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Insulin
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Type 2 diabetics typically have lost 50% beta cell function by diagnosis and continue to loose 3-5% per year insulin acts to stimulate liver muscle and adipose tissue to uptake glucose and convert to glycogen or fatty acids for storage insulin is secreted at a low basal rate to control hepatic uptake of glc insulin is secreted as a bolus in response to food (lasts 2 hours) Rapid acting - onset 5 mins, peak 60-90mins, last 2-4 hrs Aspart, Lispro, Glulisine modified to stop hexamers forming Short acting - onset 20-30m, peak 2-3h, lasts 6-8h Actrapid, Humulin S, Insuman rapid molecules clump in hexamers that need breaking down pre absorption Intermediate acting - onset 2-3h, peak 6-8h, lasts 12-18h Insulatard, Humulin I, Insuman basal mixed with Zinc to prolong action so cloudy Long acting - onset immediate, no peak, lasts 24h glargine, detemir modified for delayed release (via pH or fatty acid change) clear solution Risks Hypoglycaemia - timing depends on regime HbA1C > 58mmol/l 7.5% despite measures - need to consider insulin Admin no alcowipe before air shot to prime needle insert all the way at 90degrees and keep in for 5secs post injection to prevent spill ''sites'' - abdo good for bolus rapid acting, legs/buttocks good for long acting, arms OK but use shorter needle ''absorption'' changes with heat, exercise, IM or repetition Intercurrent illness Measure blood glc at least 4x/day continue with insulin drink plenty check for ketones Driving - if using insulin Cars - allowed if test pre-drive and 2hrly Lorries - allowed post individual medical
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Diabetes