Diabetes Care | Care of People with Metabolic Problems: Diabetes | Common Problems Encountered in Insulin Management

Common Problems Encountered in Insulin Management
Session Overview
Description
This session describes the physiological basis of insulin replacement and the commonly used insulin regimens. Practical issues in insulin management are illustrated in case histories and the significance of insulin therapy in relation to driving is reviewed.

This session was reviewed by Khyati Bakhai and last updated in June 2019.

Learning Objectives
By the end of this session you will be able to:

• Describe normal insulin physiology including understanding basal and prandial insulin secretion
• List common insulin regimens including bedtime basal insulin, twice daily pre-mixed and basal bolus regimens
• List commonly used injection devices, how to titrate insulin doses and the significance of rotating injection sites
• Describe what to advise people taking insulin during intercurrent illness
• List DVLA regulations in relation to insulin therapy

Type 2 diabetes is a progressive disease caused by the abnormal inter-relationship between insulin resistance and progressively diminishing beta cell function.

The United Kingdom Prospective Diabetes Study (UKPDS) trial suggests that approximately 50% of beta cell function has been lost at presentation of type 2 diabetes, and that this decline continues after diagnosis (Fig 1).

Many patients with type 2 diabetes will in time need insulin replacement therapy.

Insulin initiation is an important therapeutic option in type 2 diabetes. An understanding of insulin physiology and the available preparations and common insulin regimens, are all required to help patients begin this important treatment to control their diabetes.