糖尿病教育权威英文32Insulin.ppt

Pharmacological managementInsulin Section 3 | Part 2 of 3 Curriculum Module III-3 | Insulin Insulin Insulin action Increases glucose uptake, particularly in muscle, liver and adipose tissue Suppresses glucose output from the liver Increases formation of fat Inhibits breakdown of fats Promotes amino-acid uptake and prevents protein breakdown Indications for insulin therapy Type 1 diabetes Women with diabetes who become pregnant or are breastfeeding Transiently in type 2 diabetes in special situations In type 2 diabetes, inadequately controlled on glucose-lowering medicines (secondary failure) Insulin therapy Insulin therapy aims to replicate the normal physiological insulin response Insulin regimens should be individualized type of diabetes willingness to inject lifestyle blood glucose monitoring age dexterity glycaemic targets Insulin types and action International labeling Factors affecting absorption Lipohypertrophy Dose of injection Site and depth of injection Exercise Ambient and body temperature Insulin type Incomplete re-suspension What is the most common insulin regimen used in your country? How well do you think it works? How do people accept insulin? Insulin regimens: once a day insulin Twice a day insulin Three times a day insulin Commencing insulin therapy Insulin should never be used as a threat Fear of injecting is common; needle phobia is rare Healthcare professional’s attitude is key to acceptance People should be praised and encouraged to promote a positive attitude Blood test is more painful than insulin injection Forget the oranges; just do it! Commencing insulin therapy Starting dose will depend on many factors age weight type and duration of diabetes glycaemic targets In type 2 diabetes, consider continuing maximum tolerated oral glucose-lowering medicines 10 units of intermediate-acting insulin once a day Injecting insulin Should be given into subcutaneous tissue Skin of a very thin person may have to be gently pinched Insulin at room