Medication and Devices

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Medication and Devices

Insulin is used every day by people with insulin dependent diabetes. Insulin is the best - and possibly the only - alternative when neither a healthy diet and exercise nor oral medications are enough to achieve normal blood sugar levels. (by NN/DFI )

Insulin dependent diabetes

If you have insulin dependent diabetes, it means that your body no longer produces enough insulin. If you didn't take insulin, your blood sugar would rise until you developed ketoacidosis. By taking insulin injections, you can lead a healthy, active life.

Insulin manufacturing

Up until the 1980's all types of insulin were extracted from the pancreas of cows and pigs. These insulins are still in use but more and more people with diabetes take biosynthetic human insulin, which is manufactured through recombinant DNA-technology. This means that micro-organisms, such as baker's yeast, have been programmed to make insulin that is identical to human insulin.

How does insulin work?

Once injected, insulin is taken up by the blood and carried along with sugar to your body's cells. Insulin acts like a key, which enables sugar to enter cells. This lowers the level of blood sugar. Body cells, such as the cells that form muscle, use sugar as fuel. After a while, the effect of insulin wears off and you will have to inject insulin again.

Types of insulin

There are four main types of insulin: rapid acting insulin analogues, short-acting insulin, longer-acting insulins and pre-mixed insulins. Most people need more than one type of insulin. Insulins differ in how fast they start to work, when their action peaks and how long they work.

Rapid-acting insulin analogues

Rapid-acting insulin analogues are a new type of insulin. They have been chemically engineered to retain the benefits of conventional soluble (clear, short-acting) insulins, but reduce some of the problems people experience when taking them, such as the need to inject them half an hour before meals, and the risk of hypoglycaemia. Conventional soluble insulins tend to aggregate into large 6-part molecules, while rapid-acting insulin analogues exist as smaller 1 or 2-part molecules, allowing them to be absorbed much more rapidly than soluble human insulin. This means they can be injected at mealtimes, rather than 30 minutes before. The glucose-lowering activity of the rapid-acting insulin analogues is short-lived compared to conventional short-acting insulins, reducing the risk of hypoglycaemia between meals and during the night.

Short acting insulin

Like rapid-acting insulin analogues, short-acting insulin controls blood sugar after a meal, but its effects last a little longer (up to 8 hours). ). Because it is also a little slower to start working, you should usually inject a few minutes before the start of your meal.

NPH - a longer acting insulin

There are different kinds of longer-acting insulins but they all start working a bit later than the short-acting type and are active for a much longer time. For example, NPH insulin will be active within one and a half hours and effects last up to 24 hours.

Pre-mixed insulin

If you take insulin twice a day, you'll probably use a mixture of short and longer-acting insulin. Pre-mixed insulins are readymade mixtures of short and longer-acting insulin, which combine the effects of both types. An example of one such mixture is 30% short-acting insulin ( R ) and 70% longer-acting (NPH) insulin.

Types and dose of insulin

Each person with diabetes is different. The types and dose of insulin you need depends on your weight, how much you exercise, what you eat and your blood sugar level from day to day. Most people need two or more injections of insulin every day to keep their blood sugar in control.

Insulin twice a day: example

Everybody's different and so is the treatment of each person's diabetes. Your doctor may have recommended that you start your treatment by taking insulin twice a day. You may inject pre-mixed insulin in the morning and longer-acting insulin before dinner. The split of the doses might be two third in the morning and one third at dinner.

Insulin four or more times a day

Over the years your lifestyle may change. Your eating and exercise routines are likely to change with time. Even your diabetes may change as the years pass. To copy the insulin pattern of people without diabetes as close as possible, your doctor may at some point recommend that you take insulin four or more times a day. An example of this is to take rapid-acting insulin analogue or short-acting insulin before each meal, and longer-acting insulin at bedtime. Some people may get even better control by adding an extra injection of longer-acting insulin in the morning - your doctor will help you decide if this is best for you.

Adjusting mealtime insulin

Whenever you change your diet or your exercise-routine, or if you become ill, you may need to adjust your mealtime insulin (rapid-acting insulin analogue or short-acting insulin). The only way to find out if this is necessary is to test your blood sugar frequently. For example, if your blood sugar stays high over a period of time, you may add a few units of your usual pre-meal dose. Your doctor will explain when and how to do this.

Injection areas

Insulin can be injected into a number of areas on your body. Your doctor may recommend that you inject insulin in either of your thighs, your abdomen, your buttocks. Make sure you rotate the injection site within the same area. Otherwise a lump may develop and the effect of the insulin on your blood sugar will be more difficult to predict.

Best area to inject insulin

Insulin enters the blood stream faster from some areas of the body than others. Because of this, your blood sugar may be different when different areas are used. For this reason, it is best not to change the areas you use too frequently but remember to rotate the injection sites. Most people use the abdomen for short-acting insulin and the thigh for the longer-acting type.

How to inject insulin

When you are injecting insulin, the needle should go deep enough to reach the tissue under the skin. If this tissue is thin, the needle can hit a muscle by accident. Then insulin is taken up faster, and the effect on your blood sugar will be more difficult to predict. Using a short needle, for example one 6 mm long, or a site with more fat, may prevent this.

Injection devices

Your diabetes care team can help you choose a device that fits your needs and they will show you how to use it. You may choose a durable insulin device, such as an insulin pen or a prefilled insulin device. These take cartridges with enough insulin for several injections. A pre-filled insulin syringe can also be used several times. With a syringe and bottle, you must draw up insulin before taking each injection. An insulin pump is another option.

Store extra insulin

You should store extra insulin in the fridge but not too near the freezing compartment and never in the freezer. If stored correctly, insulin will last until the expiry date. That is normally at least one year. The expiry date is printed on the package. Do not use insulin which has passed its expiry date.

Your insulin currently in use

Once you have started using an insulin bottle, it is still best kept in the fridge. Insulin in a pen or a pre-filled syringe can be kept at room or body temperature - below 25 degrees Celsius - for between 4 to 6 weeks without any problems. The exact period of time your type of insulin may be kept in use will be indicated in the instructions in the package. Always protect your insulin from direct sunlight and high temperature.

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