Intensive insulin therapy is a comprehensive diabetes management system required for all type 1 diabetes (DM-1) patients and up to 40% of type 2 diabetes (DM-2) patients, aimed at maintaining blood glucose levels within recommended guidelines. Insulin can be classified by origin, such as animal or human, and by action duration, ranging from rapid-acting to long-acting types. Common rules of insulin therapy highlight the importance of accurate dosing, injection techniques, and patient dietary considerations to prevent complications.

1. “INSULIN THERAPY”

2. Intensive insulin therapy is best defined as a comprehensive
system of diabetes management with the patient and
management team as partners. The system is directed at
improvement of glycemia and patient well-being.

3. 100 % of patients with diabetes mellitus (DM) type 1
(DM-1) need insulin therapy, as hyperglycaemia that
was caused by absolute insulin deficit can be negated
only with the help of replacement therapy institution.
A diet and physical activity are considered only for
insulin dose modification Besides, up to 40 % of
patients with DM type 2 (DM-2) are on the insulin.

4. The goal of intensive insulin therapy is to maintain
control within the recommended blood glucose level
guidelines as often as possible.

5. Insulin agents are divided by origin and action duration.
I. By origin:
1. Of animal origin:
 a) Porcine,
 b) Beef
2. Of human origin:
 a) Genetically engineered

7. 3. Insulin human analogues - with fixed
pharmacokinetics:
By action duration:
1. Rapid-acting (lispro,aspart)
2. Short-acting (regular insulin)
3. Intermediate-acting (Neutral Protamine Hagedorn)
4. Long-acting (glargine,detemir)

10. An alternative to injectable insulin is inhaled insulin
(Exubera). Exubera is a rapid-acting dry powder that is
inhaled through the mouth the lungs before eating via a
specially designed inhaler.

11. Insulin acts on specific receptors located on the cell
membrane of practically every cell, but their density
depends on the cell type: liver and fat cells are very rich.
The insulin receptor is a receptor tyrosine kinase (RTK)
which is a heterotetrameric glycoprotein consisting of 2
extracellular alpha and 2 transmembrane Beta subunits
linked together by disulfidebonds, orienting a cross the
cell membrane a heterodimer.
It is oriented across the cell membrane as a heterodimer.
The alpha subunits carry insulin binding sites, while the
Beta subunits have tyrosine kinase activity.

12.  All patients with type I diabetes mellitus
 Patients with type II diabetes mellitus in whom control cannot be
adequately achieved with oral hypoglycaemics or diet.
 Patients with diabetes in pregnancy in whom control is inadequate
with diet in situations of stress, such as surgery, after myocardial
infarction, etc.
 Insulin may also be used in the treatment of hyperkalaemia.
 Ketoacidotic and hyperosmolar coma.
 Gestational DM without compensation achievement.
 Pancreatectomy

13. Conditions:
 Low blood sugar
 Low amount of potassium in the blood
 Liver problems
 Kidney disease with reduction in kidney function
 Allergies

14. The common rules of insulin therapy are :
 The regular insulin dose should not exceed 12 units in a single
injection.
 The total dose of a combined injection should not exceed 70-
80 units.
 The ratio of a daily and nightly insulin dose should be about
2:1.
 The daily insulin dose cannot be changed more than 4 U/day.
 Simultaneously a daily insulin dose should not be increased or
decreased by more than 6-8 units.

15.  Be certain to give the correct type of insulin.
 Prepare the correct dosage. Have another nurse double-check
the dose before you administer the injection.
 Use the correct syringe. Never use a regular syringe for
insulin. Use a syringe calibrated in “units.”
 Before drawing up the insulin, gently “roll” the bottle between
the palms to mix and warm the solution.
 Eliminate all air bubbles from the syringe. One small air
bubble may displace 2 or 3 units of insulin.

16.  Cleanse the skin with alcohol and allow to dry. This helps avoid pitting of
the skin.
 Give the injection subcutaneously. Rotate the injection site with each dose.
(Rotating the sites prevents tissue necrosis.)
 Always check to see whether the patient is and has been eating his normal
diet.
 Administration of the regular dosage of insulin when the patient’s intake of
food has been decreased or withheld could cause the blood sugar level to
drop too much.
 A patient who is experiencing vomiting will require adjustment of the
insulin dosage.

17.  http://insulinnation.com/treatment/what-is-insulin-
therapy/
 https://familydoctor.org/insulin-therapy/
 https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-
of-type-2-diabetes/medications-and-therapies/type-2-
insulin-rx/intensive-insulin-therapy/
 https://www.mayoclinic.org/diseases-
conditions/diabetes/in-depth/insulin/art-20050970