Type 1 diabetes is managed using daily insulin delivered by injection or a pump. NICE recommends a multiple daily injection basal-bolus regimen for all adults with type 1 diabetes. A twice daily mixed insulin regimen can be considered if multiple daily basal bolus is not possible.
Patients with type 2 diabetes have a variable combination of increased insulin resistance (increased hepatic glucose production and reduced glucose clearance) and a gradual loss of pancreatic beta-cell function (reduced basal and glucose- stimulated insulin secretion). Treatment will therefore change over time, so patients need to understand the progressive nature of diabetes and the role of insulin in the treatment pathway.

The types of insulin regimens available are listed in Table 1 (next). Most of the insulin available in the UK contains 100 units per ml of insulin (see Table 2 next two slides) but a few are also available in 200, 300 and 500 units per ml. The high strength insulin 500 units/ ml is used in patients with severe insulin resistance who require higher doses (up to 2,000 units per day in some cases).

When insulin is initiated, patients need structured education and support comprising safe storage, dose titration, injection technique, self-monitoring of blood glucose, effects of diet on glucose control (i.e. carbohydrate counting) and management of acute changes in glucose control. People receiving insulin should always carry with them a fast-acting source of glucose.

Annual checks such as HbA1c (for long-term glycaemic control), blood pressure, cholesterol, eye, feet and kidney function help to identify complications. Diabetes UK has produced a document ’15 Healthcare Essentials’ for patients.