Dr Stanley Ngare

 Pharmacology of Types of insulin available  Various routes of delivery & factors that affect absorption  Patient and provider barriers  Treatment should be individualised  Challenges in monitoring blood glucose  Complications of insulin therapy.

 Pre Type 1 DM: Was an acute terminal illness  Insulin changed this: Saved lives = chronic illness  Now: Helps achieve glycemic control hence delay or prevent microvascular complications ?prevent macrovascular complications

1. Rapid acting Analogues (insulin like) 2. Short acting /soluble/ regular 3. Intermediate acting  Isophane (NPH- Neutral Protamine Hegadorn) 4. Long acting (Analogues)  Glargine  Detemir

 Single most important “ medical” barrier to glycaemia : ▪ HYPOGLYCEMIA  Single most important “ Patient &provider barrier” to glycaemia: PSYCHOLOGICAL “ INSULIN RESISTANCE”

 All people with Type 1 Diabetes  Many Type 2 Diabetic patients  Pregnancy  Inpatient care

 Calculate the TDD Type 1 (0.6) UI kg/day Type UI kg/day  Some conditions may require higher or less doses e.g obesity, puberty, hypoglycemia unawareness.  Progressive adjust insulin to target  SMBG ( Glucometer) Essential tool

 Appreciation Mr Michael Brown -CDE