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Guide to Diabetes

Getting started on Insulin 


Gp Insulin

Before we talk about insulin regimes there a few different types of insulin that you will need to be familiar with.

 

Sources of insulin


Insulin can be from a variety of sources
 

  • Human Insulin that is produced by genetic engineering to match human insulin not taken from humans (synthetic)
  • Animal Insulin- produced and purified from pork or beef cells
  • Analogue insulins, scientifically modified insulin


Types of insulin


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.

 

1. Meal related insulin (Bolus)


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 (analogue): this can be injected up to 15 minutes before, during or up to 15 minutes after your meal e.g. Novorapid, Humalog, Apidra
  • Short acting e.g. Actrapid, Humulin S


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)

 

2. Background insulin (Basal)


This type of insulin provides a gentle continuous supply of insulin, even when asleep. Can be injected once or twice a day.
 

  • Medium acting: e.g. Insulatard, Humulin I
  • Long Acting (analogue): these are taken before going to bed. e.g Lantus (Glargine), Levemir (Detemir)
     

Long acting insulin is also referred to as “Cloudy Insulin” or “Milky” with the exception of Glargine and Levemir which is clear.


3. Pre-mixed insulin


  • Pre-mixed: a combination of medium and short acting insulin e.g. Humulin M3
  • Pre-mixed (analogue): a combination of medium acting insulin and rapid acting analogue e.g. Novomix 30, Humalog Mix 25 or 50
    See Insulin Available in the UK (Diabetes UK)


Types of Regimen


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.


Timing


  • Insulin is usually given before meals
  • Analogue insulin should be given immediately before meals or shortly afterwards
  • Long acting insulin analogues such as Lantus (Glargine) or Levemir (Detemir) last up to 24 hours and should be given once daily at approximately the same time each day. In some people it may be running out after 18 hours. This may explain why blood glucose levels may be rising around this time.

 

Increasing the dose may not be the answer and may indicate that you need twice daily background insulin.

 

How many injections will I need each day?


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.

 

Once daily insulin


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


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.

 

Four injections a day


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

 

Points to remember
 

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 I am on insulin what will I need to do?


Safe Use of Insulin


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:

  • Always carry your identity card
  • Include your gp name and number, medications, and the kind of insulin you are taking.i.e carry your Insulin Passport 
  • Carry an identity card or bracelet so others can identify you are a person with diabetes.(medicalert www.medicalert.org.uk)
  • Have regular meals, based around starchy foods. With some insulin regimes you may need a bedtime snack.
  • You may need extra snacks or insulin adjustments for you may still have hypos so: Always carry glucose or sugary snacks.


Your Equipment:

  • Fill in a prescription exemption form if you haven’t one already. (Ask your GP) See healthcare entitelments
  • Keep all your equipment clean and wash your hands before using
  • Rotate your injection sites


Telling family and work and the DVLA & driving:

  • Tell your family, friends and employer and workmates what to do in emergencies. Eg hypos see Employment section for more advice
  • If you hold a current driving licence you are by law required to inform the DVLA of the change. See DVLA website
  • Your car insurance will need to be updated and you will need to take more precautions when driving to prevent accidents. See Driving and the DVLA
  • Always test you blood before driving- see driving safely
  • NEVER drive if you are feeling “hypo” or are due a meal/snack - Driving and hypos
  • Always carry glucose or sugary snacks.