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One method of intensive insulinotherapy is based on multiple daily injections (sometimes referred to in medical literature as MDI). Meal insulin is supplied by injection of rapid-acting insulin before each meal in an amount proportional to the meal. Basal insulin is provided as a once or twice daily injection of dose of a long-acting insulin.
Insulin is usually given subcutaneously, either by injections or by an insulin pump.In acute care settings, insulin may also be given intravenously. Insulins are typically characterized by the rate at which they are metabolized by the body, yielding different peak times and durations of action. [4]
Conventional insulin therapy is characterized by: Insulin injections of a mixture of regular (or rapid) and intermediate acting insulin are performed two times a day, or to improve overnight glucose, mixed in the morning to cover breakfast and lunch, but with regular (or rapid) acting insulin alone for dinner and intermediate acting insulin at bedtime (instead of being mixed in at dinner).
Insulin is usually taken several times per day in patients who require it to control their diabetes. [32] Often patients usually take long acting insulin once a day and then take insulin before meals. The time of onset of the insulin determines how far in advance patients should take the insulin before they eat. [32]
The higher concentrations are used to lessen the volume of the injection, and allow the same dose of insulin to be injected with less force. [10] In some cases, these medications may be combined into one pen to be administered daily, for example insulin degludec with liraglutide [6] and insulin glargine with lixisenatide. [11]
Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922. [85] [86] This is a chronology of key milestones in the history of the medical use of insulin. For more details on the discovery, extraction, purification, clinical use, and synthesis of insulin, see Insulin
Condition of the patient. In acute situations, in emergency medicine and intensive care medicine, drugs are most often given intravenously. This is the most reliable route, as in acutely ill patients the absorption of substances from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or bowel motility.
The traditional subcutaneous (S.C.) insulin administration regimens used by diabetic patients fails to capture the pulsatile nature of natural insulin secretion and does not reach high enough insulin concentrations at the hepatocyte level (e.g., 10 U regular insulin injected S.C. produce a peak systemic circulation concentration of 30–40 μU ...