Patients with type 1 diabetes must take insulin daily because of their absolute deficiency. Patients with type 2 diabetes may require insulin to control blood glucose levels unresponsive to diet and oral antidiabetic agents, or during periods of acute stress. Patients with other types of diabetes commonly require daily insulin therapy to achieve blood glucose control.
Insulin therapy:
Administer insulin as prescribed, usually by subcutaneous injection with a standard insulin syringe. Subcutaneous insulin can also be given with a penlike injector device that uses a disposable needle and replaceable cartridges, eliminating the need to draw it into a syringe. Jet-injection devices are expensive and require special cleaning procedures, but they disperse insulin more rapidly and speed absorption.
These devices draw up insulin from standard containers (which allows the patient to mix insulins, if necessary, but requires a special procedure for drawing up) and deliver it into the subcutaneous tissue with a pressure jet.
Pump it up:
Multiple-dose regimens may use an insulin pump to deliver insulin continuously into subcutaneous tissue. The infusion rate selector automatically releases about one-half of the total daily insulin requirement evenly over 24 hours. The patient releases the remainder in bolus amounts before meals and snacks.
Ready, set, rotate!
When it administering subcutaneous injections, rotate the injection sites. Because absorption rates differ at each site, diabetic educators recommend rotating the injection site within a specific area such as the abdomen. Site rotation also helps prevent lipodystrophy, which can affect insulin absorption.
Only I.V. or I.M.
Regular or lispro may also be administered I.M. or I.V. during severe episodes of hyperglycemia. Never administer any other type by these routes.
Grand experiment:
Now undergoing clinical trials, the programmable implantable medication system (PIMS) has an implantable infusion pump unit that holds and delivers the insulin and a delivery catheter that feeds it directly into the peritoneal cavity. The pump, encased in a titanium shell, contains a tiny computer to regulate dosages and runs on a battery with a 5-year life span. The patient uses a handheld external radio transmitter to control release.
