In normal physiology, there is a basal insulin secretion regardless of eating. There is an extra rise of insulin after eating. So, in type 1 diatebes, patient needs base line insulin with or without eating. It is for the normal body metabolism.

 Next, we need to be familiar with type of insulin and names before prescribed. There are 2 main insulin production companies, which are Novo Nordisk and Eli Lilly.

Basically, the followings are the types of insulin we are commonly using at my work , despite a variety of preparations.

1980-1990 (R-DNA)

• short acting :Actrapid, Humulin S
• Intermedate and Long acting: Insulintard, Humulin I
• combined: Mixtard 30

1990-2007 (Analogue)

• Short acting: Humulog, Novorapd
• Intermedate and long acting: Glargine, Levemir
• Combined: Novomix 30, Humulog Mix 25

Hululog has more rapid action than Actrapid.

How to give:

Bolus-Basal

• Glargine (Nocte)+ Novorapid TDS with meal

for example, Novorapid 10 units TDS with meal and Glargine 10 units at bed time.

Photo: wikipedia

OR

Pre-mixed

• Short and intermedaite acting combined BD

for example, 20 units of Novomix 30 BD

In type 2 DM with poor control, we use Basal insulin + OHA

Apart from subcutaneous insulin, some patients have been using insulin pump (CSII). It is nearly perfect. But pump injects insulin into systemic circulation. In normal physiology, pancreas secretes insulin into portal vein throuch which it reach liver where it works.