Principles of Insulin Therapy

Historical Background 461 Types of Insulin 461 Rapid-Acting Insulins 461 Intermediate-Acting Insulins 462 Long-Acting Insulins 462 Insulin Purity, Species, and Concentration 463 Beef and Pork Insulins 463 Human Insulin 463 Insulin Concentrations 464 Initiation of Insulin Therapy 464 Coals of Therapy 465 Treatment Strategies 466 Single-Dose Regimens 466 Twice-Daily Regimens 467 Multiple Daily Injections 467 Coals of Intensive Therapy 469 Continuous Subcutaneous Insulin Infusion 469 Insulin Treatment of Non-Insulin-Dependent Diabetes 470 Intermediate-Acting Insulins 471 Ultralente Insulin 472 Bedtime insulin 472 Combined Insulin and Sulfonylurea 473 Practical Aspects of Insulin Use 473 Storage 473 Insulin Injection Technique 473 Site of Injection 474 Rotation of Injection 474 Adjustments to Exercise and Meals 474 Blood Glucose Monitoring 475 Urine Testing 475 Use of Glycosylated Hemoglobin Measurements 476 Mixing Insulins 476 Complications of Insulin Therapy 476 Hypoglycemia 476 Hypoglycemia Unawareness 477 Nocturnal Hypoglycemia: Somogyi Effect, Waning Insulin, and the Dawn Phenomenon 477 Treatment of Hypoglycemia 478 Brittle Diabetes 478 Insulin Edema 480 Lipoatrophy 480 Lipohypertrophy 480 Insulin Antibodies 480 Insulin Allergy 481 Localized Insulin Allergy 481 Generalized Insulin Allergy 482 Insulin Resistance 483 Obesity and Weight Gain 483 Immunologic Insulin Resistance 484