Insulin Types and Their Uses

• Insulin is vital for glucose metabolism regulation.
• It facilitates glucose absorption from the blood into cells for energy or storage.
• Insulin is essential for individuals with diabetes mellitus, especially type 1, where the pancreas produces little to no insulin.
• It is also used in type 2 diabetes if other treatments do not control blood glucose levels adequately.

Types of Insulin

• Rapid-acting insulin works within 15 minutes, peaks in 1-2 hours, and lasts 2-4 hours.
• Examples include insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra).
• Short-acting insulin (regular insulin) starts working within 30 minutes, peaks in 2-3 hours, and lasts 3-6 hours.
• Humulin R and Novolin R are examples.
• Intermediate-acting insulin works within 2-4 hours, peaks in 4-12 hours, and lasts 12-18 hours.
• Insulin NPH (Humulin N, Novolin N) is an example.
• Long-acting insulin starts working several hours after injection and lasts 24+ hours.
• Examples are insulin glargine (Lantus, Toujeo) and insulin detemir (Levemir).
• Ultra-long-acting insulin starts working around 6 hours, has no peak, and lasts 36+ hours.
• An example is insulin degludec (Tresiba).
• Pre-mixed insulin combines rapid- or short-acting insulin with intermediate-acting insulin.
• Premixed insulin offers convenience by reducing injections.

Methods of Insulin Administration

• Subcutaneous injection involves injecting insulin into the fatty tissue under the skin.
• Common injection sites are the abdomen, thigh, and upper arm.
• Insulin pens are pre-filled or reusable devices delivering insulin through a small needle.
• Pens offer convenience and adjustable doses.
• Insulin syringes are a traditional method using a syringe to draw insulin from a vial and inject it.
• Inhaled insulin is a rapid-acting form absorbed through the lungs.
• Oral insulin is under development.
• Insulin pumps deliver a continuous, controlled insulin dose through a catheter under the skin.
• Pumps can be programmed to release basal insulin throughout the day and bolus doses at mealtimes.

Factors Affecting Insulin Absorption

• Injection site impacts absorption rates; the abdomen generally gives the consistent absorption.
• Insulin should be injected subcutaneously; intramuscular injection can speed absorption and increase hypoglycemia risk.
• Different insulin types have different absorption profiles.
• Larger insulin doses may be absorbed more slowly.
• Physical activity can increase insulin absorption.
• Heat can increase insulin absorption, while cold can decrease it.
• Repeated injections at the same site can cause fat accumulation (lipohypertrophy), leading to erratic absorption.
• Insulin antibodies can develop after long-term treatment, affecting insulin action.

Insulin Dosage and Timing

• Insulin dosage is individualized based on blood glucose levels, carb intake, activity level, and overall health.
• Basal insulin covers the body's basic insulin needs between meals and overnight.
• Bolus insulin is taken before meals and covers the carbohydrate content of food.
• Correction or supplemental insulin corrects high blood glucose levels.
• Blood glucose monitoring is essential for determining insulin dosage and timing.
• Continuous Glucose Monitoring (CGM) devices provide real-time glucose readings and help adjust insulin doses.

Potential Side Effects and Complications

• Hypoglycemia presents as low blood glucose levels, which can occur if too much insulin is taken, meals are skipped, or activity levels are increased.
• Symptoms of hypoglycemia include shakiness, sweating, dizziness, confusion, and loss of consciousness.
• Hyperglycemia presents as high blood glucose levels, which can occur if not enough insulin is taken, meals are excessive, or during illness or stress.
• Symptoms of hyperglycemia include increased thirst, frequent urination, blurred vision, and fatigue.
• Lipohypertrophy presents as deposits under the skin caused by repeated injections at the same site.
• Allergic reactions are rare, but can occur with certain types of insulin or preservatives.
• Insulin can promote weight gain, especially if not balanced with diet and exercise.
• Edema can manifest as fluid retention.

Patient Education

• Proper injection technique, including site rotation to prevent lipohypertrophy.
• Blood glucose monitoring and target ranges.
• Carbohydrate counting and meal planning.
• Recognition and treatment of hypoglycemia and hyperglycemia.
• Managing insulin during illness or travel.
• Storage of insulin vials and pens.
• Importance of regular medical check-ups and HbA1c testing.
• How to handle "sick days".

Special Considerations

• Children and adolescents require careful attention to growth, activity levels, and meal patterns in insulin management.
• Regular communication and collaboration between parents, caregivers, and healthcare providers are essential.
• Pregnant women's insulin requirements may change during pregnancy, requiring close blood glucose monitoring.
• Older adults may have cognitive or physical limitations affecting their ability to manage insulin therapy.
• Simplifying the regimen and providing support from caregivers may be necessary for older adults.
• Patients with kidney and liver disease can see affected insulin metabolism and clearance, often requiring dosage adjustments.
• Individuals with cognitive or physical impairments require assistance from caregivers or healthcare professionals to ensure proper insulin administration and monitoring