INSULIN
FACTS
What
is insulin?
Insulin
is a naturally-secreted hormone that the body cannot
function correctly without. When insulin is depleted,
impaired or destroyed within the body, it cannot regulate
the amount of glucose in the blood. The body gains
a significant proportion of its energy from glucose.
What
is the role of insulin in diabetes treatment?
The answer
to this question varies depending on what type of
diabetes you suffer from. Type 1 diabetics, whose
natural insulin is inadequate or completely destroyed,
are heavily reliant on insulin therapy as their ongoing
treatment.
When insulin
treatment is irregular or poorly regimented type 1
diabetics may experience rising blood sugar levels.
When this occurs, the body relies on its fat. If this
condition is not checked, a life-threatening complication
known as diabetic acidosis may occur.
Symptoms
for this disorder are numerous, and at their worst
may include unconsciousness. Usual signs include paleness,
sweating, increased heartbeat, blurred vision and
hunger.
Type 2
diabetes is a slightly different disease. The body
has not actively destroyed its insulin stocks, but
a combination of factors lead to increased resistance
to the positive benefits of insulin. At a pre-diabetes
level this is known as impaired glucose tolerance.
At this stage, the pancreas begins to become overloaded,
and cannot produce enough insulin to match the body’s
needs. When the pancreas cannot cope, the patient
will probably need insulin therapy. However, this
only affects approximately 25% of type 2 diabetics
(at advanced stages of their conditions), and in many
instances this variant of the disease can be controlled
through diet and exercise.
Insulin
Types
Individual
insulin products are numerous, but insulin may be
divided into four major types.
Short-acting
insulin – Soluble insulin acts quickly (30-60
minutes) and lasts for between 6 and 8 hours. Some
types may be faster-acting and shorter-lasting.
Intermediate-acting
– Isophane insulin acts slightly slower (1-2
hours) and lasts for between 10 and 14 hours.
Long-acting
insulin – These insulin types (determir, glargine,
protamine zinc, zinc suspension) act slowly (1-2 hours)
and last much longer, for up to 24 hours.
Mixtures
of insulin – Mixed short and intermediate-acting
insulin, divided into different amounts depending
on the individual case.
Which
insulin is suitable for me?
Insulin
is most commonly administered in three different regimes,
although this may vary according to each individual
patients needs.
Two times
daily – of short/ intermediate-acting insulin.
Administered pre-prandial (before breakfast and evening
meal). In theory short-acting provides stability throughout
the morning and evening and the intermediate-acting
insulin ensures stability through the afternoon and
overnight.
Three times
daily – Short/intermediate-acting pre breakfast,
short-acting before supper, and intermediate-acting
before sleep (covers overnight period.)
Multiple
daily – Short-acting pre meals, intermediate
or long-acting before sleep (covers overnight period.)
Other regimes
do exist, and some diabetics’ conditions may
be controlled by single injections of long-acting
insulin.
How
do I take insulin?
Administering
insulin can be a major lifestyle issue for diabetic
patients. An injection regimen can disrupt the daily
routine of many diabetics, particularly adolescents
and children.
Generally,
insulin is administered via disposable insulin pens,
or via ampoules designed for multiple-use pens. Most
people commonly use 8mm needles although other lengths
(12mm, 16mm) are available.
Insulin
pumps are also sometimes employed. The pump is attached
to the patient at all times, and feeds constant insulin
to the blood via needle. The pump regulates the amount
of insulin. Pumps are still relatively uncommon in
the UK.
Injections
are still the favoured method of administering insulin.
They allow the patient more flexibility and most closely
resemble the natural processes that should be occurring
in the body.
Oral insulin
is swiftly becoming a reality. Several companies around
the world are leading the field in inhaled insulin.
Methods include buccal delivery: through the mouth.
Injecting
insulin
Injection
facilitates the speed of absorption into the bloodstream,
commonly through the upper arm, the thigh, the buttocks
or the abdomen. Medical thinking generally dictates
that short-acting insulin should be injected into
the skin of the abdomen, intermediate and long-acting
should be injected into the thigh, and a mix may be
injected into either area.
Directions
for injection are fairly simple: take a small fold
of skin in hand, insert the lancet at an angle, and
inject the required amount of insulin. Slowly retract
the needle from the injection area. It is a good idea
to rotate the injection site regularly, thereby avoiding
fatty tissue build-up. If this does occur, amounts
of insulin taken up can become irregular.
Developing an insulin regime
After learning
how to properly inject yourself with insulin, and
following consultation with specialists, you can begin
to administer insulin to yourself. It is necessary
to know exactly what the warning signs are of an impending
hypoglycaemic reaction, and how to treat yourself.
You will become expert at measuring your blood sugar,
and will generally develop a idea of how to maintain
controlled blood glucose levels. At initial stages,
doctors can help you adjust your regime to suit your
lifestyle.
When should
I vary my insulin schedule?
Keeping
blood sugar low can be taken too far, and the patient
can risk a hypo (hypoglycaemic reaction.) A strict
balance between control and avoiding hypos is necessary.
You may
need to administer more short-acting insulin when
you eat more than usual or are exercising less. You
may be able to reduce the amount of short-acting insulin
when the reverse is true: you are eating less or exercising
more.
Caution
is advised if a patient is thinking of adjusting the
dose of long-acing insulin as a short term measure
– it may continue working for several days.
Insulin
schedules also vary depending on the patient themselves,
and the aim of treating the disease. This may vary
according to age and outlook
