Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS
Chapter
8
Insulin
Regimens and Other Drugs Used in the Treatment of Type 1 Diabetes
Standard Insulin Regimens
There are many different insulin protocols in use. These are just six commonly used methods of delivering insulin.
One injection of long-acting insulin used in conjunction with oral meds or alone in type 2 diabetes. This helps reduce the liver’s release of glucose overnight.
Conventional Therapy
Can be premixed, but doing so will reduce flexibility of doses.
Can be premixed, but doing so will reduce flexibility of doses.
Intensive Therapy
Intermediate-acting insulin moved to bedtime (HS) to reduce nocturnal hypoglycemia and/or reduce fasting hyperglycemia.
Comparison of Rapid Acting Insulin Analogs and Short Acting Insulin
- Can generally make a 1:1 substitution (rapid for short)
- Rapid associated with lower postprandial blood glucose, and quicker correction of hyperglycemia
- Fewer hypoglycemic episodes with rapid;
- Faster recovery from hypoglycemia with rapid
- High fat meals or gastroparesis – short may be best choice
- High carbohydrate meals – rapid more effective to lower postprandial blood glucose (BG) excursions
- Decreased need for between meal snacks when using rapid
- Rapid can be given immediately after the meal when food intake is not predictable.
- May need more basal insulin when using rapid versus short
- Rapid may be superior
for:
- insulin pump use
- those using
long-acting for basal and rapid before meals and snacks
Pramlintide acetate was released for use in 2005 and is used in addition to insulin and/or analogs to assist in gaining better control of blood glucose levels. Pramlintide acetate (Symlin®) is a synthetic analog of human amylin. Amylin is a hormone also made and secreted by the beta cells, and therefore lacking in persons with type 1 diabetes. In those without diabetes, it is secreted along with insulin to control post-prandial blood glucose levels. Its anti-hyperglycemic effects include:
-
Slowing gastric emptying
-
Suppressing glucagon release, resulting in less glucose release from the liver.
-
Regulation of food intake due to modulation of appetite.
Pramlintide acetate is administered by subcutaneous injection prior to meals to mimic normal levels. Injection technique is the same as that for insulin. It cannot be mixed with insulin and may require pre-meal insulin be reduced to prevent hypoglycemia. Side effects may include nausea, vomiting, dizziness, indigestion, stomach pain, decreased appetite and fatigue. Its use is contraindicated in those with gastroparesis, hypoglycemia unawareness, women who are pregnant or breastfeeding and children.
Vials in use can be stored at room temperature (less than 77°F) for 28 days and then discarded. Vials not in use should be stored in the refrigerator and discarded after the expiration date.
References: American Diabetes Association (2006). Clinical Practice Recommendations. Diabetes Care, Vol 29 (1).
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