The short-acting component acts as bolus insulin.
Pre-mixed insulin: these include both long and short-acting insulins. Short (or ultra-short) acting insulin: types available in Australia include NovoRapid®, Humalog®, Apidra®, Actrapid®, and Humulin® R. Insulin pumps: these are programmed to provide basal insulin by providing a slow continuous infusion of short acting insulin.īolus insulin maintains normoglycaemia following a meal. Types available in Australia include Mixtard® 30/70 and 50/50, NovoMix® 30, Humalog® Mix25 and Mix50, and Humulin® 30/70. The long-acting component acts as basal insulin. Pre-mixed insulin: these include both long and short acting insulins. Long (or intermediate) acting insulin: types available in Australia include Lantus®, Levimir®, and various brands of isophane or “NPH”. When correctly adjusted, it is the insulin required when a patient is nil by mouth and not receiving parenteral glucose. Definitionsīasal insulin maintains normoglycaemia when fasting. Such cases are beyond the scope of these guidelines and should be discussed with an endocrinologist or general physician, and an intensivist and/or retrieval service as appropriate. Other presentations, particularly with severe incurrent illness, where BGL cannot be adequately controlled without an insulin infusion. Illness states causing hypoglycaemia, including hypermetabolic states such as sepsis, or glucocorticoid insufficiency. These guidelines are for adult diabetic patients on insulin where it is expected that reasonable BGL control can be achieved in ED, and subsequently on a general ward, with subcutaneous insulin injections. DKA can occur in Type 1 or 2 diabetes, especially with intercurrent illness. In any non-trivial medical, surgical, or psychiatric presentation, diabetic ketoacidosis (DKA) or a hyperglycaemic hyperosmolar state (HHS) should be considered and excluded. In non-trivial presentations, repeat BGLs should be taken at least every 2-3 hours until it is clear that the BGL is stable, then at least every 4-6 hours. Hypoglycaemia should be treated immediately.
Guidelines for insulin management for adult diabetics with unrelated ED presentations Guidelines for insulin management for adult diabetics with unrelated ED presentations.
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