Your AI powered learning assistant

INSULIN TREATMENT FOR DIABETES | HOW TO START INSULIN ON A PATIENT | DIABETES MELLITUS TREATMENT |

Intro

00:00:00

Insulin is a crucial component in diabetes management, and starting a patient on insulin involves understanding various types and regimens. Different insulins serve specific purposes; some are fast-acting while others provide long-term control. The basal-bolus regimen combines both short-acting and long-acting insulins to mimic natural insulin production, allowing for better blood sugar regulation throughout the day.

NORMAL GLUCOSE PEAKS & INSULIN

00:00:22

Normal glucose levels are maintained by insulin, which responds to food intake. After eating, glucose spikes occur but are regulated back to baseline by insulin release. In diabetics, the absence of insulin leads to elevated baseline glucose levels as they cannot effectively manage these spikes.

DIABETICS

00:01:15

Diabetic patients often experience high baseline glucose levels due to insufficient insulin or insulin resistance, leading to significant post-meal spikes. Effective diabetes management involves administering insulin in alignment with these peaks after meals. Various treatment regimens include basal-bolus therapy, mixed insulin approaches, and sliding scale insulins.

TYPES OF INSULIN

00:02:07

Insulin is categorized into different types based on their action duration and peak times. Ultra short-acting insulins, like insulin lispro and glulisine, act quickly with a peak within 20 to 30 minutes but have a brief overall effect. Short-acting insulins such as regular insulin reach their peak in two to four hours while lasting longer than ultra short options. Intermediate acting insulins (e.g., NPH) take six to twelve hours for onset but last between twelve to eighteen hours; long-acting variants like glargine provide stable blood levels over twenty-four hours without significant peaks.

BASAL BOLUS REGIMEN

00:03:50

The basal bolus regimen mimics the body's natural insulin release by administering long-acting insulin to maintain baseline glucose levels and ultra-short acting insulin before meals to control spikes. The long-acting dose, known as the basal dose, works over 24 hours while the bolus doses are taken right before each meal after checking blood sugar levels. Patients must eat immediately after taking their bolus shot; otherwise, they risk hypoglycemia which can be life-threatening. Although this method is effective for managing glucose levels, many patients struggle with compliance due to frequent injections and monitoring requirements.

MIXED INSULIN

00:08:22

Mixed insulin combines rapid-acting insulin, typically regular insulin, with intermediate-acting insulin like NPH. This mixture is often referred to as 70/30 insulin, consisting of 30% regular and 70% NPH. The purpose of mixed insulin is to replicate the basal-bolus approach in diabetes management; the intermediate acting component serves as a basal level while the rapid acting mimics bolus doses.

MIXED REGIMEN

00:09:33

A mixed insulin regimen involves two daily injections, one before breakfast and another in the evening. This method uses intermediate-acting insulin to manage baseline glucose levels while short-acting insulin addresses post-meal peaks. Although it offers less effective glucose control compared to a basal-bolus approach—leading to persistent hyperglycemia—it is preferred by patients for its simplicity of only needing two injections per day. The total daily dose is calculated similarly as with basal-bolus regimens, typically using 0.3 to 0.4 units per kg split into morning and evening doses.