People with diabetes usually have high blood glucose levels. These high levels usually occur because glucose remains in the blood rather than enter the cells. The responsibility of making sure that glucose gets into the cells belongs to insulin. However, for people who are diabetic, their bodies (pancreas) can either not produce insulin or their bodies (cells) are not sensitive to the insulin being produced.
People with type 1 diabetes cannot make insulin. For this reason, insulin injections are the only way they can keep their blood glucose levels in check. The insulin can be administered either as monotherapy (alone) or in combination with oral glucose lowering medication. Diet and physical activity also play critical roles in management of blood sugars when combined with the medical therapy.
For type 2 diabetes (depending on the level of severity during diagnosis), the first line of treatment is usually lifestyle interventions – meal planning for blood glucose control; weight loss; exercising and stress management. However, sometimes these measures are not enough to control the blood glucose levels. In such a scenario, the best option is to take oral glucose lowering medications or insulin, depending on what the doctor deems fit for an individual.
Insulin is the most common type of medication used during treatment of type 1 diabetes patients because their bodies cannot make their own insulin. Insulin is also used in treatment of type 2 diabetes and is usually administered through injections or insulin pumps. More research is being carried out on better insulin delivery methods.
If you have type 1 diabetes, learning how to count carbohydrates and matching your insulin to the food you eat is the ideal strategy for managing the condition. Therefore, your mealtime insulin doses should vary from meal to meal and day to day depending on what you eat.
Three terms usually come up more than often when it comes to insulin treatment: onset; peak time; and duration.
The onset refers to how long it takes for the insulin to start lowering your blood sugar.
The peak time is when it is at its maximum strength.
The duration is how long it continues to work
Based on this information, here is a look at the different types of insulin. Premixed insulin is a mix of two different types of insulin.
Rapid acting insulin – begins to work about 15 minutes after injection, peaks in about one hour, and continues to work for 2-4 hours
Regular or Short acting insulin – begins to work about 30 minutes after injection, peaks anywhere from 2-3 hours after injection, and is effective for approximately 3-6 hours
Intermediate acting insulin – begins to work 2-4 hours after injection, peaks 4-12 hours later, and is effective for about 12-18 hours
Long acting insulin – begins to work several hours after injection and tends to lower glucose levels evenly over a 24-hour period
Pre-mixed insulin – Usually contains a pre mixed combination of either rapid acting or short acting insulin, together with intermediate acting insul
Basal-Bolus Insulin therapy
This is an intensive insulin treatment that involves taking a combination of insulins
Some people might take only basal, or “background” insulin. This is a long-acting insulin that boosts activity for around 24 hours at a time, but to a lower peak than rapid-, intermediate-, or regular-acting insulin. Basal provides a constant supply of insulin to bring down high resting blood glucose levels.
Bolus insulin, on the other hand, has a much more powerful but shorter-lived effect on blood sugar, making it an ideal supplement for people with diabetes to take after meals and in moments of extremely high blood sugar.
A basal-bolus insulin regimen involves a diabetic person taking both basal and bolus insulin throughout the day. It offers people a way to control their blood sugar levels without needing to eat meals at specific times each day and helps them achieve similar blood sugar levels to people who do not have diabetes.
Insulin injection sites
Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. It should not go into muscle or directly into blood since this changes how quickly the insulin is absorbed and works.
Absorption of insulin varies depending on, among other things, where in the body it is injected. The abdomen absorbs insulin the fastest and is used by most people. The upper arms, buttocks and thighs have a slower absorption rate.
Factors that speed up insulin absorption
injecting into an exercised area such as the thighs or arms
high temperatures due to a hot shower, bath, hot water bottle, spa or sauna
massaging the area around the injection site
injecting into muscle – this causes the insulin to be absorbed more quickly and could cause blood glucose levels to drop too low than originally intended.
Factors that delay insulin absorption
Overusing the same injection site can scars the area under the skin or make it lumpy (Known as hypertrophy)
Using insulin that is cold (for example, if insulin is injected immediately after taking it from the fridge)
Insulin needs to be stored correctly. These involves:
storing unopened insulin on its side in a fridge
keeping the fridge temperature between 2 and 8°C
making sure that insulin does not freeze
once opened, keeping it at room temperature (less than 25 °C) for not more than one month and then disposing it off safely
Extreme (hot or cold) temperatures can damage insulin and render it useless. It must not be left where temperatures are over 30 °C.
There are various insulated carry bags available for transporting insulin.
Do not use insulin if:
clear insulin has turned cloudy
cloudy insulin has lumps or flakes in it, or deposits of insulin are visible on the inside of the vial, Penfill or cartridge and cannot be dissolved by gentle rotation
expiry date has been reached
it has been frozen or exposed to high temperatures
a vial, Penfill or cartridge has been used or has been out of the fridge for longer than one month.
Oral Glucose lowering medications
There are many different types of oral diabetic medications. Whilst each drug is unique in the way it works to help patients with diabetes keep their condition under control, some act similarly to each other and are grouped in the same class. The way in which they are administered can also differ, with some medicines taken orally and others injected directly into the blood.
Depending on individual circumstances, the doctor may prescribe more than one anti-diabetic drug from different classes to help treat a patient.
Side effects of anti-diabetic medicine
As with any type of medication, blood glucose-lowering drugs can have several side effects. These potentially harmful side effects are listed in the patient information leaflet that accompanies the medication, so make sure you check this before starting your drug treatment.
You may not experience any of the adverse effects listed, but if you do, consult your doctor and/or diabetes care team as they may be able to suggest another suitable medication for your condition. They will also be help with any questions or concerns you have regarding your medicine.
Take note of the following important points when taking prescribed oral diabetic medications
Make sure your prescribed diabetes medication is safe to take with your other medicines.
Before starting your course, read the manufacturer’s printed information leaflet from inside the pack.
Stick to the drug dosage prescribed by your doctor. If you think you have taken an overdose of this medicine, get yourself to the nearest local hospital as quick as you can, and remember to carry along the container.
Never give your medication to other people, even if their condition appears to be similar to yours
Dispose of any out-of-date or unwanted medicines.