In people with type 2 diabetes treated with insulin, problems can arise due to the injection technique used and an incomplete understanding of the principles of insulin adjustment. Ongoing patient review and education is essential.
- Insulin should be injected subcutaneously and the needle/injector should not move after insertion.
- Insulin injection technique, including site, should be reviewed as part of the annual cycle of care of a person using insulin.
- Premix, self-mix and basal–bolus schedules offer increasing levels of flexibility, effectiveness, complexity and imposition.
- A premixed schedule may suit people with a regular daily routine, whereas those with a more variable routine or wanting tighter glycaemic control may prefer a self-mix or basal–bolus schedule.
- Differences in endogenous insulin secretion explain why people with type 1 or long-standing type 2 diabetes are more likely to have wide swings in blood glucose levels than those with shorter duration type 2 diabetes.
- Any corrective bolus insulin doses should be small, blood glucose levels should be checked two to four hours later and further small bolus doses given if necessary.
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