Successfully reported this slideshow.
Your SlideShare is downloading. ×

insulinbasics-190212181714.pdf

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Upcoming SlideShare
ed_PatientAssessFCS05.pdf
ed_PatientAssessFCS05.pdf
Loading in …3
×

Check these out next

1 of 55 Ad
Advertisement

More Related Content

Recently uploaded (20)

Advertisement

insulinbasics-190212181714.pdf

  1. 1. Basics of Basics of insulin therapy insulin therapy Mohsen Eledrisi, MD, FACP, FACE Department of Medicine Hamad Medical Corporation Doha, Qatar eledrisi@yahoo.com
  2. 2. Banting & Best The discovery of insulin 1921: Isletin isolated 1922: 1st human experiment 1923: Name changed to “Insulin” Insula (latin) = island
  3. 3. Insulin secretion Polonsky K et al. New Eng J Med 1988;318:1231 10 20 30 50 40 Serum Insulin mcU/ml Breakfast Breakfast Basal insulin Lunch Lunch Dinner Dinner Meal insulin
  4. 4. Types of Insulin Types of Insulin • Basal insulin • Meal insulin
  5. 5. Basal insulin Intermediate –acting: NPH (Humulin N® , Insulatard® ) Long-acting: Glargine U-100 (Lantus® ) Glargine U-300 (Toujeo® ) Glargine biosimilar (Basaglar® ) Detemir (Levemir® ) Degludec (Tresiba® )
  6. 6. NPHInsulin (Neutral Protamine Hagedorn) Humulin N® Insulatard® Looks cloudy (Like milk)
  7. 7. Insulin Glargine U-100 (Lantus® ) Looks CLEAR Like water - Gray pen - Vial with purple top
  8. 8. Insulin Glargine U-300 (Toujeo® ) CLEAR Like water White pen with green top
  9. 9. Glargine biosimilar (Basaglar® , Abasaglar® )
  10. 10. Insulin Detemir (Levemir® )
  11. 11. Insulin Degludec (Tresiba® ) U-100 & U-200
  12. 12. Meal Insulin Meal Insulin • Short-acting: Regular (Actrapid® , Humulin R® , Novolin R® ) • Rapid-acting: (analogs) - Lispro (Humalog® ) - Aspart (Novorapid® , Novolog® ) - Glulisine (Apidra® ) All look clear (like water)
  13. 13. Regular insulin Actrapid ® Humulin® R Novolin® R
  14. 14. Insulin Regular U-500 (Humulin R® U-500)
  15. 15. Insulin Lispro (Humalog® ) U-100 & U-200
  16. 16. Insulin Aspart [Novorapid® ] (Novolog® in USA)
  17. 17. Insulin Glulisine [Apidra® ]
  18. 18. Action Profile of Insulins 0 1 2 5 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Plasma insulin levels Regular NPH Hours Glargine, Degludec Lispro, Aspart, Glulisine Detemir Hirsch I. New Eng J Med 2005;352:174
  19. 19. Premixed insulins Premixed insulins • NPH/R 70/30 • Aspart 70/30 • Aspart 50/50 • Lispro 75/25 • Lispro 50/50 All premixed insulins look cloudy (like milk)
  20. 20. NPH/ R70/ 30 Mixtard® 30 Contains 70 % NPH + 30 % Regular Mixtard® 30 Mixtard® 30/70 Contains 70 % NPH + 30 % Regular
  21. 21. NPH/ R70/ 30 Humulin® 70/30
  22. 22. Lispro 75/25 (Humalog® 25, Humalog Mix 75/25® ) Contains 75 % Lispro protamine + 25 % Lispro
  23. 23. Lispro 50/50 (Humalog® 50, Humalog Mix 50/50® ) Contains 50 % Lispro protamine + 50 % Lispro
  24. 24. Insulin Aspart 70/ 30 (Novomix® 30) (Novolog® mix 70/30 in USA) Contains 70 % Aspart protamine + 30 % Aspart
  25. 25. Insulin Aspart 50/ 50 (Novomix® 50) Contains 50 % Aspart protamine + 50 % Aspart
  26. 26. Combination Degludec/Aspart (Ryzodeg® )
  27. 27. Combination Degludec/Liraglutide (Xultophy® )
  28. 28. Combination Glargine/Lixisenatide (Soliqua® )
  29. 29. Indications for insulin Indications for insulin • Failure of non-insulin glucose-lowering therapy • Type 1 DM • Type of DM is not known • Pregnancy • Significant symptomatic hyperglycemia (random ≥ 300 mg) or A1c ≥ 10 • In-hospital
  30. 30. Insulin vials Insulin vials • “U-100 “ = every 1 ml has 100 units • 1 vial has 10 ml = 1000 units • New bottles should be kept in refrigerator [2-8 C°) [not freezer] until expiration date • Opened vials are valid for 4 weeks • Opened vials can be kept in refrigerator or in room temperature (15-25 C°)
  31. 31. Care of insulin vials • Do not keep in hot places. • Do not keep in a freezer. • Do not leave in sunlight. • Never use insulin if expired. • Write the date on the insulin vial on the day you open it or start keeping it outside the fridge. Throw the insulin away 4 weeks after opened or since kept out of the fridge. • Inspect your insulin before each use. Look for changes in color or clarity. Look for clumps, solid white particles or crystals in the bottle or pen. Insulin that is clear should always be clear and never look cloudy.
  32. 32. Insulin syringes Insulin syringes 50 units 50 units (0.5 ml) (0.5 ml) 100 units 100 units (1 ml) (1 ml)
  33. 33. 50-units insulin syringe • Lines arranged in order of 5 (5, 10, 15,….) • Every line equals one unit of insulin Example: when injecting 12 units, you draw TWO lines after line 10 10 15
  34. 34. 100-units insulin syringe • lines arranged in order of 10 (10, 20, 30….) • Every line equals two units of insulin Example: when injecting 12 units, you draw ONE line after line 10 10 20
  35. 35. • There are 2 types of pens: 1) Reusable (cartridges are changed) -Pen stays 2) Disposable: - Whole pen is changed • Keep new disposable pen or cartridges in refrigerator • Once pen or cartridge is opened, keep in room temperature (validity depends on type) Insulin pens
  36. 36. Insulin pen care • Insulin pens must be stored at room temperature: Storing your insulin pen in extreme temperatures can lead to changes in the concentration of the pen's insulin. • Do not share your insulin pen with anyone: even if you are changing the needles. Infections (HBV, HIV) happened as insulin itself can be contaminated • Do not withdraw insulin from the pen cartridge: can lead to inaccurate dose measurement the next time the insulin pen is used for dose delivery. The reason for this is related to air entering the pen unintentionally, interfering with the proper mechanics of the pen
  37. 37. Insulin pen care • Do not leave an open needle attached to an insulin pen It can lead to unintentional air entering into the insulin pen and ultimately improper dosing of insulin. It could also lead to insulin contamination. • Proper insulin pen mixing: Every time you use a pen containing NPH or premixed mixtures . The insulin should look uniformly cloudy or milky after mixing. If there are clumps floating in the insulin, or white particles stuck to the bottom or sides of the pen giving it a frosted look, don't use it.
  38. 38. How long is the opened pen or unopened pen outside the refrigerator valid for ? • Aspart, Lispro, Glulisine: 4 weeks • NPH: 2 weeks • Glargine: 4 weeks • Detemir: 6 weeks • Degludec: 8 weeks • Aspart 70/30: 2 weeks • Premixed 70/30, Lispro 75/25, Lispro 50/50: 10 days
  39. 39. Sites of Insulin Injection Abdomen, Arms ,Thighs ** Rotate injection sites
  40. 40. What time to give insulin? NPH: - At bedtime - Or usually twice/day (usually mixed with meal insulin) Glargine/Detemir: - At bedtime (or AM) - Some need twice daily Degludec: - Once daily (at same time of the day)
  41. 41. What time to give insulin? Regular: - 30 minutes before meals (once, twice or 3 times/day) Rapid-acting insulins: - 5 minutes before meals (once, twice or 3 times/day) - Can be given immediately after meals
  42. 42. What time to give insulin? Premixed 70/30 (Mixtard® 30 or Humulin® 70/30) - 30 minutes before meals (once, twice or 3 times/day) Aspart 70/30, Lispro 75/25, Lispro 50/50: - 5 minutes before meals (once, twice or 3 times/day)
  43. 43. Which insulin to use? Depends on: Glucose control Patient characteristics Lifestyle Patient preference
  44. 44. Insulin regimens in DM 2 Bedtime Basal long-acting once/day
  45. 45. Insulin regimens in DM 2 Bedtime Basal intermediate once/day
  46. 46. Insulin regimens in DM 2 Bedtime Basal intermediate twice/day Breakfast
  47. 47. Insulin regimens in DM 2 Lunch Bedtime 1 Basal + 1 Meal Basal Meal
  48. 48. Insulin regimens in DM 2 Lunch Dinner Bedtime 1 Basal + 2 Meals Basal Meal Meal
  49. 49. Insulin regimens in DM 2 Breakfast Lunch Dinner Bedtime 1 Basal + 3 Meals Basal Meal Meal Meal
  50. 50. Insulin regimens in DM 2 Breakfast Lunch Dinner 2 Basal + 3 Meals Meal Basal + meal Basal + meal
  51. 51. Insulin regimens in DM 2 Breakfast Dinner 2 Intermediate + 2 Meals
  52. 52. Insulin regimens in DM 2 Breakfast Dinner 2 Intermediate + 3 Meals Lunch
  53. 53. Insulin regimens in DM 2 Breakfast Dinner 3 Intermediate + 3 Meals Lunch
  54. 54. Insulin regimens in DM 2 Breakfast Dinner 2 Premixed /day
  55. 55. Insulin regimens in DM 2 Breakfast Lunch Dinner 3 Premixed /day

×