Clock time (hours)

Figure 57 Insulin injection technique: the modern practice is to insert the needle vertically into the subcutaneous tissue. Needles of 8 mm in length are used with a pinch-up technique except in obese patients, in whom the standard 12-mm needle should be used. When insulin is being injected without pinch-up into the arms, 6-mm needles are recommended. It is no longer considered necessary to swab the skin with alcohol or to withdraw the skin plunger to check for blood. Care must be taken in thin patients to avoid intramuscular injection as this will result in more rapid absorption of insulin

Figure 58 Physiologic plasma insulin and glucose profiles: in non-diabetic subjects, basal fasting insulin secretion is very low and suppresses hepatic glucose production, but meal ingestion results in a rapid increase in insulin secretion (shown here). This tight regulation keeps plasma glucose concentrations within a narrow range of about 3.5-7.5 mmol/l (63-135mg/dl). It is this pattern which exogenous insulin therapy attempts to emulate o lo Bl

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