INSULIN THERAPY

Insulin vials should be preferably stored at 4-80C. If possible they should be kept in the refrigerator, but not in the freezer compartment. The insulin vial should be brought down to body temperature by gently rubbing it between the palms before withdrawing the insulin into the syringes.

If refrigeration facilities are unavailable, then the currently used vial can be stored at room temperature away from heat and direct sunlight. If vials have to be stored for longer periods, a simple method is for the unopened vials to be stored in the earthen pots, which contain drinking water and are found in most homes where a refrigerator is not present.

Initiation of Insulin:

There are no precise formulae by which the initial dose can be calculated. The usual total dose of insulin is between 0.5 and 1 unit/kg/day although it is usual to start with a starting dose of 0.25 unit/kg/day.

The usual regimen is to start with a small dose of an intermediate acting insulin about 8-12 units S.C. before breakfast or with a mixture of a short acting insulin and Intermediate acting insulin in small doses.

When stabilized most patients require about 60% of total insulin in the morning and 40% in the evening. However insulin-dosing regimen is highly individualized and it has to be tailor made depending upon the patient’s age, weight, sugar levels and presence of any other condition, which may affect the status of blood sugars.

Often overweight patients may need more insulin due to insulin resistance.

Most of the short acting and the intermediate/long acting insulins available here may be mixed in the same syringe except Lantus.

Insulins are presently available in strengths of U-40, and U-100. The patient must ensure that the syringes used by him/her are compatible with the strength of insulin used.

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