Insulins in primary care setting Domina Petric, MD

Insulins can be divided into: fast (rapid and short) acting insulins intermediate acting insulins intermediate acting insulins with rapid effect long acting insulins

I. Fast acting insulins

Daily dose is usually in a range from 0,3 to 1,0 IU/kg. Human insulin Daily dose is usually in a range from 0,3 to 1,0 IU/kg. Dose is adjusted due to individual pateint´s needs and also is adjusted in specific situations: physical activity, infection...

Application Insulins (all of them) are applicated like subcutaneous injection (45 degrees). The needle should be kept under the skin for at least 6 seconds during the application process. Application sites are abdominal wall, tight, gluteal or deltoid area. Application site should be changed to prevent lipodystrophy.

Application sites (www. lantus.com) https://www.lantus.com/-/media/EMS/Conditions/Diabetes/Brands/Lantus/Consumer/22Chart%20png.png

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Insulin injection lipodystrophy https://lh4.googleusercontent.com/-03dHQClnROg/TXzpdmwlGvI/AAAAAAAACUU/Obq7F52XYsw/w1200-h630-p-k-no-nu/F2.large.jpg

The action of insulin (duration) depends on: dose site of application blood flow body temperature physical activity

Warning! Within 30 minutes after injection of human insulin, the meal shoud be taken (containing carbohydrates).

Dangerous interaction Human insulin Actrapid and pioglitazone can cause heart failure in patients with risk factors for heart insufficiency.

Insulin aspart It is an insulin that is taken with the meal. It is applied subcutaneously 2 minutes before the meal. It can be also applied during 20 minutes after the meal starts. It is usually applied in combination with intermediate or long acting insulins.

Insulin aspart Daily dose is from 0,5 to 1 U/kg. In patients with DMT1 that are not treated with insulins before, dose is 0,2 to 0,4 U/kg/day (50% of total daily insulin dose). In patients with DMT2 recommended dose is 4 U during one or more meals. Not yet approved for children under the age of 18.

In combination with intermediate or long acting insulins. Insulin glulisine In combination with intermediate or long acting insulins.

Intermediate acting insulins II. Intermediate acting insulins

Insulinum humanum intermediate acting It can be applied alone or together with rapid acting insulin. Intensified insulin therapy: it can be used as basal insulin therapy (subcutaneous injection in the evening and/or in the morning) with rapid acting insulin injection in the time of meal Dose is 0,3 to 1,0 IU/kg/day.

intermediate acting insulins with rapid effect III. intermediate acting insulins with rapid effect

Human insulin with rapid start effect It has a rapid onset of action and longer duration of acting. It is usually given once or twice a day (dose 0,3-1,0 IU/kg/day). It is biphasic formulation that contains rapid and long acting insulin. It is not appropriate for intravenous application.

IV. Long acting insulins

Insulin glargine It is applied once a day at any time, but always at the same time. It can be applied in patients with DMT2 together with oral hypolipemics. It can not be applied intravenously. In the case of diabetic ketoacidiosis, human insulin (short acting) is applied iv.

It can be used as monotherapy or together with bolus insulin. Insulin detemir It can be used as monotherapy or together with bolus insulin. If it is used together with oral hypolipemics, dose is 0,1-0,2 U/kg.

Pregnancy and lactation Insulins are safe for application during pregnancy and lactation!

Literature HALMED MEDIATELY www.lantus.com