THERAPEUTIC REGIMENS The goal of SC insulin therapy is to replace the normal

Therapeutic regimens the goal of sc insulin therapy

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THERAPEUTIC REGIMENS The goal of SC insulin therapy is to replace the normal basal (overnight, fasting, and between meals) as well as bolus or prandial (mealtime) insulin. In the nondiabetic individual, the pancreas secretes boluses of insulin in response to snacks and meals. Between meals and throughout the night, the pancreas secretes small amounts of insulin that are sufficient to suppress lipolysis and hepatic glucose output (basal insulin). Two methods are used to achieve a similar pattern of insulin release: Basal-Bolus Insulin Regimens consisting of once to twice daily doses of basal insulin coupled with pre-meal doses of rapid or short-acting insulin. Insulin Pump Therapy (previously referred to as “continuous subcutaneous infusion of insulin”) BASAL-BOLUS INSULIN REGIMENS (MULTIPLE DAILY INJECTIONS) The regimen that most closely mimics physiological insulin release, besides the use of an insulin pump, is the use of a once-daily basal insulin such as insulin glargine or insulin detemir to provide basal insulin levels throughout the day, along with doses of regular insulin, insulin lispro, insulin aspart, or insulin glulisine before meals The long-acting insulin can be given at bedtime, or, alternatively, in the morning. If patients skip a meal, they omit a premeal bolus; if they choose to eat a larger meal than usual, they increase the premeal bolus. Similar dose adjustments can be made to accommodate snacks, exercise patterns, and acute illnesses. INSULIN PUMP THERAPY The use of an insulin pump is the most precise way to mimic normal insulin secretion. It consists of a battery-operated pump and a computer that can program the pump to deliver predetermined amounts of insulin from a reservoir to a subcutaneously inserted catheter or needle. These systems are portable and designed to deliver various basal amounts of insulin over 24 hours as well as meal-related boluses.
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LD250216 10 Most patients using an insulin pump prefer to use the rapid-acting insulin analogs in their pump. For meal coverage, the rapid-acting insulin can be given 0 to 15 minutes before eating. ADVERSE REACTIONS HYPOGLYCEMIA Most serious and common adverse reaction to overdose. Long-term diabetics often do not produce adequate amounts of counterregulatory hormones (glucagon, epinephrine, cortisol, GH) that normally provide effective defense against hypoglycemia. Rapid-acting insulin analogs (lispro, aspart, glulisine) are associated with lower incidence of severe hypoglycemic episodes as compared with regular insulin. Long-acting insulin analogs (glargine, detemir) are associated with lower risk of nocturnal hypoglycemia than NPH insulin. Hypoglycemia is rapidly relieved by glucose administration. In a case of mild hypoglycemia in a patient who is conscious and able to swallow, orange juice, glucose or any sugar-containing beverage or food may be given. If more severe hypoglycemia has produced unconsciousness or stupor: 20-50 mL of 50 % glucose solution by IV infusion over 2-3 min. If IV therapy is not available: 1mg glucagon SC or IM.
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