DIABETES EDUCATION

Whether or not you take insulin does not decide what type of diabetes you have.

Insulin and Other Injectables: At a GlanceWhy do I need to take insulin but other people with diabetes don’t?If you have type 1 diabetes, your body is not able to produce insulin. Without insulin there is no way for the excess glucose that occurs in the blood, especially after a meal, to be transported from the blood stream to the cells where it is used to produce energy. The glucose builds up in the blood to very high and dangerous levels that can have dire consequences. Those with type 1 diabetes take insulin through injections or by using an insulin pump.

If you have type 2 diabetes you may also need insulin but for different reasons. Often people with type 2 diabetes can continue to produce an adequate amount of insulin to meet their body’s needs for some time after they are diagnosed, while others need to start insulin sooner. The results of your glucose self-monitoring, along with the results of the A1C test, will help your health care provider decide what treatment is right for you.

Whether or not you take insulin does not decide what type of diabetes you have. The type of diabetes you have depends on the causes of your diabetes.

I’ve heard that there is an insulin pill, is that right?No, currently there is no oral (pill) form of insulin. Insulin is a protein, so oral insulin would be broken down during digestion before it could get into the blood stream to

help lower glucose levels. Researchers are currently working on newer forms of oral insulin but human trials are still a few years away. Currently, the only forms of insulin available for those with diabetes who need it is injected or pumped.

Is it true that insulin causes complications?No, this is not true. In the past, insulin often wasn’t started in people with type 2 diabetes until late in their disease process, often after complications from high blood glucose levels had begun. Today we know that if you control the blood glucose earlier in the disease, you can actually prevent or delay some of the health-related issues that can happen with uncontrolled blood glucose levels. Talk to your health care provider or diabetes educator about insulin therapy. They can answer your questions and help calm some of the fears you may be having about starting insulin.

I’ve heard that insulin injections hurt.With the newer products on the market today, giving an injection can be near painless. The needles are smaller and sharper and many people say that they actually feel the insulin injection less than doing a finger stick to check their blood glucose. Insulin and other injectable medicines for diabetes are given into the fatty tissue just below the skin and not into muscle tissue, often resulting in a less painful injection.

medication: insulin

Does it mean I’ve failed if I have to start taking insulin when I didn’t need it before?No, you have not failed. Diabetes is a chronic and progressive disease meaning that the longer you have it the more likely you are to need changes in your treatment plan to continue keeping your blood glucose in a target range. Your pancreas, over time, may have trouble keeping up with the insulin needs of your body and your blood glucose levels begin to rise despite your best efforts. Taking insulin can help get glucose levels back in target and help you to feel better.

Characteristics of insulinThe insulin that you take by injection or through a pump works like your body’s own insulin to lower your blood glucose. Insulin has three main characteristics: Onset, Peak time and Duration. Let’s look at these a little closer.

Onset: The time it takes for the insulin to get to the blood stream and start lowering your blood glucose.

Peak time: The time when the insulin is at its maximum strength at lowering your blood glucose.

Duration: The length of time the insulin works at lowering your blood glucose

Types of insulinRapid-acting and short-acting insulin are considered bolus insulin and are taken before a meal. Rapid-acting insulins are taken right before the meal and short-acting (regular) insulin is taken 30-45 minutes before you plan to eat. These insulins start working as the blood glucose begins to rise from your meal.

Intermediate and long-acting insulin are called basal insulin and stay in the body longer. Intermediate insulin works all day if taken in the morning or all night if taken in the evening. Long-acting insulin is usually taken once a day at any time as long as it is taken at about the same time each day. Long-acting insulin works throughout the day and night

Pre-mixed InsulinsThere are a variety of insulin preparations which combine different types of insulin in one vial, cartridge or pen and these are called pre-mixed insulins. They are useful for those with visual or dexterity problems and those that need to take two kinds of insulin at the same time. The action times for these insulins will depend on the type and amount of each insulin in the mixture.

Humulin 70/30, Novolin 70/30 and Humulin 50/50 - each contain mixtures of short acting and intermediate acting insulin.

Humalog Mix 75/25 and Novolog Mix 70/30 - each contain a mixture of rapid acting and intermediate insulin.

Note: Many of the insulin preparations discussed here are available in a convenient dosing pen. Ask your pharmacist or health care provider for more information about this option.

IMPORTANT: glargine and detemir cannot be mixed with any other types of insulin in the same syringe.

DIABETES EDUCATION

Hypoglycemia (low blood glucose)Using insulin raises your risk of having hypoglycemia or a low blood glucose.

To help prevent this from happening:

• Eat your regular meals or snacks on time

• Check your blood glucose more frequently when you are more physically active than usual

• Know the action of the insulin you are using, especially the peak time since this is when you may be more likely to experience a low blood glucose

• Plan ahead, keep something with you at all times to treat low blood glucose.

If you feel symptoms of low blood glucose such as shaking, sweating, hunger or nervousness, check your blood glucose immediately. If your blood glucose is below 70 mg/dl or below your target

range, use the “Rule of 15”. Take 15 grams of carbohydrate such as 3-4 glucose tablets or 5-6 hard candies or 4 oz. of juice or regular soda, wait 15 minutes and check your blood glucose again. Repeat until your blood glucose is at least 70 mg/dl. Talk to your health care provider at your next visit if you are experiencing episodes of low blood glucose, they may make changes to your treatment plan.

Other Injectables:Exenetide (Byetta): An injectable medication, not insulin, which is used twice a day to help lower blood glucose after a meal in people with type 2 diabetes. Exenatide can be used with certain other diabetes pills. It is used twice a day before breakfast and the evening meal and works to lower the blood glucose only when it is elevated. If you skip the meal you do not take the medication as this may put you at risk for low blood

glucose. This medication has been shown to cause weight loss in some people. It may cause you to feel full sooner and you may eat less food. It can also cause some mild to moderate nausea which improves over time. You don’t need to adjust the dose of this medication and it comes in a convenient dosing pen.

Pramlintide acetate (Symlin): An injectable medication, not insulin, used by both those with type 1 or insulin-using type 2 diabetes. It is used with insulin at mealtimes to help lower your after-meal blood glucose level. It can put you at a higher risk for low blood glucose, so insulin doses may need to be adjusted accordingly. Nausea is the most common side effect with this medication and is more likely to happen during the first few weeks of therapy. Pramlinitide comes in a convenient dosing pen.

Tips

• Always check the expiration date on

your insulin.

• Check manufacturer’s suggestion for

storing open and unopened insulin.

• Keep insulin out of direct sunlight

and heat. Keep insulin in a cool pack

when traveling.

• Don’t freeze insulin.

• Check that your insulin looks normal

before using: it should look clear

for glargine, detemir, regular, lispro,

aspart and glulisine. NPH and any pre-

mixed insulin that contains NPH insulin

will look cloudy and the bottle, pen or

cartridge will need to be gently rolled

in your hands before drawing up the

dose into the syringe or using the pen.

• Use needles only once for injecting

insulin and discard them in a safe

manner. A #2 plastic container such

as a liquid detergent or bleach bottle

works well. Check with your town or

state about rules for disposing of used

needles and syringes.

1-800-353-0206www.libertymedical.com

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Keep insulin out of direct sunlight and heat and keep it in a cool pack when traveling.

Notes

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