DIABETES CARE – INSULIN THERAPY

  • What is insulin?
  • Who needs insulin?
  • If the blood sugars are uncontrolled and doctor has prescribed insulin. Can a person control blood sugar by oral medicine?
  • If one is taking insulin, does that mean his disease condition is severe?
  • If one is started with insulin therapy, he has to follow it throughout life. Is it true?
  • Can insulin therapy be substituted with some form of an oral medicine?
  • What is the ideal time to inject insulin?
  • Are insulin injections painful?
  • Where is insulin injected?
  • Is it necessary to rotate the insulin injection site?
  • Does injecting insulin slowly affect its absorption rate?
  • At what angle should insulin be injected?
  • Why do I have to match the insulin strength to the syringe units?
  • Does exercise affect the rate of insulin absorption?
  • Is it ok to keep the insulin pens in freezer?
  • Why should we not vigorously shake the vial before drawing insulin?
  • Can syringes and pen needles be reused?
  • What about some of the non-invasive ways of administering insulin? Are these reliable?
  • How can insulin be carried during travelling?
What is insulin?

Insulin is a naturally occurring hormone secreted by the pancreas. It acts like a key to the door lock of cells. The food that we eat is broken down into glucose by the body and insulin aids in the movement of this glucose from the blood to the body cells. This glucose or sugar serves as the primary source of energy.

Who needs insulin?

Many people with diabetes are prescribed insulin, either because their bodies do not produce any insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes).The other group of people who may require insulin are women who develop diabetes during pregnancy (gestational diabetes).

If the blood sugars are uncontrolled and doctor has prescribed insulin. Can a person control blood sugar by oral medicine?

It is a common practice to start on with oral medication before insulin in type 2 diabetics; you may start on insulin based on several factors, including the following:

  • Duration of diabetes
  • Levels of blood glucose
  • What all medicines the patient is taking
  • Severity of associated complications
  • Current health status.

Some people with type 2 diabetes have to use a combination therapy in order to control their blood sugars i.e. take oral drugs along with insulin shots.

If one is taking insulin, does that mean his disease condition is severe?

No, insulin is given when the sugars are very high or oral drugs fail to achieve sugar control. Sometimes insulin is given temporarily like before a major surgery or during hospitalization and may be withdrawn or continued depending on the existing scenario.

If one is started with insulin therapy, he has to follow it throughout life. Is it true?

Once diagnosed, type 1 diabetics need insulin for life  because the body is deficient in making insulin but daily injections can be avoided using an insulin pump .In type 2 diabetes, insulin may be used temporarily or for long-term depending upon the severity of their disease.

Can insulin therapy be substituted with some form of an oral medicine?

No. Insulin currently cannot be taken as a pill because it would be broken down during digestion just like the protein in food by the gastric juices. Therefore, it must be injected into the fat under your skin for it to get into your blood. Research is ongoing on the oral forms of insulin.

What is the ideal time to inject insulin?

Different types of insulin are injected at different times of the day. Short-acting insulins are taken before a meal while longer acting insulins can be taken at a fixed time daily irrespective of meals. There are three kinds of insulin:

  • Rapid acting: This peak earlier and do not last as long as regular insulin. They should be taken 5-15 minutes before the meal. It’s clear in nature.
  • Regular Insulin: Its duration of action is 4-6 hours and it should be taken 30 minutes before meals.
  • Intermediate-acting Insulin: Its action lasts for about 12-15 hours and has its main effect in 3-8 hours. It’s cloudy in nature
  • Long-acting Insulin: It has a peak less delivery for 24 hours. It’s taken at bedtime or in the morning as advised by the doctor irrespective of meals.

Talk to your health care provided for detailed information.

Are insulin injections painful?

Currently, very short and narrow gauge needles are available and most patients don’t complain of pain. Use of insulin pens further makes the injection easier and painless.

Does taking insulin injections cause any side effects?

  • Many patients who begin insulin therapy may gain weight (usually 1-2 kg) with improved blood sugars and greater meal plan flexibility.
  • Allergy or swelling at injection site
  • Hypoglycaemia (low blood sugar) if injected wrong dose or wrongly injected insulin
  • Lipohypertrophy (accumulation of extra fat at injection site) or Lipoatrophy (loss of fat) may occur if taken insulin injections at the same site regularly.
Where is insulin injected?

The ideal areas to inject insulin are parts of the body with a thick layer of fat. The most effective area for insulin to be absorbed is the abdomen, followed by the thighs. For some people, Abdomen is also not suitable because of stretch marks and surgery incisions. In such case, the other area of preference should be used.

Is it necessary to rotate the insulin injection site?

Yes. It’s better to keep rotating within the same area of the body for the same type of meal. For example, if you injected insulin into the left side of your abdomen yesterday at breakfast, you could inject into the right side of your abdomen for the next day’s breakfast. Using the same site again and again can irritate the skin and cause lump formation under the skin. This can be painful and decrease the efficacy of insulin at that site.

Does injecting insulin slowly affect its absorption rate?

The way insulin is absorbed in the body can have a profound impact on blood sugar levels. The velocity of injecting insulin does not make a difference however it should not be injected too slowly otherwise it tends to be more painful.

At what angle should insulin be injected?

It is best for most people to inject their insulin at an angle of 90 degrees. However, if you are thin, you can inject at an angle between 45 and 90 degrees. This will prevent intramuscular injections, which leads to sudden hypoglycemia.

Why do I have to match the insulin strength to the syringe units?

Insulin vials are of different concentrations and commonly 40 IU and 100 IU strengths are available. Thus it becomes very important to match the strength of the insulin vial to the units of the syringe i.e. use a 40 IU vial with a 40 unit syringe and 100 IU vial with a 100 unit syringe. In India both 40 and 100 IU vials are available. The strength of insulin used in insulin pens is 100 IU/ml.    

Does exercise affect the rate of insulin absorption?

Yes, the physical activity typically increases the rate of insulin absorption and causes your insulin to act faster but sometimes intense exercise can actually spike blood sugar levels and decrease insulin sensitivity. The best thing to do is to monitor your blood glucose before, during and after your workouts to determine how exercise influences your need for insulin.

Is it ok to keep the insulin pens in freezer?

The way you store insulin affects its stability, and exposure to extreme heat or cold can decrease its potency and affect its absorption rate. Unopened insulin vials should be stored in a refrigerator door (not in the freezer). Avoid storing insulin vials at a temperature < 2 °C and > 30 °C.  Opened insulin vials and pens can be stored at room temperature below 25 °C for about 28 days. Being mindful of these factors will increase the effectiveness of insulin and help you regulate your blood sugar levels more effectively.

Why should we not vigorously shake the vial before drawing insulin?

Vigorous shaking can break up the insulin molecules and decrease the potency of insulin. It creates air bubbles, making it harder to draw the correct amount of insulin into the syringe. Insulin pens or vials can be gently rolled between the palms in case the insulin is cloudy in nature i.e. if it’s a premixed, long-acting or NPH insulin. Other insulins do not have to be rolled.

Can syringes and pen needles be reused?

Reusing an insulin syringe is not recommended. It increases the chances of infection and also it makes the insulin injection painful due to the removal of the silicon coating which otherwise smoothens the way into the layer of fat. Insulin pen needles should be discarded after three pricks or even less than this, in case the needle becomes dull and the procedure becomes painful.

What about some of the non-invasive ways of administering insulin? Are these reliable?

Researchers have, for some considerable time, been looking for non-invasive ways to administer insulin. These have included insulin nasal and oral sprays, patches, tablets and inhalers. After many years of work, some of the methods being researched are showing a degree of success, although it will take time before these devices are available to people with diabetes in India (and elsewhere in the world).

How can insulin be carried during travelling?

Insulin can be carried by keeping in mind the following steps:

  • Always keep your insulin in your travel bags with some coolants like ice packs or ice gels.
  • You can make use of a small thermo cool box with the coolant and keep the insulin vials or insulin pens in it.
  • Insulin can be stored in the aircraft fridge door, but check if it maintains the temperature between 2 to 8 °C.
  • Take care not to give your insulin pens or vials in the luggage compartment as the temperature may vary and decrease the viability of the insulin
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