear.
• Before use, NP insulins must be rotated, or rolled between the palms to ensure that
the insulin suspension is mixed well; otherwise, an inaccurate dose will be drawn;
vigorously shaking the bottle will cause bubbles to form.

23. INSULIN NEEDLE

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THANK YOU