Facts about Insulin

If he or she takes too little insulin, your child may not develop properly; therefore, your child requires sufficient insulin treatment from the time of diagnosis and for the rest of his/her life.

Taking too little insulin may result in:

• Poor blood sugar control (elevated A1C)
• Reduced growth (height and weight)
• Delayed puberty
• Low quality of life

For these reasons, people with type 1 diabetes require sufficient insulin treatment beginning at the time of diagnosis and continuing throughout life.

Insulin is available in different types and combinations

Rapid-acting insulin (e.g. NovoRapid®)

• Is taken alone or in combination with other types of insulin.
• Can be taken with meals.
• Is effective from 15 mins to 3-5 hours after injection.

Short-acting insulin (e.g. Actrapid®)

• Is taken alone or in combination with other types of insulin.
• Is effective from ½ to 8 hours after injection.
• Is most effective between 1 and 3 hours after injection.
• Lean patients can inject at a 45° angle.
• Obese patients can inject at either a 45° or a 90° angle.

Longer-acting insulin (e.g. Insulatard®)

• Is often taken in combination with other types of insulin.
• Is effective from 1 ½ to 24 hours after injection.
• Is most effective between 4 and 12 hours after injection.

Pre-mixed insulins (e.g. Mixtard® - fixed combinations of short-acting and longer-acting insulin)

• Are often taken alone or in combination with other types of insulin divided into 2 - 3 injections per day.
• Are available in mixtures of 10/90; 20/80; 30/70; 40/60; 50/50. Mixtard® 20/80, for example, contains 20% Actrapid® and 80% Insulatard®.
• Vary in effect depending on the type of mixture. The more Actrapid® in the Mixtard®, the faster the effect.

Both longer-acting insulin and pre-mixed insulins are injected into the fatty tissue under the skin at a 45° or 90° angle as instructed. To ensure a uniform mixture of the insulins, the injection device should be gently turned up and down at least 10 times just before injection. A new needle must be put on for each injection.

Points to remember

• Insulin absorption - especially longer-acting insulin - can vary greatly from day to day.
• Never change the dose of insulin before seeing a clear pattern of blood sugar readings. The pattern should show consistent high/low levels over at least 3 - 5 ordinary days. Do not adjust the insulin dose over birthdays, times of especially heavy exercise or other unusual situations.
• Change an insulin dose only as instructed by your diabetes team. The exact amount of the change will depend on the individual child, the usual daily dose of insulin and the number of injections per day.
• Do not change both the morning and evening doses at the same time.
• Lumps at injection sites may be the cause of poor control.
• Always discuss proposed changes with your diabetes care team.

APP/KOL/AC 22/02/07