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Thursday, September 5, 2013

Insulin therapy and its types

Insulin types depicted on the graph below : Regular insulin is preferred in the initial treatment of Diabetic ketoacidosis(DKA). Recognize the different types insulins and their durations of action.

Line A- rapid-acting (e.g., lispro)
Line B-regular
Line C-NPH
Line D-Lente
Line E-Ultralente
Line F-Glargine

Diabetic patients need two types of insulin: both a basal long-acting insulin and a short acting insulin. 
The latter covers post-meal hyperglycemia. The best basal, long-acting insulin is glargine insulin(Lantus), which is supplemented by at least 3 shots of short-acting insulin at mealtimes. Before the advent of glargine, NPH was the best long-acting basal insulin.
Since NPH is only good for 12-18 hours, patients need two shots per day, plus the short-acting mealtime shots. Glargine allows only four shots per day, while the use of NPH requires five shots.

The best short-acting insulins are aspart and lispro. Before the advent of these two drugs, regular insulin was the best option for postmeal hyperglycemia. Insulin aspart and insulin lispro have a very rapid onset of action.

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