Before we talk about insulin regimes there a few different types of insulin that you will need to be familiar with.
Insulin can be from a variety of sources
There are many types of Insulin available to treat diabetes and the type of insulin you will be prescribed will be specific to you. It is important to make a note of the type of insulin you are taking, the delivery method e.g. (Pens), the dosage you have been prescribed and the time when you need take it.
This type of insulin provides a boost of insulin to control glucose produced by the meal. This pattern of insulin secretion is produced naturally in people who do not have diabetes.
Quick acting insulin tends to last from 2-5 hours just long enough for the meal they are taken. They can be referred to as “Clear Insulin” (like water)
This type of insulin provides a gentle continuous supply of insulin, even when asleep. Can be injected once or twice a day.
Long acting insulin is also referred to as “Cloudy Insulin” or “Milky” with the exception of Glargine and Levemir which is clear.
Insulin can be used in different combinations to meet your individual needs, which may change over time. Detailed descriptions of the different regimens can be downloaded from here. Finding a suitable regimen for you will be discussed at your appointment.
Increasing the dose may not be the answer and may indicate that you need twice daily background insulin.
Your diabetes team will discuss with you any fears or concerns you may have regarding starting insulin. Insulin therapies or regimes can vary from person to person dependent on individual circumstances. Insulin can be given once, twice, three, four or five times a day. Commonly for people with Type 2 Diabetes, Metformin therapy may be continued when insulin is started. This is because Metformin has been shown in research to protect the heart and reduce blood sugars and has some benefit with keeping weight gain to a minimum.
You may be started on insulin using a once daily long acting (‘basal’ or background) insulin. This may be added to the tablets you usually take, or you may be advised to stop one of your tablets when you start the insulin. Once daily injections (Glargine & Detemir) are given at the same time each day , eg morning or bedtime. Most people who have once daily insulin tend to give it in the evening, commonly before bed. This insulin is absorbed slowly over the next (24) twenty-four hours.
For Example Combination tablets and bedtime insulin- injected at bedtime e.g Lantus or Detemir lasts 24 hours and should once daily at approximately the same time NB. Detemir may be given twice daily.
Twice daily injections are usually given before or with breakfast and with the evening meal. Often twice daily injections involve insulin that is a mixture of two types of insulin, quick acting and slow acting. The quick acting part helps to reduce the blood glucose after meals and the long acting covers the period from one injection to the next. People with diabetes often like this regime because they only have to give two injections a day, and can find this most convenient. The regime can work well particularly for people who do have an established routine to their days and their work/meal patterns.
For Example: Pre- mixed insulin- Injected at breakfast and evening meal such as Humulin M3
However there can be problems if you work shifts or change your routine regularly as this regime does not give you much flexibility.
This type of insulin regime is referred to as a ‘Basal- Bolus’ regime. The basal (background) insulin is given once a day and provides slowly absorbed background insulin over a 24 hour period. The bolus insulin is given three times a day before/with each meal and provides a quick insulin response to reduce blood sugars after a meal.
This regime offers the most flexibility as people can vary their doses for each meal, and will find that they don’t have to take extra snacks to maintain their blood sugars. They are often less likely to have problems with hypoglycaemia or weight gain.
For Example: Basal-Bolus Therapy Background (Basal) at bedtime and quick / short acting (bolus) - injected at breakfast, lunch and evening meal
Remember that insulin varies according to how quickly or slowly it is absorbed into the blood stream and how long its action lasts. There are many different insulin types available as mentioned above. Your diabetes team will discuss with you what your options are for insulin therapy.
Now that you are on insulin you there are a few necessary changes you will need to make.
It is important to make a note of the type of insulin you are taking, the delivery method, (e.g. pen) the dosage you have been prescribed and the time when you need take it.
You and Your insulin:
Telling family and work and the DVLA & driving: