All About Insulin

What Is Insulin? Inside the pancreas, beta cells make the protein insulin. With each meal, beta cells release insulin to help the body use or store the glucose it gets from food. People with type 1 (insulin-dependent) diabetes no longer make insulin. Their beta cells have been destroyed. They need insulin shots to use glucose from meals. People with type 2 (non-insulin-dependent) diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or extra insulin in shots to help their bodies use their own insulin better. If you have type 1 or type 2 diabetes and inject insulin, you have many questions about insulin. Insulin cannot be taken as a pill. Because it is a protein, it would be broken down during digestion just like the protein in food. It must be injected into the fat under your skin for insulin to get into your blood. The insulins in Malaysia are made by two main companies. These insulins differ in how they are made, how they work in the body, and price. Today's insulins are very pure. Allergic reactions to insulin are rare. Insulin comes from either animals or is made in labs by bacteria that have gene instructions to make human insulin. Human insulin does not come from humans. There are three broad types of insulin, based on: How soon the insulin starts working (onset). When it works the hardest (peak time). How long it lasts in your body (duration). However, each person responds to insulin in his or her own way. That is why onset, peak time, and duration are given as ranges. Short-acting (Regular) insulin usually reaches the blood within 30 minutes after injection. It peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. They peak 4 to 14 hours later and stay in the blood for about 14 to 24 hours. Long-acting (Ultralente) insulin takes 6 to 14 hours to start working. It has no peak or a very small peak 14 to 24 hours after injection. It stays in the blood between 20 and 36 hours. Some types of insulin come mixed together. For example, you can buy Regular and NPH insulins already mixed in one bottle. They make life easier if you need to inject two kinds of insulin at the same time. However, you can't adjust the amount of one insulin without also changing how much you get of the other insulin. Strength Insulins come dissolved in liquids at different strengths. Most people use U-100 insulin. This means it has 100 units of insulin per millilitre of fluid. Be sure that the syringe you use matches the insulin strength. U-100 insulin needs a U-100 syringe. In Europe and Latin America, U-40 insulin is also used. Additives All insulins have added ingredients to keep them fresh and help them work better. Intermediate- and long-acting insulins also have ingredients to make them act longer. The additives may vary among different brands of the same kind of insulin and may cause slight differences in the onset and duration times. Storage and Safety Insulin makers advise storing insulin in the refrigerator, but using cold insulin can make the shot more painful. You can keep the bottle of insulin you are currently using at room temperature or warm the bottle by gently rolling it between your hands before you fill the syringe. If you buy more than one bottle of insulin at a time, store the extra bottles in the refrigerator until you start to use them. Never store insulin at very cold (under 36 degrees Fahrenheit) or very hot (over 86 degrees Fahrenheit) temperatures. Extreme temperatures destroy insulin. Do not put your insulin in the freezer or in direct sunlight. Before using any insulin, check the expiration date. Insulin may lose potency slightly if the bottle has been used for more than 30 days. Look at the bottle closely to make sure the insulin looks normal. If you use Regular, it should be perfectly clear --no floating pieces or colour. If you use NPH or Lente, it should be cloudy, with no floating pieces or crystals on the bottle. If you find any problems, return the bottle of insulin for an exchange or refund. Insulin Therapy With your health-care team's help, you can find an insulin therapy routine that will control your blood glucose, help you feel good, and fit your lifestyle. Conventional insulin therapy means taking the same shots at the same times each day -- usually a shot in the morning and a shot in the evening. For most people, conventional therapy prevents dangerously high or low blood glucose levels. But conventional therapy may leave blood glucose levels too high. These higher glucose levels increase the risk of problems with your eyes, kidneys, and nerves. For that reason, many doctors now advise intensive insulin therapy. This therapy aims to keep your blood glucose as close to normal as possible. Intensive therapy means either taking three or four shots daily or using an insulin pump. For good results, you must take a very active role in your diabetes care and test your blood glucose level often. Based on your blood glucose records, you and your health-care team will fine-tune your treatment plan. Intensive therapy takes more work but gives you more choices. You are not tied to certain eating or exercise times. However, because you are keeping your blood glucose levels lower, there is a chance of more low blood glucose reactions. You may also gain some weight. Because you are matching insulin needs closely to glucose levels, your body is able to use and store more of the calories from glucose instead of losing them in the urine. Talk with your health-care team about whether the greater freedom and chance to avoid diabetes complications are worth the drawbacks of intensive therapy. Insulin Delivery Most people who require insulin take shots. Another choice is an insulin pump. Insulin pumps are devices that give a steady dose of Regular insulin. In addition, you signal the pump to give extra Regular insulin to cover meals. Insulin comes through a plastic tube called an infusion line. This tube is attached to a needle that is inserted into fat under the skin (usually in the abdomen) and taped into place. About the size of a beeper, an insulin pump can be attached to a belt loop or even worn in a shirt or skirt pocket. Fine-Tuning Control Whether you are on conventional or intensive insulin therapy, many factors affect your blood glucose levels. These include: What you eat. How much and when you exercise. Where you inject your insulin. When you take your injections. Illness. Stress. To feel your best, work with your health-care team to learn how each of these factors can affect your glucose control. When you want to improve your insulin routine, consider the following. Self-monitoring It is hard to improve your blood glucose control without testing your blood glucose. Writing down your results and looking over weeks or months of results can help you predict and avoid low or high blood glucose levels. Tests show how exercise, an exciting event, or a special meal changed your glucose level. By knowing that, you can change your insulin to prevent problems. Site Rotation The place on your body where you inject insulin affects blood glucose control. Insulin enters the blood at different speeds when injected at different sites. Insulin shots work fastest when given in the abdomen. Insulin arrives in the blood a little more slowly from the upper arms and even more slowly from the thighs and buttocks. Injecting insulin in the same general area (for example, your abdomen) will give you the best results from your insulin. This is because the insulin will reach the blood with about the same speed with each shot. Don't inject in exactly the same place each time but move around the same area. If you take several shots a day, you may want to choose one site (perhaps the upper arm) for morning shots, another site for lunch shots, and a third site for evening shots. If you inject near the same place each time, hard lumps or extra fatty deposits may develop. Both of these problems are unsightly and make the insulin action less reliable. Any member of your health-care team should be able to show you how to correctly rotate your injection sites. Timing Good blood glucose control is all in the timing. The idea is to time your shots so that insulin goes to work when glucose from your food starts to enter your blood. To do this, you need to know how soon your insulin starts to lower your blood glucose. You can find this out by self-monitoring. Too Much or Not Enough Insulin? High morning blood glucose levels before breakfast can be a puzzle. If you haven't eaten, why did your blood glucose level go up? There are two common reasons. If you have very low blood glucose while sleeping, your body releases glucose from the liver. This causes a high blood glucose level in the morning. Morning nausea and headache may be signs that you've had low blood glucose while sleeping. You may need to eat a bedtime snack to avoid low blood glucose in early morning hours. To see whether this is the problem, set your alarm to self-monitor around 2 or 3 am for several nights. The other reason for high fasting blood glucose levels on waking is the dawn phenomenon. Near dawn, the levels of certain hormones in your blood naturally increase. These hormones cause blood glucose to rise, usually around 5 or 6 am. This usually means you need to take a bedtime injection of intermediate- or long-acting insulin that will go to work around dawn. Syringe Reuse Some doctors believe that you can safely reuse your syringe. However, if you are ill, have open wounds on your hands, or have poor resistance to infection for any reason, you should not risk syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused. Keeping them germ-free is up to you. Keep the needle clean by keeping it capped when you're not using it. Don't try to clean it with alcohol. Alcohol wiping removes the coating that helps the needle slide into the skin easily. Never let the needle touch anything but clean skin and the top of the insulin bottle. Most important, never let anyone use a syringe you've already used, and don't use anyone else's syringe, ever. Reusing syringes may help you cut costs, avoid buying large supplies of syringes, and reduce waste. However, talk with your doctor or nurse before you begin reusing. They can help you decide whether reuse would be a wise choice for you. Syringe Disposal It's time to dispose of a syringe when the needle is dull or bent or if it has come in contact with anything other than clean skin. Proper syringe disposal is important. Your syringe is medical waste. If you can do it safely, clip the needles off the syringes. When you remove the needle, no one can use the syringe. It's best to buy a device that clips, catches, and contains the needle. Do not use scissors to clip off needles -- the flying needle could hurt someone or become lost. If you don't destroy your needles, recap them. Place the needle or entire syringe in an opaque (not clear) heavy-duty plastic bottle with a screw cap or a plastic or metal box that closes firmly. Do not use a container that will allow the needle to break through. Make sure your syringe container doesn't get recycled. Your area may have special rules for getting rid of medical waste like used syringes. Ask your refuse company or city or county waste authority what method meets their rules. When travelling, bring your used syringes home. Pack them in a heavy-duty holder, such as a hard plastic pencil box, for transport.