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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