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Home | Articles | Diabetes and Endocrinology | Subcutaneous Insulin

Subcutaneous Insulin

Last updated 3rd December 2020

Last updated on 5th June 2013 by Calum Murray

Four Regimens Commonly Used

  1. Basal bolus ie injection of insulin before each meal with injection of long acting insulin once or twice daily
  2. Twice daily mixture of short & medium acting insulin given before breakfast and before tea
  3. Once daily long acting insulin given with or without oral hypoglycaemic drugs
  4. DAFNE regime (see page on Other Antidiabetic Drugs)

Glycaemic Control

  1. Needs to be individualised. Pre-meal BG 4-8 mmol/l represents good control but not necessarily appropriate for all patients.
  2. Avoidance of hypoglycaemia is an equally important goal – many individuals with diabetes require regular carbohydrate snacks in order to avoid hypoglycaemia

Prescribing Insulin

  1. Ensure insulin prescribed by full name and device eg Novomix 30 flexpen or Mixtard 30 Penfills on medicine chart and diabetic chart
  2. Timing of doses should be circled on the medicine chart and write “see diabetic chart” under dose. The doses to be given should be specified on the diabetic chart.
  3. Do not write ‘units’ on insulin chart. State the number of units only ie ‘24’ and not ‘24 units’.

How to Adjust Insulin

    1. The level of BG at the time of injection is not usually taken into account when deciding on the dose to give.
    2. Insulin dose increases should be made in response to consistently high BG ie at same time of day on 3 consecutive days, though patients with intercurrent illness or on high dose steroids may need much more rapid increases in dose
    3. A single unexplained low BG <4mmol/l should prompt reduction in dose of responsible insulin next day – don’t wait for 3 hypos in a row. If low result can be explained easily eg a missed snack then reduction may not be required.

    How Big a Change in Dose?

    1. Doses <40 units of insulin per injection are usually changed by 2 units at a time
    2. Doses >40 units per injection by 2-4 units at a time.

    What if BG Low Just Before Injection Due?

    1. Do not omit or delay the insulin that is due, but treat the hypo (see previous page) & ensure that patient takes enough carbohydrate subsequently

    Dose Adjusting For Normal Eating (DAFNE)

    1. Some Type 1 patients in Dumfries use this method to manage their diabetes. They will adjust dose of short acting insulin before meals according to the carbohydrate content. They may also use correction doses of insulin outwith mealtimes. It is important to respect their knowledge. Please contact the diabetes team if you have any concerns about their management