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Diabetes Drugs (Oral Antihyperglycemics \u0026 Insulins)Insulin and diabetes management -
Training is necessary. Insulin Inhaler Inhaled insulin is taken using an oral inhaler to deliver ultra-rapid-acting insulin at the beginning of meals. Advantages of insulin inhalers Is not an injection. Acts very fast and is as effective as injectable rapid-acting insulins.
Can be taken at the beginning of meals. Could lower risk of low blood sugar. Could cause less weight gain. Inhaler device is small. Disadvantages of insulin inhalers Might cause mild or severe coughing. May be more expensive. Still requires injections or a pump for basal insulin.
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When blood glucose levels are above predefined targets, additional short-acting insulin may be added to the bolus dose before meals. For example, a patient takes 40 units of glargine daily and 12 units of lispro Humalog before each meal, and has a correction factor of 1 unit for every 20 mg per dL 1.
If the blood glucose level at breakfast is mg per dL 8. Premixed insulin similarly reduces A1C compared with basal-bolus insulin. Fewer injections are needed, but patients are more restricted in their eating habits and schedule. Patients must eat breakfast, lunch, dinner, and possibly midmorning and bedtime snacks to prevent hypoglycemia.
If used, correction insulin must be administered separately with a short-acting insulin. This may increase the number of injections compared with basal-bolus therapy Figure 5 2.
The initial dosage of insulin is individualized based on the patient's insulin sensitivity. Insulin therapy may be started with a set dosage, such as 10 units of glargine daily, or by using weight-based equations.
Equations to estimate augmentation, replacement, carbohydrate ratio, and correction therapy are listed in Table 2. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal and 50 percent as bolus, divided up before breakfast, lunch, and dinner.
For example, a kg lb patient requiring basal-bolus and correction insulin would need 36 units of basal insulin 0. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Some physicians have adopted the Treat-to-Target Trial's titration schedule for basal insulin Table 4.
Patients should go to the physician's office for follow-up at least every three to four months. The frequency of communicating insulin titration via clinical contact, telephone, e-mail, or fax is highly correlated with improvement of A1C levels.
Insulin is effective only if administered appropriately. The needle should be placed at a degree angle to the skin and held in place for five to 10 seconds after injection to prevent insulin leakage.
Rotation of injection sites is important to prevent lipohypertrophy i. Insulin is available in pens and vials. Benefits of insulin pens include the convenience of storing at room temperature for 28 days after opening and ease of use for patients with visual or dexterity problems.
Patients should be instructed to prime the insulin pen before every use. Priming consists of drawing up 1 or 2 units of insulin and injecting into the air to allow the insulin to fill the needle. Many oral medications are safe and effective when combined with insulin therapy.
To maximize benefit without causing significant adverse effects, it is important to consider the mechanism of action for different therapies.
Insulin sensitizers have been proven safe and effective when combined with insulin therapy. Alpha-glucosidase inhibitors delay absorption of carbohydrates in the gastrointestinal tract to decrease postprandial hyperglycemia.
These medications are safe and effective when combined with insulin. Insulin secretagogues sulfonylureas and glitinides can be combined with insulin, especially when only basal augmentation is being used.
However, there is a possible increased risk of hypoglycemia that needs to be monitored closely. Usually by the time insulin is required for meals, insulin secretagogues are not effective or necessary.
However, it is recommended to continue oral medications while starting insulin to prevent rebound hyperglycemia. Incretin therapies include dipeptidyl-peptidase IV inhibitors sitagliptin [Januvia] and saxagliptin [Onglyza] and glucagon-like peptide-1 agonists exenatide [Byetta] and liraglutide [Victoza].
Sitagliptin is currently the only one of these medications that is approved by the U. Food and Drug Administration for combination therapy with insulin. This combination is associated with improved fasting and postprandial glucose control.
Data Sources : A PubMed search was completed in Clinical Queries using the key terms intensive insulin therapy, insulin and cancer, insulin and weight gain, UKPDS, self-titration insulin, human and analog insulin, metformin and insulin, sulfonylurea and insulin, and incretin and insulin.
The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Search dates: August 24, , and November 29, Ritzel RA, Bulter PC.
Physiology of glucose homeostasis and insulin secretion. In: Leahy JL, Cefalu WT, eds. Insulin Therapy. New York, NY: Marcel Dekker; — Diabetes Education Online. University of California, San Francisco.
Accessed December 10, Gastaldelli A, Ferrannini E, Miyazaki Y, Matsuda M, DeFronzo RA. Betacell dysfunction and glucose intolerance: results from the San Antonio metabolism SAM study. Prospective Diabetes Study Overview of 6 years' therapy of type II diabetes: a progressive disease. Prospective Diabetes Study UKPDS Group [published correction appears in Diabetes.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS UK Prospective Diabetes Study UKPDS Group.
Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. Lindström T, Jorfeldt L, Tegler L, Arnqvist HJ.
Hypoglycaemia and cardiac arrhythmias in patients with type 2 diabetes mellitus. Diabet Med. American Diabetes Association. Insulin administration. Diabetes Care. Jonasson JM, Ljung R, Talbäck M, Haglund B, Gudbjörnsdòttir S, Steineck G.
Insulin glargine use and short-term incidence of malignancies—a population-based follow-up study in Sweden. Giovannucci E, Harlan DM, Archer MC, et al.
Diabetes and cancer: a consensus report. Jellinger PS, Davidson JA, Blonde L, et al. Endocr Pract. UK Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS UK Prospective Diabetes Study UKPDS Group [published correction appears in Lancet.
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. Often people needing insulin feel much better once they start having insulin.
If you need to start using insulin, your doctor or diabetes nurse educator can help with education and support. They will teach you about:. Your doctor or diabetes nurse educator will help you to adjust your insulin. An important part of insulin adjustment is regular blood glucose monitoring and recording.
When you start using insulin it is important to have a review by an accredited practising dietitian to understand how carbohydrates and insulin work together. If you have type 1 diabetes, learning how to count carbohydrates and matching your insulin to the food you eat is the ideal way to manage it.
Depending on what you eat, your mealtime insulin doses may therefore vary from meal to meal and day to day. Insulin is grouped according to how long it works in the body.
Both help manage blood glucose levels. The 5 different types of insulin range from rapid- to long-acting. Some types of insulin look clear, while others are cloudy. Check with your pharmacist whether the insulin you are taking should be clear or cloudy. Before injecting a cloudy insulin, the pen or vial needs to be gently rolled between your hands to make sure the insulin is evenly mixed until it looks milky.
Often, people need both rapid- and longer-acting insulin. Everyone is different and needs different combinations. Rapid-acting insulin starts working somewhere between 2.
Its action is at its greatest between one and 3 hours after injection and can last up to 5 hours. When you use this type of insulin, you must eat immediately or soon after you inject.
Fiasp — released in Australia June — is a new, rapid acting insulin with faster onset of action. It is designed to improve blood glucose levels after a meal.
Short-acting insulin begins to lower blood glucose levels within 30 minutes, so you need to have your injection 30 minutes before eating. It has its maximum effect 2 to 5 hours after injection and lasts for 6 to 8 hours.
These insulins begin to work about 60 to 90 minutes after injection, peak between 4 to 12 hours and last for between 16 to 24 hours. Mixed insulin contains a pre-mixed combination of either very rapid-acting or short-acting insulin, together with intermediate-acting insulin.
In Australia, the strength of the above insulins is units per ml. Some countries have different strengths. The exception to this is the once-daily long-acting insulin Toujeo which was released in and has a strength of units per ml.
Do not change between Lantus and Toujeo without consulting a health professional. Different insulin delivery devices are available. The main choices are syringes, insulin pens and insulin pumps. Syringes are manufactured in unit 0. The size of the syringe needed will depend on the insulin dose.
For example, it is easier to measure a 10 unit dose in a 30 unit syringe and 55 units in a unit syringe. The needles on the syringes are available in lengths ranging from 6 to 8 mm.
Your doctor or diabetes nurse educator will help you decide which syringe and needle size is right for you. Insulin syringes are single-use only, and are free for people in Australia registered with the National Diabetes Service Scheme NDSS.
Most Australian adults no longer use syringes to inject insulin. They now use insulin pens for greater convenience. Insulin companies have designed insulin pens disposable or reusable to be used with their own brand of insulin.
Disposable insulin pens already have the insulin cartridge in the pen. They are discarded when they are empty, when they have been out of the fridge for one month, or when the use-by date is reached. Reusable insulin pens require insertion of a 3 ml insulin catridge. The insulin strength per ml is units.
When finished, a new cartridge or penfill is inserted. Pen cartridges also need to be discarded one month after commencing if insulin still remains in the cartridge. Your doctor or diabetes nurse educator will advise you about the right type of pen for your needs.
Pen needles are disposable needles that screw on to an insulin pen device to allow insulin to be injected. They are available in different lengths, ranging from 4 to However research recommends that size 4 to 5 mm pen needles are used. The thickness of the needle gauge also varies — the higher the gauge, the finer the needle.
It is important that a new pen needle is used with each injection. Your diabetes nurse educator can advise you on the appropriate needle length and show you correct injection technique.
An insulin pump is a small programmable device that holds a reservoir of insulin and is worn outside the body. The insulin pump is programmed to deliver insulin into the fatty tissue of the body usually the abdomen through thin plastic tubing known as an infusion set or giving set.
Only rapid-acting insulin is used in the pump. The infusion set has a fine needle or flexible cannula that is inserted just below the skin. This is changed every 2 to 3 days. The pump is pre-programmed by the user and their health professional to automatically deliver small continual amounts of insulin to keep blood glucose levels stable between meals.
Individuals can instruct the pump to deliver a burst of insulin each time food is eaten, similar to the way the pancreas does in people without diabetes. The insulin pump isn't suitable for everyone.
If you're considering using one, you must discuss it first with your diabetes healthcare team. The cost of an insulin pump is generally covered by private health insurance for people with type 1 diabetes a waiting period applies.
Disposable extras required for use such as cannulas, lines and reservoirs are subsidised by the National Diabetes Service Scheme NDSS.
Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer.
Diabetds may take just diabetse type of insulin or different types throughout the Nutrient-dense foods for performance depending Isnulin your lifestyle, diabwtes you eat, Insulin and diabetes management your blood sugar levels. Ask Insulin and diabetes management doctor to refer you to diabetes self-management education and support DSMES services when you start using insulin. Intermediate- or long-acting insulin taken to keep blood sugar levels steady between meals and overnight. Syringes and insulin pens deliver insulin through a needle. Pens may be more convenient, and children may find them more comfortable than syringes.
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