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Insulin Treatment When prescribing insulin for diabetes management, it is crucial to understand the distinct needs of clients with type 1 versus type 2 diabetes. Clients with type 1 diabetes require insulin as their bodies do not produce it, making insulin therapy essential for their survival and d...

Insulin Treatment When prescribing insulin for diabetes management, it is crucial to understand the distinct needs of clients with type 1 versus type 2 diabetes. Clients with type 1 diabetes require insulin as their bodies do not produce it, making insulin therapy essential for their survival and daily glucose control. Clients with type 1 diabetes often need a combination of basal (long-acting) and bolus (rapid-acting) insulins to mimic the body\'s normal insulin release patterns. In contrast, clients with type 2 diabetes may have varying insulin requirements based on the progression of their condition and their body\'s insulin resistance level. Initially, they might manage their glucose levels through oral medications, diet, and exercise. However, as the disease progresses, they may require supplemental insulin to achieve glucose targets, starting with basal insulin to address fasting hyperglycemia and potentially adding bolus doses for mealtime glucose control if basal insulin alone is insufficient. The choice of insulin type, dosage, and administration schedule should be personalized, considering factors like the client\'s blood glucose patterns, lifestyle, preferences, ability to manage insulin therapy, and risk of hypoglycemia. Ongoing monitoring and adjustments are essential to optimize therapy and minimize complications (Rosenthal & Burchum, 2021).  **Insulin Action** Insulin is a hormone produced by the pancreas, playing an essential role in regulating blood glucose levels by facilitating glucose uptake into cells and managing the body\'s metabolism of fats, proteins, and carbohydrates. On a cellular level, insulin binds to receptors on the cell surface to open glucose transporters, allowing glucose to move from outside the cell to inside the cell, thereby reducing blood sugar levels and allowing cells to use glucose for energy. Insulin also promotes the conversion of glucose into glycogen in the liver for storage and inhibits the breakdown of fat. Insulin also contributes to the stimulation of protein synthesis and the regulation of lipid metabolism by preventing the excessive breakdown of fats. Examine the image below to review how insulin facilitates the movement of glucose into cells.  **Title: How Does Insulin Work** - Insulin Receptor - Insulin  - Glucose - Glucose channel (closed) - Insulin is the key that unlocks the glucose channel - Glucose channel opens, glucose to enter the cell.  **Hotspot 4: Diabetes and Insulin** In individuals with diabetes, the body\'s ability to produce or effectively use insulin is compromised, leading to elevated blood sugar levels. Insulin medications are prescribed to mimic the body\'s natural insulin release patterns and manage blood glucose levels to stay within a normal range.  **Hotspot 5: Diabetes and Insulin DnD** The pancreas produces little or no insulin due to autoimmune destruction of the insulin-producing beta cells. \[Type 1 Diabetes\] Insulin resistance occurs when cells fail to respond adequately to insulin, often accompanied by a gradual decrease in pancreatic insulin production. \[Type 2 Diabetes\] **Hotspot 6: Insulin Types** Many types of insulin are available for diabetes treatment, reflecting the complexity of managing blood glucose levels in individuals with diabetes. Each type of insulin has distinct characteristics, including onset, peak, and duration, which allow providers to tailor treatment plans to the unique needs of clients with diabetes. Click each **plus** (**+**) **sign **in the activity below to learn more about different types of insulin.  **Hotspot 7:  Insulin Types in a Graph** **Title: Onset, Peak, and Duration Based on Insulin Type** **Rabid acting insulin** - Rapid-acting insulins start working within minutes, peaking in effectiveness to manage blood sugar spikes post-meals and lasting for a few hours. Rapid-acting insulins are given subcutaneously before or after meals or via continuous infusion through an insulin pump.   **Type of Rapid-Acting Insulin** **Onset** **Peak** **Duration** ---------------------------------- --------------- ----------- -------------- Insulin lispro (Humalog) 15-30 minutes 1-2 hours 3-6 hours Insulin aspart (Novalog) 10-20 minutes 1-2 hours 3-5 hours Insulin glulisine (Apidra) 10-15 minutes 1-2 hours 3-5 hours **Short-acting insulin: ** - Regular insulin is a short-acting insulin with a slightly delayed onset and a longer duration compared to rapid-acting insulins. Regular insulin is given subcutaneously before or after meals or via continuous infusion through an insulin pump. It can also be administered via oral inhalation. Regular insulin in U-100 strength can also be administered via IV or IM routes in emergency situations.  **Type of Short-Acting Insulin** **Onset** **Peak** **Duration** ---------------------------------------- --------------- ----------- -------------- Regular Insulin (Humulin R, Novolin R) 30-60 minutes 1-5 hours 5-10 hours **Intermediate-acting insulin:  ** - NPH insulin is an intermediate-acting insulin designed for longer-lasting effects, helping to maintain baseline blood sugar levels. Its onset is slower, making it unsuitable for mealtime spikes but ideal for filling gaps between doses of rapid or short-acting insulins. It is administered 2-3 times daily on a schedule to provide glycemic control between mealtimes and overnight. It can be mixed in the same syringe with short-acting insulins to ease client administration.  **Type of Intermediate-Acting Insulin** **Onset** **Peak** **Duration** ----------------------------------------- ----------- ------------ -------------- NPH Insulin (Humulin N, Novolin, N) 1-2 hours 4-12 hours 18-24 hours **Long and Ultra Long acting insulin** Long-acting insulins (also called basal insulin) provide a steady level of insulin to manage blood sugar throughout the day and night with no peak. They are typically administered once daily to ensure consistent blood sugar control, mimicking the basal rate of natural insulin production. While it can be administered at any time of day, consistent timing is most critical.  **Type of Long-Acting Insulin** **Onset** **Peak** **Duration** --------------------------------- ------------ ----------- ---------------- Insulin glargine (Lantus) 70 minutes 6-8 hours 24 hours Insulin detemir (Levemir) 1-2 hours 6-8 hours Up to 24 hours   **Type of Ultra Long-Acting Insulin** **Onset** **Peak** **Duration** --------------------------------------- ----------- ---------- ---------------- Insulin degludec (Tresiba) 1 hour None Up to 42 hours **Hotspot 8: Insulin Types Matching** **Insulin Type** **Statement** ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rapid-Acting Insulin These insulins quickly reduce blood sugar spikes that occur after eating. They are ideal for mealtime blood sugar control. Short-Acting Insulin A traditional insulin form that has a slightly delayed onset and longer duration compared with rapid-acting insulins. Intermediate-Acting Insulin This insulin type offers a balance between rapid and long-acting insulins, often used in combination with rapid-acting insulins to provide glycemic coverage between meals and overnight. Long- and Ultra-Long Acting Insulin This insulin type is often used to manage blood sugar levels throughout the day, providing a slow and steady insulin release that mimic basal insulin secretion. **Hotspot 9: Total Daily Insulin Dose** Calculating insulin dosage involves understanding an individual's insulin needs, which can vary significantly based on body weight, diet, exercise level, and the presence of any additional health conditions. Providers use insulin calculations to determine a client's initial insulin dosages and make ongoing adjustments based on the client\'s self-monitoring of blood glucose levels, dietary intake, activity levels, and overall health status. Insulin therapy is highly personalized and requires regular review and adjustment to maintain optimal blood glucose control while minimizing the risk of hypoglycemia.  **Calculating Insulin Needs** **Total Daily Insulin Requirement (TDIR):**   Calculate the TDIR based on the individual\'s weight and health condition.   - Type 1 Diabetes: 0.5-0.6 units/kg/day   - Type 2 Diabetes: 0.2-0.6 units/kg/day  Insulin requirements may vary more widely in clients with type 2 diabetes and often depend on the degree of insulin resistance and remaining beta-cell function.  ** correction doses and adjustments for activity and sick days. ** - The amount of bolus insulin needed is further divided based on the carbohydrate content of each meal, often using a carbohydrate-to-insulin ratio, which varies widely among individuals.   - Physical activity can lower blood glucose levels, potentially requiring adjustments to insulin dosages to prevent hypoglycemia. Conversely, illness or stress can increase blood glucose levels, necessitating higher insulin doses.