Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-32 • Differences in action depending on the injection site are relatively minimal with rapid insulin analogues, but the abdomen still has an advantage offering the fastest and most consistent absorption (5645). In a 10- hour euglycemic clamp study comparing regular human vs. aspart given in three injection sites (abdomen, deltoid, thigh), Muldalair et al. reported that site of injection had similar effect on absorption and onset of aspart as on regular insulin (56). While aspart was faster than human insulin at all sites, the abdomen had a shorter duration of action (up to 34 min or three to 12%, p<0.001). Lispro also reported to have similar results, with a 4 to 7% shorter duration with abdominal site (57). • Rapid analogues offer superior performance in terms of glucose control only when given preprandially (58). Some authors advise that analogue insulin be injected 10 to 15 minutes before meals to optimize performance and prevent post-meal hyperglycemia (59,60). Walsh & Roberts recommend to bolus 15 to 20 minutes before eating to help eliminate postprandial spikes (61). • Faster-acting insulin aspart’s onset of action is four minutes faster when compared to the nine minutes of insulin aspart (62). There are several points to be discussed with patients when providing education about analogue use. A comparison table may help (see Table 1). There may be instances where both rapid- and short-acting insulin are used to design an insulin plan. For example, rapid-acting insulin is used for breakfast and short-acting insulin is used for lunch and/or dinner to provide more basal insulin or accommodate a small between-meal snack. This will not provide as precise postprandial glycemic control, but may be necessary if individuals are reluctant to take injections with snacks or choose not to have a snack or are unable to use a pump. or are unable to use a pump.