1. Insulin Overview

2. Objectives: Know the different types of insulin.
Understand it’s action,duration and side effects.
Demonstrate proper insulin preparation and administration both single and mixed type.
Identify injection site and site rotation.
Know the correct management of insulin side effect.

3. WHAT IS INSULIN ?
● Is a hormone secreted by the Beta cells of the pancreas.
● Helps to transfer glucose from the blood into the body cells to be used for energy.
● Aid to store glucose in the form of glycogen in the liver and muscle.

4. GOAL OF INSULIN 1. Maintain good glycaemic control.
2. Prevention of DKA {Diabetic Ketoacidosis} and Hyperosmolar Coma.
3. Reduction of frequent infection.
4. Prevention and delay of microvascular and macrovascular complications.
5. Reduce the risk of fetal abnormalities, still birth or abortion.

5. Who should be treated with insulin?
1. All Type 1 DM.
2. During pregnancy with GDM.
3. Type 2 DM in the following situations:
During stress (acute illness)
Renal failure
Acute emergency (DKA, NKHS)
Allergy to oral hypoglycemic agent
Intensive therapy to delay or prevent complications.

6. HISTORY OF INSULIN ¾ 1921 –Two Canadian Physicians
discovered Insulin by extracting
and purifying from animal pancreas
¾ First to utilized insulin injection
therapy was in Toronto General
Hospital

7. ¾ 1980 - Improvement in the extraction
and purification with insulin
- Human insulin was introduced
¾ Available commercially

8. ¾ 1996 - Rapid acting insulin
( Insulin Lispro – Humalog )
- Very quick onset and duration

9. ¾ Basal Insulin
( Insulin Glargine – Lantus )
- Peak - less and long acting insulin
- Less hypoglycemia and reduced
incident of nocturnal hypoglycemia

10. ¾ Inhaled Insulin
( EXUBERA )
- More rapid absorption
- Administer 5 minutes before meal
¾ Oral insulin
( Exenatide capsule)
- The protective cover is made of gelatin, it will not protect enough the insulin

11. SOURCES OF INSULIN Bovine Insulin - Obtained from the pancreas of cow
- Earliest form of insulin but now
obsolete.
Porcine Insulin
- Derived from the pancreas of the pig

12. Human Insulin
- Copies of the Human insulin molecule
- Produced from recombinant DNA in
E. coli bacteria
- It stimulates less antibody formation
than animal insulin

13. TYPES OF INSULIN Rapid Acting Insulin ( INSULIN LISPRO - HUMALOG )
ONSET minutes
PEAK hours
DURATION hours

14. ( Actrapid HM, Humulin R )
Short Acting Insulin
( Actrapid HM, Humulin R )
ONSET minutes
PEAK hours
DURATION hours

15. Intermediate Acting Insulin
( Insulatard HM, Humulin N)
ONSET 1 ½ hour
PEAK hours
DURATION hours

16. Long Acting Insulin
( Lantus or Levemir)
DURATION hours

17. Pre Mixed Insulin
a) Intermediate and Short Acting Insulin.
( Mixtard 30 HM & Humulin 70/30 )
ONSET minutes
PEAK hours
DURATION hours

18. Pre Mixed Insulin
b) Intermediate And Rapid Acting Insulin.
( Novomix 30 & Humalog Mix)
ONSET minutes
PEAK hours
DURATION hours

19. INJECTION DEVICES ● Insulin Pumps / CSII
(Continuous Subcutaneous Insulin Infusion)
• Deliver insulin continuously via the
subcutaneous route
• A bolus of insulin dose given before meal.
• Tubing and needle replaced every 3
days.

20. ●Insulin Pens
NOVO PEN FLEXPEN
• With detachable needle and Prefilled cartridge.
• Deliver the dose by pressing the injection button.

21. ● J - Tip Injection Device) INJEX)
• Administer insulin
through the skin
by air pressure.

22. ● Insulin Syringes 100 units Syringe 50 units Syringe
Two (2) units/ line One (1) unit/line

23. • Insulin syringes are marked differently
according to their capacity.
• These are standardized internationally.
Needle of Insulin Syringe
Gauge 30 x 8 mm (Adult)
Gauge 31 X 5 mm ( Children & Thin adult)

24. ROUTE OF ADMINISTRATION
1. Subcutaneous
- Injection into the adipose tissue
beneath the skin
- It causes minimal tissue trauma and
little risk of striking large blood
vessels and nerve

25. 2. Intramuscular
- Absorption is more rapid than
subcutaneous injection
- Absorbs in the muscle with in 10
minutes
3. Intravenous
- Maintain stable level of the medication
in the blood

26. SITES OF INSULIN INJECTIONS BY SUBCUTANEOUS ( subcut)
♦ Abdomen ♦ Buttocks
♦ Thighs ♦ Upper Arm

27. MULTIPLE INJECTION SITES

28. ANGLE & PLACEMENT OF THE NEEDLE.
Always inject in 90 º angle.
except for a very small children or extremely thin adult ( inject in 45 º angle )

29. SIDE EFFECT or COMPLICATIONS OF INSULIN INJECTION
Hypoglycemia
- Excessive sweating, tremors, palpitations,
blurred vision, dizziness, nervousness, hunger
confusion, irritability ,weakness
Causes
: Late or missed meals & snacks.
: accidental overdose or taking
too much insulin or OHA.
: Increased physical activity without
taking snacks.
: Excessive alcohol intake .
: Delayed or impaired absorption of
Carbohydrates (Gastro intestinal neuropathy)

30. Allergic Reactions
- Itchy & small hard red spot at the
injection site.

31. Lipodystrophies
a. Lipoatrophy
- A hollowing or pitting of
subcutaneous tissue.
- A condition resulting from
loss of fat to the area due to
repeated injections of impure
insulin.

32. b. Lipohypertrophy
- A thickening of the
subcutaneous tissue.
- It is the formation of
scar tissue in an area
that has been used
repeatedly for injection.

33. Infection or Abscess
- Caused by wrong injection
technique or using unsterile
syringes and needles.

34. Factors Affecting Insulin Absorption
a. HEAT
Hot baths, hot bottles or containers will
increase the absorption of insulin.
b. COLD
Cold weather, cold solutions, cold bottles
or containers will decrease the absorption
of insulin.

35. c. MASSAGE
Is not recommended after the injection.
It will increase the absorption of insulin.
d. Do not inject insulin into an area which
you will use for exercise.
Example : legs for jogging
arms for weight lifting

36. e. Injection sites must be rotated to prevent
fibrosis of fatty tissue. This will decrease
the absorption of insulin.
f. Depth of injection
Deeper injection induces faster absorption
& shorten the duration of action.
g. Insulin absorption can be delayed if injected into an edematous or with Ascites ( the upper arm or the thigh will be preferred site in this situation)

37. To ensure correct delivery:
Administer injection 2 cm (2 fingers) away from the previous site.
Try not to inject the same site with in 2-3 weeks.
After injecting the insulin the needle should remain under the skin for at least 5 seconds and press the injection site to prevent insulin from leaking.
Inject 5 cm away from the umbilicus.
Use a new sterile needle and syringe for each injection to prevent contamination and blocked needles.

38. STORAGE GUIDELINES FOR INSULIN VIAL
1. It can be stored at a room temperature of less than 25 degrees Centigrade.
2. If in doubt about the room temperature,
keep in refrigerator with temperature
of 2 – 8 degrees Centigrade.
3. Avoid freezing of insulin.

39. 4. Insulin should not be exposed to direct
sunlight.
5. Check the vial of insulin for sediments or other visible changes before withdrawing.
Humulin R / Actrapid is clear or colorless
Humulin N / Insulatard HM is suspension or milky

40. 6. Date the vial on the first day of opening.
This is good only for one (1) month from
the date of opening.
7. Check for expiration date of the insulin vial
before use.
8. Always keep a spare vial of insulin in case
the present one will be broken.

41. As a general rule, use one brand when mixing two types of insulin

42. Oralin Generex

48. Points to Remember Insulin is in category of HIGH ALERT MEDICATION.
One unit of insulin will DECREASE BLOOD GLUCOSE (30 – 50 mg/dl).
Prior to insulin injection
Check blood glucose
Inject insulin
Instruct to eat a regular diabetic meal

49. Thank You...