Insulin - FAQ

If you take a blood test before a meal and it is found to be low, say 3.5mmol/l, what should you do about your insulin injection?

Should you still take it or could it be dispensed with since the blood glucose reading is low?

If you test half an hour before your meal, prior to injecting, and you have a blood glucose reading of 3.5mmol/l, you would need to treat your low glucose levels first. I would recommend you have something for the hypo, to raise your levels quickly, and then inject and have your meal straight away. This reduces the risk of having a hypo during the meal but you may be more prone to a hypo several hours after the meal — to avoid this you may want to have a snack in between meals. If this is happening on a regular basis, you may need to adjust the level of the insulin you are using.

You should not miss your injection as it works during the meal and for several hours afterwards. Eating without injecting, even if you are low initially, will generally raise your blood glucose levels too high before your next meal.

My father has been diabetic for around 30 years. He's had to change insulin from animal insulin to human insulin at the discretion of the hospital quite a few times.

Last one he was on worked really well for him. He has many highs and lows and can he not go back to his original insulin?

It is frustrating that your father feels that if only he could get back on his original insulin, everything would be alright. Unfortunately, bovine insulin was withdrawn for professional reasons. Synthetic insulin is regarded as superior to animal insulin, as it is absorbed more rapidly, and has a shorter more manageable duration of effectiveness. Synthetic human insulin also causes fewer allergic or autoimmune reactions than the insulin hormone extracted from the pancreas of animals. When some people change from animal to human insulin, they may find that their warning signs disappear. In most cases these return when they go back to using animal insulin. The hospital change insulin based on the general condition and glyceamic control of the individual. Many people may consider that they are managing their diabetes well but the overall control may not be as good as they think or feel. People can feel very well and have no symptoms of higher blood sugars that are causing damage to the blood vessels in the body.

The best recommendation is to try and discuss your frustration with the diabetes team and work together to find an appropriate insulin.

During the initial years any warnings of a hypo came when my blood glucose dropped to 3-4mmol/l, but during the last few years it could go as low as 1.5mmol/l before I felt a warning.

Some people who have had diabetes for a long time may begin to lose their warning signs of hypoglycaemia. However, this does not happen to everyone and there may be other reasons for this happening. If your blood glucose is low most of the time, the body gets used to this and is less likely to notice if your levels dip below 4mmol/l. Running your blood glucose less tightly for a while, never letting it drop below 4 mmol/l, may restore your warning signs.

Another thing to check is that your meter is reading accurately and that you are using it properly. Some meters, if you put too little blood on, will give a low reading.

If you have lost your warning signs you should discuss this with your diabetes team as they may be able to help you get them back or they may need to adjust your treatment.

What types of insulin are accessible in Ireland and how much do they cost?

The insulins available in Ireland in 2005 are

Novo Nordisk - Levemir, NovoRapid, NovoMix 30, Actrapid, Insulatard, Mixtard 10, Mixtard 20, Mixard 30, Mixtard 40, Mixtard 50.
Lilly - Humalog, Humalog Mix 25, Humulin I, Humulin S, Humulin M3.
Aventis - Lantus

People in Ireland do not pay for there insulin. It is supplied through a long term illness plan.

How long will insulin last when out of the refrigerator?

Insulin once opened does not need to be stored in the fridge and should be used within one calender month to ensure it retaines it's full potency. During that time, it should not be exposed to extreme temperatures or excessive agitation.

What is the best way to bring insulin abroad?

Depending on how much insulin that has to be transported, a frio bag or cooler bag should be sufficient. We supply the frio bags from our head office in Gardiner Street (call 1850 909 909 or 01 8363022). They cost €35 for a large size (holds 12 vials and a pen) or €40 for the extra large size (holds 18 vials and a pen). Insulin will need to be carried as hand luggage when flying and if you are travelling between countries, it is essential to have a letter on headed medical paper stating you have diabetes. Carry insulin in its original containers and wrappings.

 

APP/KOL/AC 22/20/07