Care at NUH

Knowing Your Insulins (for People with Type 1 Diabetes)

2024/09/27

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In Type 1 Diabetes, the pancreas is unable to produce insulin. Therefore, insulin needs to be replaced through injections.

For optimal management, individuals with Type 1 Diabetes should be on a basal-bolus regimen, comprising  two types of insulin: 

  • Basal insulin 
  • Quick-acting (bolus) insulin for meals
BASAL INSULIN

Basal insulin provides a consistent background level of insulin to stabilise blood glucose levels throughout the day, including periods of fasting. 

Even when you are not eating, your body requires a small amount of basal insulin to keep blood glucose levels from rising.

This insulin type is generally injected once or twice daily, due to its longer duration of action compared to quick-acting insulin. 

The dose of basal insulin is usually  40 to 50% of your total daily insulin dose. Too little basal insulin can cause high blood glucose. Too much basal insulin can cause hypoglycaemia especially when you miss a meal or when you sleep. Being on the right dose will keep your glucose levels stable when you are not eating (Figure 1).

Utilise this worksheet (Overnight basal insulin evaluation worksheet) under the guidance of your healthcare team to assess if your basal insulin dose is appropriate. 

QUICK-ACTING (BOLUS) INSULIN
Quick-acting (bolus) insulin is administered multiple times daily to cover insulin needs for meals. It can also be used to correct (bring down) high blood glucose levels. It acts rapidly and has a short duration of action.

The amount of quick-acting insulin required for each meal varies. Knowing how to adjust your quick-acting insulin doses can help you avoid hyperglycemia and hypoglycemia. Refer to the section on  flexible insulin dosing for more information.  
INSULIN PUMP

Insulin can also be delivered through the use of an insulin pump. This is a battery-operated device containing a reservoir of quick-acting insulin connected to a tubing and a cannula under your skin.

The pump delivers both a constant infusion of basal insulin, and also boluses of quick-acting insulin without the need for injections. 

Consult your healthcare team for more information about insulin pumps.

INJECTING INSULIN

For a visual guide on insulin injection using a vial or insulin pen, watch our instructional video: 

English  l  胰岛素疗程  l  Terapi Insulin  l  இன்சுலின் சிகிச்சை 

Download a step-by-step guide for future reference here: 

Minimise injection pain with these tips: 

  • Use insulin that is at room temperature
  • Use a new needle for each injection to reduce pain 
  • Discuss the appropriate needle length for your needs with your healthcare team. Using a needle which is too long leads to injection into muscle. Insulin should be injected into the subcutaneous area (fat layer under the skin).
  • Insert the needle swiftly 

How to avoid lumps 

Lumps or lipohypertrophy can form under your skin if you inject repeatedly at the same spot. Injecting into lumpy areas with lipohypertrophy affects insulin absorption and leads to unstable glucose levels.

Regularly rotating injection sites can prevent lumps under the skin.

Before injecting, feel the chosen area for lumps. If you detect any, select a different site.  Avoid injecting in lumpy areas for at least three to six months to allow the lumps to resolve

TIPS ON STORING INSULIN
  1. Store all unopened insulin in the refrigerator, not the freezer. 
  2. Mark the date on the vial or pen when you first open it. 
  3. Keep opened vials and pens at room temperature.  
  4. Do not leave the insulin in the car or under direct sunlight. 
  5. Dispose of opened vials or pens 28 days after opening. 
  6. For some brands of cloudy insulin pens (such as NovoMix), discard the pen and use a new one when less then 12 units remain to ensure adequate volume for re-suspension before injection.  
  7. If you are planning to travel, please click the following link for tips:  Travelling with Type 1 Diabetes  
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