areas than when given in the thighs and buttocks. Heat and massage can increase
subcutaneous absorption. Cooling the area can decrease absorption.
Insulin can also be delivered via insulin pump. An insulin pump is surgically
implanted in the abdomen and delivers an insulin infusion and bolus doses with
meals either intraperitoneally or intravenously.
Insulin can also be administered intranasally to provide a rapid-onset effect
for a short duration although this method is expensive and rarely used.
Insulin injectors deliver insulin under high pressure through the skin into
fatty tissue without a needle. Insulin injectors can cause bruising, pain, and
burning and are not indicated for children or the elderly. Insulin injectors
are expensive.Insulin types
There are three standard types of insulin:- Rapid-acting (regular or Lispro [Humalog] insulin), onset^1 /^2 to 1 hour,
peak 2 to 4 hours, and a duration of 6 to 8 hours - Intermediate-acting (NPH, Humulin N, Lente, and Humulin L insulin),
onset 1–2 hours, peak 6–12 hours, duration 18–24 hours - Long-acting (Ultralente insulin), onset 5–8 hours, peak 14–20 hours, dura-
tion 30–36 hours
There are also combinations that include Humulin 70/30 (NPH 70%, regular
30%) and Humulin 50/50 (NPH 50%, regular 50%).
Unopened insulin vials are refrigerated until needed. Once an insulin vial has
been opened it may be kept at room temperature for 1 month or in the refriger-
ator for 3 months. An open insulin vial should not be put in the freezer, placed
in direct sunlight, or in a high-temperature area.A list of drugs utilized in the treatment of diabetes is provided in the Appendix.
Detailed tables show doses, recommendations, expectations, side effects, con-
traindications, and more; available on the book’s Web site (see URL in Appendix).ORAL ANTIDIABETICS
Oral antidiabetic drugs such as sulfonylureas are administered to patients who
have Type 2 diabetes mellitus to stimulate beta cells to secrete insulin. This
results in an increase in insulin cell receptors, enabling cells to bind to insulin(^394) CHAPTER 21 Endocrine Medications