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    Insulin Therapy: Prof. Khalifa Abdallah

    Uploaded by

    Ahmed Adel Mostafa
    The document discusses insulin therapy for diabetes. It outlines the types of insulin, their durations of action, storage requirements, and common insulin regimens including combination therapy with oral medications and a basal-bolus regimen. It provides guidelines for initiating and titrating insulin dosage based on blood glucose levels.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Insulin Therapy: Prof. Khalifa Abdallah

    Uploaded by

    Ahmed Adel Mostafa
    214 views33 pages
    The document discusses insulin therapy for diabetes. It outlines the types of insulin, their durations of action, storage requirements, and common insulin regimens including combination therapy with oral medications and a basal-bolus regimen. It provides guidelines for initiating and titrating insulin dosage based on blood glucose levels.

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    Original Title

    Insulin Treatment 2

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    The document discusses insulin therapy for diabetes. It outlines the types of insulin, their durations of action, storage requirements, and common insulin regimens including combination therapy with oral medications and a basal-bolus regimen. It provides guidelines for initiating and titrating insulin dosage based on blood glucose levels.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    214 views33 pages

    Insulin Therapy: Prof. Khalifa Abdallah

    Uploaded by

    Ahmed Adel Mostafa
    The document discusses insulin therapy for diabetes. It outlines the types of insulin, their durations of action, storage requirements, and common insulin regimens including combination therapy with oral medications and a basal-bolus regimen. It provides guidelines for initiating and titrating insulin dosage based on blood glucose levels.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    Insulin Therapy

    Prof. Khalifa Abdallah


    Diabetes, Metabolism and Lipidology Unit
    Alexandria Faculty of Medicine
    Objectives
     To know indications for insulin therapy
     To know types and pharmaco-dynamics of insulin
     To know different types of insulin regimens
     To know how to initiate and titrate insulin dosage
    Current indications for insulin therapy
     Patients with type 1 DM
    Type 2 DM
     Initial stabilization of patients with severe hyperglycemia

     Hyperglycemic crises

     Pregnancy

     Significant liver or kidney disease

     Stressful situations ( ACS, ICU, major surgery, severe

    infection, corticosteroid therapy….etc


     Patients in whom oral glucose-lowering therapy has failed
    Insulin types and duration
    of action
    Onset of Peak Maximal
    Insulin Preparation
    action action duration
    (h or min) (h) (h)
     Short-acting 30 min 1-3 6-8
     Intermediate-acting 1-2 h 5-10 18-24
     Premixed insulin 30/70
    .
    0.5-1 h 5-9 18-24
     Rapid-acting insulin analogue 10-20 min 1-2 h 3-5 h
     Long-acting insulin analogue
    (glargine,Detemir) Peakless 24 h
    Storage of insulin

     Stable at room temperature for 4 weeks


     Should not be exposed to temperatures >

    25ºC or under freezing point


     Unused vials and cartridges should be

    stored in the refrigerator


     Should never be exposed to sunlight

     Should never be frozen


    Insulin Regimen

     Combination therapy (for T2DM only)


    - bed-time insulin + OHA

     Total insulin replacement (Type 1&2 DM)


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Insulin Regimen

     Combination therapy
    - bed-time insulin + OHA

     Total insulin replacement


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Insulin Therapy for Type 2 DM
    Combination therapy
     Continue Maximal dose of OHA
     Add either NPH or insulin Glargine at bed time
    (both are effective but the incidence of noctural
    hypoglycemia is lower with insulin Glargine)
     Start by 10 units and adjust insulin dose guided by
    FBG to achieve FBG between 80 and 120 mg/dl
     If PPG <180 mg/dl continue combination therapy
    otherwise shift to total insulin replacement therapy
    Initiation and Titration of Basal Insulin
    in DM2 patients on OHA
     Add 10 units Basal insulin at bedtime
    (NPH , Detemir, or Glargine)
     Continue current oral agents
     Titrate insulin weekly to fasting BG < 120
    mg/dL
    - if 120-140 mg/dL, increase 2 units
    - if 140-160 mg/dL, increase 4 units
    - if 160-180 mg/dL, increase 6 units
    - if >180 mg/dL, increase 8 units
    Insulin Regimen

     Combination therapy
    - bed-time insulin + OHA

     Total insulin replacement


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Insulin Regimen

     Combination therapy
    - bed-time insulin + OHA

     Total insulin replacement


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Biphasic insulin treatment guidelines
    Twice-daily regimen

    Indications

    Type 2 diabetic patients not controlled


    on once-daily regimen
    Type 1 diabetic patients

    Giudelines

     For Type 2 diabetic patients stop OAD except Metformin


     Starting daily dose = 0.3-0.5 U/Kg body weight
     Give 2/3 of the total daily dose before breakfast and 1/3 before dinner
     Titrate the dose according to FBG and PPG
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S
    Hypoglycemia
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S
    Snack
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    hyperglycemia

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S

    Hypoglycemia
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S
    Insulin Regimen
    Twice-daily injections, mixture short and intermediate,
    before breakfast and the evening meal

    8 am 12 4 pm 8 pm 12 4 am 8am
    B S L S D S
    Insulin Regimen

     Combination therapy
    - bed-time insulin + OHA

     Total insulin replacement


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Insulin Regimen

     Combination therapy
    - bed-time insulin + OHA

     Total insulin replacement


    - Twice daily insulin mixture
    - Basal-bolus regimen
    Physiological Insulin Secretion
    Profile
    75
    Breakfast Lunch Dinner
    Plasma Insulin µU/ml)

    50

    25

    4:00 8:00 12:00 16:00 20:00 24:00 4:00


    Time
    Basal Bolus Therapy

    Prandial insulin
    e.g. Aspart, Lispro,
    Glulisine
    levels
    n leve ls

    Basal insulin
    e.g. Glargine
    Insu
    Ins lin
    uli

    00.00 08.00 12.00 18.00 24.00


    Basal Bolus Therapy

    Prandial insulin
    Insulin levels

    Basal insulin
    eg: Glargine

    00.00 08.00 12.00 18.00 24.00


    Basal Bolus Therapy

    Prandial insulin
    Insulin levels

    Basal insulin
    eg: Glargine

    00.00 08.00 12.00 18.00 24.00


    Starting a Basal-Bolus Regimen
    TDD = Weight (kg) x 0.5 U/kg

    TDD

    Basal Insulin Dose Bolus Insulin Dose


    ½ TDD ½ TDD

    Breakfast Dose Lunch Dose Dinner Dose


    1/6 TDD 1/6 TDD 1/6 TDD
    Starting a Basal-Bolus Regimen
    TDD = Weight (kg) x 0.5 U/kg

    TDD

    Basal Insulin Dose Bolus Insulin Dose


    ½ TDD ½ TDD

    Breakfast Dose Lunch Dose Dinner Dose


    1/6 TDD 1/6 TDD 1/6 TDD
    Starting a Basal-Bolus Regimen
    TDD = 110 (kg) x 0.5 U/kg

    TDD

    Basal Insulin Dose Bolus Insulin Dose


    ½ TDD ½ TDD

    Breakfast Dose Lunch Dose Dinner Dose


    1/6 TDD 1/6 TDD 1/6 TDD
    Starting a Basal-Bolus Regimen
    TDD = 110 (kg) x 0.5 U/kg

    55 U

    Basal Insulin Dose Bolus Insulin Dose


    ½ TDD ½ TDD

    Breakfast Dose Lunch Dose Dinner Dose


    1/6 TDD 1/6 TDD 1/6 TDD
    Starting a Basal-Bolus Regimen
    TDD = 110 (kg) x 0.5 U/kg

    55 U

    Basal Insulin Dose Bolus Insulin Dose


    27 U 27 U

    Breakfast Dose Lunch Dose Dinner Dose


    1/6 TDD 1/6 TDD 1/6 TDD
    Starting a Basal-Bolus Regimen
    TDD = 110 (kg) x 0.5 U/kg

    55 U

    Basal Insulin Dose Bolus Insulin Dose


    27 U 27 U

    Breakfast Dose Lunch Dose Dinner Dose


    9U 9U 9U
    Adjustment ofTitrate
    insulin
    100 mg/dL
    insulin weeklydosage
    to fasting BG <

    Basal-bolus regimen
    - if 120-140 mg/dL, increase 2 units
    - if 140-160 mg/dL, increase 4 units
    - if 160-180 mg/dL, increase 6 units
     Basal insulin is adjusted according to FPG
    - if >180 mg/dL, increase 8 units

    levels
     Prandial insulin is adjusted according to
    the PPG level after each meal by
    increasing the corresponding insulin dose
    by 2-4 units
    Sliding scale
    Insulin Insulin

    300
    Plasma glucose mg/dl

    250

    200

    150

    100

    50

    6AM 12MD 6PM 12MN


    Time
    Thank You

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