AJ Graveling, EA McIntyre



Insulin therapy remains the cornerstone of treating patients with diabetes mellitus. All patients with Type 1, and many with Type 2, diabetes are treated with insulin. This article describes the discovery and evolution of insulin preparations and discusses current analogue, standard human and animal insulin preparations available for prescription in the UK, highlighting the advantages and disadvantages of the various preparations. An overview of initiating insulin therapy and typical insulin doses and regimes is given. To update general physicians, the necessary adjustments of insulin therapy for intercurrent illness are briefly considered. There is an array of different insulin delivery devices for subcutaneous insulin injection, which can be confusing, and the general advantages and disadvantages of such devices are examined. Recent insulin delivery device advances include the modern continuous subcutaneous insulin infusion devices or external insulin pumps. Advances in this field are rapid and strive towards the development of a closed loop insulin delivery device. Continuous subcutaneous insulin infusion devices are discussed along with the existing guidelines for their use in the UK. Currently continuous subcutaneous insulin infusion therapy is more widely used in other countries compared with the UK. Finally, future possible methods and routes of insulin delivery are reviewed, including inhaled, closed loop pump or oral.

Keywords Analogue insulin, continuous subcutaneous insulin infusion (CSII), diabetes mellitus, insulin

Declaration of Interests No conflict of interests declared.