How do the schemes with premixed insulin preparations work

In these schemes, individualization again constitutes the golden rule. The choice of the most suitable mixture, but also the dosage of insulin, depends on many factors, including the age of the patient, his or her nutritional programme, his or her physical activity, renal and hepatic function, etc. The most 'popular' mixtures are those that contain 30 percent rapid or very rapid-acting insulin and 70 percent intermediate-acting insulin (Figure 28.4). Usually, 2/3 of the total dose are given in the morning and 1/3 in the evening, pre-prandially (30-45 minutes before the meal) if the mixture contains regular insulin or immediately before the meal if it contains a very rapid-acting insulin analogue. However, the proportion of morning/evening dose varies considerably among patients. In certain cases the administration of a different mixture in the morning and in the evening may be required.

Most patients with Type 2 DM need 0.5-2 units of insulin per kilogram of body weight daily. When there is high insulin resistance, the dose can be much bigger. The onset of the treatment is done with the lowest dose in order to achieve metabolic control progressively and to avoid possible

Breakfast Snack Lunch Dinner Snack at bedtime

Breakfast Snack Lunch Dinner Snack at bedtime

13 A 21 24 Time

Breakfast Lunch Dinner

Figure 28.4. Schematic representation of a therapeutic scheme with administration of a) mixture of insulin (30% regular insulin, 70% intermediate acting insulin) in the morning and evening pre-prandially and b) mixture insulin of (30% very-rapid-acting insulin analogue, 70% intermediate acting insulin analogue) in the morning and evening pre-prandially. Notice the smaller overlaps among the insulins in scheme b) where there is usually no need for intake of additional snacks in between.

13 A 21 24 Time

Breakfast Lunch Dinner

Figure 28.4. Schematic representation of a therapeutic scheme with administration of a) mixture of insulin (30% regular insulin, 70% intermediate acting insulin) in the morning and evening pre-prandially and b) mixture insulin of (30% very-rapid-acting insulin analogue, 70% intermediate acting insulin analogue) in the morning and evening pre-prandially. Notice the smaller overlaps among the insulins in scheme b) where there is usually no need for intake of additional snacks in between.

hypoglycaemias in patients with higher insulin sensitivity. The coadministration of metformin decreases the insulin needs.

The schemes with two injections of premixed insulin compounds are widely used because they are relatively simple and practical. However, in order for the blood sugar to get under control, the daily programme of the patients should be relatively stable, with only small divergences from day to day as regards the timing and content of meals and the level of physical activity. Patients who receive an insulin mixture that contains regular insulin in the morning, should usually eat a snack 2-3 hours after the injection to avoid hypoglycaemias (see Figure 28.4a). At the same time, lunch should be temporally placed when the peak of the morning intermediate-acting insulin begins (i.e., 5-6 hours after the morning injection). The administration of an insulin mixture in the evening before dinner, leads sometimes to night-time hypoglycaemia, especially if the dinner is consumed early, whereby the peak of the intermediate-acting insulin coincides with the early morning hours (1-3 a.m.) of high insulin sensitivity. This is avoided either by instructing the patients to receive a small quantity of carbohydrates (for example, a glass of milk with a rusk) before bedtime (if at that time the blood glucose level is < 140mg/dl [7.8mmol/L]), or by administering the regular insulin (pre-prandially) separate from the intermediate-acting insulin (before bedtime).

The mixtures containing very rapid-acting insulin analogues (see Figure 28.4b) have an advantage because they decrease the probability of hypoglycemia in the early afternoon hours and at night. This is due to the shorter duration of action of the analogue which leads to only a small degree of overlap with the intermediate-acting insulin. On the other hand, the administration of these mixtures presupposes the reception of a large breakfast, and sometimes they do not sufficiently cover the lunch needs, resulting in post-prandial hyperglycaemia. The latter is corrected by administering one dose of very rapid-acting insulin pre-prandially.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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