Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-28

Selecting the Appropriate Insulin

Insulin Development

Insulin has come a long way since its initial discovery 100 hundred years ago. A consistent theme in the evolution of insulin has been the effort to improve the physiological characteristics of insulin to more closely match endogenous insulin production. Despite the tremendous advances, we are not there yet.

The Evolution of Insulin and How it Informs Therapy and Treatment Choices. (43)

Factors Affecting Insulin Absorption

There continues to be considerable variance in insulin absorption among patients and even within the same patient despite similar doses and injection technique. Referred to as between subject variance (BSV) and within subject variance (WSV), this is attributed to several factors and can differ according to the type of insulin being used. For example the NPH/N insulin and Regular insulin have been found to have slower absorption in the deltoid and femoral regions whereas this has not been found with the newer insulin analogues (44). Similarly, when considering injecting larger volumes of insulin (>50 ml) with NPH/N and short acting insulin a flatter profile and prolonged action time are expected. This is not the case with the newer insulin analogues(45). Body weight and pen needle length were thought to have an impact on the delivery of insulin in the subcutaneous space but recent research using lispro insulin showed that