Thursday, January 25, 2007
This blog is not spam, and it is not for spamming purposes. Please read all information provided below with my first blog that details Insulin, what insulin is and the different types that can be used to treat Diabetes.

Humapen Luxura
Humapen Luxura

Use of insulin to treat diabetes, called insulin therapy, has two main goals:

1. To maintain blood sugar (glucose) at near-normal levels
2. To prevent long-term complications of diabetes

A successful treatment plan takes into consideration what you eat and how much you exercise in determining the amount of insulin you need each day. The most widely used form of insulin is synthetic human insulin. It's called human insulin because its chemical makeup is identical to that of insulin produced by the human pancreas, but this insulin is made in a laboratory. It's easier to understand the importance of insulin therapy if you understand how insulin normally works in your body. Food is made up of carbohydrates, protein and fats. All three affect your blood sugar, but carbohydrates affect it the most. Carbohydrates are broken down and absorbed into your bloodstream in the form of sugar (glucose), raising your blood sugar level. Your pancreas releases insulin continuously, whether or not you're eating. When the amount of sugar in your blood rises, however, such as after a meal, secretion of insulin increases. The main job of insulin is to keep your blood sugar level within its normal range. It does this by "escorting" sugar - your body's main energy supply - from your bloodstream to your individual cells. As sugar enters your cells, the amount of sugar in your blood drops. Insulin also influences your liver, which plays a key role in maintaining normal blood sugar levels. After you eat, when insulin levels are high, your liver accepts and stores extra sugar in the form of glycogen. Between meals, when insulin levels are low, your liver releases glycogen into your bloodstream in the form of sugar, keeping your blood sugar level within a narrow and normal range. All people with type 1 diabetes and some people with type 2 diabetes need insulin medication to make up for the insulin that their pancreas is unable to produce. The medication is administered by injection with a syringe or an insulin pen, or through constant infusion from an insulin pump. Insulin isn't available in pill form because its chemical structure is destroyed during digestion, making the hormone ineffective by the time it gets to your bloodstream. Many types of insulin are used, and they differ in the time it takes for them to begin working and in their duration. These include:

1. Short-acting insulin. Short-acting insulin works quickly, but its effects last for only a limited time.
2. Intermediate-acting insulin. Intermediate-acting insulin starts working later than short-acting insulin, and its effects last longer.
3. Long-acting insulin. Long-acting insulin takes several hours to work, but the duration of its peak action is greater than that of other forms of insulin.
Insulin humalog
Insulin humalog

The goal of any insulin program is to keep blood sugar within or close to its normal range by mimicking normal pancreatic secretions of insulin. Ideally, this regimen would provide continuous (basal) secretion of insulin as well as periodic meal-related secretions. As useful as the current types of human insulin are, they're not perfect. Their action and rate of absorption vary. Researchers have discovered that by rearranging the chemical structure of synthetic human insulin, they can create modified forms of insulin called insulin analogues. The onset and duration of these newer types of insulin more closely resemble those of natural insulin.

Lispro (Humalog) and insulin aspart (NovoLog). These forms of insulin are called rapid-acting because they're absorbed more quickly than regular insulin. They also peak faster and their effects wear off sooner. Lispro and insulin aspart work just long enough to keep your blood sugar from rising too high after meals. One of the downfalls of rapid-acting insulins - which also can occur with other types of insulin - is that they can cause your blood sugar level to drop too low (hypoglycemia) if they're administered too early before a meal. To prevent this from occurring, these medications should be taken at the time you eat.

Glargine (Lantus). Researchers hope long-acting insulin analogues can provide more consistent blood sugar control. Development of these medications has been slow, but one such insulin analogue has received Food and Drug Administration approval. Glargine requires only one injection a day, begins working 1 to 2 hours after injection and has no distinct peak effect. The type and dosage of insulin you need depends on the characteristics of your disease. Your daily insulin regimen may involve one or two types of insulin. Mixing two types of insulin often can more accurately mimic normal insulin production. You might take a short-acting insulin to simulate insulin secretion at mealtime and a longer-acting insulin to mimic basal insulin secretions. Your doctor will help you decide which insulin regimen will work best for your diabetes and your lifestyle. Several types of insulin regimens exist:

1. Single dose. You inject a dose of intermediate-acting insulin once each day. This regimen is the least beneficial for people with type 1 diabetes.
2. Mixed dose. You inject both short-acting and intermediate-acting insulins - mixed in one syringe - each morning.
3. Pre-mixed single dose. You inject a dose of pre-mixed insulin each morning.
4. Split dose. You give yourself two injections of intermediate-acting insulin each day. These injections are usually given before breakfast and before the evening meal, or before breakfast and at bedtime.
5. Split mixed dose. You give yourself two injections that contain a combination of a short-acting and an intermediate-acting insulin - mixed in one syringe - each day. These are generally given before breakfast and before the evening meal.
6. Split pre-mixed dose. You give yourself two injections of pre-mixed insulin daily. These are usually given before breakfast and before the evening meal, or before breakfast and at bedtime.
7. Intensive insulin therapy. This regimen involves multiple daily injections of insulin or use of a small portable pump that continuously administers insulin.

Intensive insulin therapy involves monitoring your blood sugar frequently, using a combination of insulins and adjusting your insulin doses based on your blood sugar levels, your diet and changes in your routine. When practiced effectively, intensive insulin therapy can:

1. Reduce your risk of eye damage
2. Reduce your risk of kidney disease
3. Reduce your risk of nerve damage
4. Improve your cholesterol levels
5. Reduce your risk of cardiovascular disease

Insulin novolin GE NPH (novolin N)
Insulin novolin GE NPH (novolin N)

Two methods for implementing intensive insulin therapy are:

1. Multiple daily injections (MDIs). Multiple daily injection therapy includes three or more injections of insulin daily to achieve good blood sugar control. Both a short-acting insulin and a longer-acting insulin are used.

2. An insulin pump. An insulin pump most closely resembles how your body delivers insulin. The short-acting insulin used with insulin pumps offers more consistent and predictable effects than longer-acting insulin.

Intensive insulin therapy has two possible drawbacks:

1. Low blood sugar (hypoglycemia). The tighter your blood sugar levels, the greater your risk of experiencing low blood sugar when your routine changes and your blood sugar varies from its normal range. You can counter this risk by being aware of the symptoms of low blood sugar and responding quickly when you begin to experience them.
2. Weight gain. This can occur because the more insulin you use to control your blood sugar, the more sugar that gets into your cells and the less sugar that's wasted in your urine. Sugar that your cells don't use accumulates as fat. Following a healthy eating plan can help limit weight gain. The most common way to receive insulin is by syringe. This method delivers insulin underneath the skin, where it's absorbed into the bloodstream. An alternative method for injecting insulin involves the use of an insulin pen. For many years a standard syringe containing a needle was the only tool used to inject insulin. Now other options are available:

1. Insulin pen injectors. Although a needle is still involved, insulin pens offer a convenient, more accurate and discreet means of receiving insulin. This device looks like a pen with a cartridge - but the cartridge is filled with insulin rather than ink. Some pens use disposable cartridges containing pre-filled insulin. Other pens are completely disposable. You place a fine point needle, much like the one on a syringe, on the tip of the pen. You turn a dial to select the desired insulin dose, insert the needle under your skin and then click down on a button at the end of the pen to deliver the insulin.

2. Insulin jet injectors. These devices use high-pressure air to send a fine spray of insulin under your skin. This can be a painful way to receive insulin, and it's not as accurate as other methods because some of the medication can be lost during injection. Jet injectors may be an option if you can't use needles. However, if you use the device incorrectly, you could injure your skin. Jet injectors cost more than pen injectors, generally $250 or more.

Insulin may be injected into any area of your body where a layer of fatty tissue is present and where large blood vessels, nerves, muscles and bones aren't close to the surface. Direct injection of insulin into your bloodstream - although sometimes done in a hospital - isn't recommended for day-to-day use because it's inconvenient and would make the insulin act too fast. Insulin is absorbed most evenly from injections in the abdomen except for the 2-inch radius around the navel. Rotate the site of each injection. Your doctor or diabetes educator may show you alternative areas for injection, such as your hips, buttocks, upper arms and thighs. It's generally best to administer insulin in your abdomen because insulin absorption in other areas is more variable and often dependent on your level of physical activity. After you determine the site for your insulin injection, clean it with an alcohol wipe or soap and water, and allow it to dry before giving yourself an injection.

With time and practice, the process of drawing insulin into a syringe becomes routine and is no longer so daunting. Here's how to do it:

1. Collect the materials you'll need: alcohol wipes, insulin and a syringe.
2. Check the label on the insulin bottle for the source, type, concentration and expiration date. You should use the same kind of insulin every time, unless your doctor tells you otherwise. Changing insulin types may affect blood sugar control.
3. Check the insulin bottle for any changes in the insulin. Make sure no clumping, frosting, precipitation or change in clarity or color has occurred. Any changes in appearance may mean that the insulin has lost potency.
4. Wash your hands with soap and water.
5. Gently roll the bottle of insulin between your hands to mix the insulin. Shaking it may decrease its potency. Check to make sure that no particles remain on the bottom of the bottle.
6. Wipe off the top of the insulin bottle with an alcohol wipe.
7. Remove the needle cap from the sterile syringe.
8. Pull the plunger to draw into the syringe an amount of air equal to the amount of insulin you need.
9. Insert the needle through the rubber stopper of the insulin bottle and push the air in the syringe into the bottle.
10. While keeping the needle in the bottle, turn the bottle completely upside down.
11. Pull the plunger on the syringe slightly past the number of units of insulin you are to inject. Be sure that you're withdrawing insulin, not air. Air isn't dangerous but it can decrease the amount of insulin in the syringe.
12. Remove air bubbles either by pushing the insulin back into the bottle and withdrawing it again or snapping the syringe sharply with your finger and then pushing the plunger to expel the air into the bottle.
13. Recheck the syringe for air. If air is present, repeat the previous step.
14. Double-check the amount of insulin in the syringe.
15. Pull the needle out of the bottle.

If you need to inject two types of insulin at the same time, write on a piece of paper the amount of each type of insulin to be injected and add the two to determine the total number of units. Follow the preceding steps for drawing up insulin until you reach the point that you remove the needle cap from the sterile syringe. From then on, do as follows:

1. Pull the plunger to draw into the syringe an amount of air equal to the amount of intermediate- or long-acting insulin you need.
2. Insert the needle through the rubber stopper of the intermediate- or long-acting insulin bottle and push the air in the syringe into the bottle. This will equalize air pressure in the vial. Without it, it'll be hard to withdraw the insulin.
3. Pull the needle out of the bottle without withdrawing any insulin.
4. Pull the plunger to draw into the syringe an amount of air equal to the amount of short-acting insulin you need.
5. Insert the needle through the rubber stopper on the short-acting insulin bottle and push the air in the syringe into the bottle.
6. Turn the bottle completely upside down, while keeping the needle in the bottle.
7. Pull the plunger on the syringe slightly past the number of units of short-acting insulin you are to inject. Be sure that you're withdrawing insulin, not air.
8. Remove air bubbles either by pushing the insulin back into the bottle and withdrawing it again or by snapping the syringe sharply with your finger and then pushing the plunger to expel the air into the bottle.
9. Recheck the syringe for air. If air is present, repeat the previous step.
10. Double-check the amount of insulin in the syringe.
11. Pull the needle out of the bottle.
12. Insert the needle through the rubber stopper of the intermediate- or long-acting insulin bottle.
13. Turn the bottle completely upside down, while keeping the needle in the bottle.
14. Carefully withdraw the required number of insulin units. If you draw past the correct amount, don't push the insulin back into the bottle. Throw away the syringe and begin again.
15. Double-check the amount of insulin in the syringe. It should equal the sum on your piece of paper.
16. Pull the needle out of the bottle.

Once you have the right amount of insulin in the syringe and you've removed the needle from the bottle, it's time to inject the medication:

1. Hold the syringe like a pencil. Quickly insert the entire length of the needle into a fold of your skin at a 90-degree angle. If you're thin, you may need to use a short needle or inject at a 45-degree angle to avoid injecting into your muscle, especially in the thigh area.
2. Release the pinched skin and inject the insulin by gently pushing the plunger all the way down at a steady, moderate rate. If the plunger jams as you're injecting the insulin, remove the needle and note the number of units remaining in the syringe. Contact your doctor, nurse or diabetes educator for more instructions.
3. Place the alcohol wipe on your skin next to the needle and withdraw the needle.
4. Apply gentle pressure with the alcohol wipe at the injection site for 3 to 5 seconds. Don't rub.
5. Discard the needle in a covered, puncture resistant container.

Some people develop indentations, hard lumps or thickened skin in areas where they inject insulin. Ask your doctor or diabetes educator what you can do to avoid this. Often, rotating the site of your injections will prevent or reduce this problem. Avoid injecting in areas of indentations, hard lumps or thickened skin because insulin isn't absorbed as well there.

Store your insulin in the refrigerator until it's opened. After a bottle has been opened, it may be kept at room temperature for 1 month. Insulin at room temperature causes less discomfort when injected. Throw away your insulin after the expiration date or after being kept at room temperature for a month. Never freeze insulin or expose it to extremely hot temperatures or direct sunlight. Before taking any medication other than your insulin, including over-the-counter products, read the warning label. If the label says you shouldn't take the drug if you have diabetes, consult your doctor before taking it.

Researchers have been experimenting with a preparation in which insulin is inhaled through the nose. However, absorption of insulin through membranes in the nasal cavity is varied and still too unreliable. Other studies that show promise involve administering insulin by means of:

1. A patch. An insulin patch is placed on the skin to provide a continuous low dose of insulin. Insulin levels can be adjusted before meals by pulling off a tab on the patch to release insulin. Because insulin doesn't permeate skin easily, the patch is still not as effective as a needle.
2. An inhaler. With this delivery method, dry powder is inhaled through the mouth directly into the lungs where the insulin enters the bloodstream. The inhaler is about the size of a flashlight and uses rapid-acting insulin

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Tuesday, January 23, 2007

What is Insulin and how do I know if i need it?

Insulin is an essential hormone. Without it, the body cannot control or properly use glucose (sugar) – one of its main energy supplying fuels.

How does insulin help diabetes?

People with Type 1 diabetes produce inadequate amounts of insulin, so insulin replacement is their key treatment.

Without adequate insulin replacement, people with Type 1 diabetes will see their blood sugar levels rise and the body will start to burn up its fat stores. In a few days this leads to a condition called diabetic acidosis, which is life threatening.

Too much insulin, on the other hand, leads to such low levels of blood sugar that it causes a condition called hypoglycaemia.

The symptoms include paleness, shaking, shivering, perspiration, rapid heartbeat, hunger, anxiety and blurred vision. In some cases it can cause loss of consciousness (hypoglycaemic coma) and convulsions.

In Type 2 diabetes the problem is not a lack of insulin output, but increasing resistance of your cells to the effects of insulin.

In the early years, the body compensates for this insulin resistance by increasing the output of insulin from the pancreas gland.

Ultimately, the pancreas becomes unable to cope.

About 25 per cent of people with Type 2 diabetes eventually need treatment with insulin. The longer a person has Type 2 diabetes, the more likely they will have to start insulin treatment at some point.


There are four main kinds of injectable insulin.

Short-acting insulin: soluble insulin (eg Actrapid, Humulin S, Hypurin bovine neutral, Hypurin porcine neutral, Insuman rapid, Pork actrapid, Velosulin) starts working within 30 to 60 minutes and lasts six to eight hours. The insulin analogues insulin aspart (NovoRapid), insulin lispro (Humalog) and insulin glulisine (Apidra) start working within 15 minutes and last for up to five hours.

Intermediate-acting insulin: isophane insulin (eg Humulin I, Hypurin bovine isophane, Hypurin porcine isophane, Insulatard, Insuman basal, Pork insulatard) starts working after one to two hours and lasts 10 to 14 hours.

Long-acting insulin: insulin zinc suspension (Hypurin bovine lente), protamine zinc insulin (Hypurin bovine protamine zinc), and the insulin analogues insulin glargine (Lantus) and insulin detemir (Levemir). They start working after one to two hours and last for up to 24 hours.

Biphasic insulins: mixtures of short-acting and intermediate-acting insulins in different proportions, such as 30/70, 50/50 (eg NovoMix 30, Humulin M3, Hypurin porcine 30/70, Insuman comb, Mixtard, Pork mixtard 30, Humalog Mix25). The type of insulin you use will depend on your individual needs and lifestyle.

An inhaled insulin product (Exubera) was launched in the UK in August 2006. It is a short acting insulin that starts working within 10 to 20 minutes and lasts for around six hours.

How often do I take insulin?

There are three common insulin regimes.

1. Twice daily doses of short- and intermediate-acting insulin

These are given before breakfast and before the evening meal.

The short-acting doses cover the insulin needs of the morning and evening.

The intermediate-acting doses cover the afternoon and overnight.

The pre-mixed insulin injections are convenient for this type of dosing.

2. Three times a day dosing

Short-acting and intermediate-acting insulin before breakfast.

Short-acting insulin before the evening meal.

Intermediate-acting insulin before bed.

Moving the second intermediate-acting dose to before bedtime gives better coverage of the overnight period.

3. Multiple daily doses

Short-acting insulin is used before each main meal.

An intermediate or long-acting insulin is used before bedtime to give coverage overnight.

How is insulin taken?

Most people use insulin in:

disposable insulin pens cartridges that go in multiple-use insulin pens.

Needles for pens are disposable and come in 5mm, 6mm, 8mm, 10mm, 12mm and 12.7mm lengths.

Your diabetes specialist will advise on which is most suitable for you.
A new needle should be used for each injection.
Exubera is a new powdered form of insulin that is inhaled into the lungs from an insulin inhaler, similar to those used for asthma.

There are other types of regimes - for example diabetes in some older people can be adequately controlled with a single daily injection of long-acting insulin.

Pump treatment is sometimes used in young people with diabetes. It involves a constant drip-feed of insulin through a needle in the skin and extra insulin doses with meals. The feed is controlled by a small portable pump called an infusion pump.

Multiple injections are increasingly being favoured, because they give the most flexibility and are most capable of mimicking natural insulin release.

The regimen needed and the dose used will be adjusted on an individual basis until you and your doctor find the combination that controls your blood sugar best.

Insulin injections

Insulin is inactivated by the digestive enzymes in the gut and can't be taken by mouth. Insulin is therefore most commonly given as an injection under the skin (subcutaneously), usually into the thigh, buttocks, abdomen or upper arm.

The needles used are very small. Although the injections can be a little painful at first, people soon get used to them and they become second nature.

A member of your diabetes team will teach you how to inject yourself. If you have any concerns or questions about your insulin injection, these are the people to ask for help.

You should use:

short-acting insulin injected in the skin of your abdomen

intermediate- or long-acting insulin injected in the thigh

insulin mix can be injected in either place.

To inject, take a small fold of skin between the fingers, insert the needle at an angle and inject the right amount of insulin. Then slowly retract the needle and let go of the fold of skin. With short needles you don't need to pick up a fold of skin to inject into.

Rotate the injection site you use on a regular basis, because overusing one site can cause the fatty tissue there to thicken. This is called lipodystrophy and can lead to erratic absorption of the insulin from that site.

Exercising after an injection can increase the speed that the insulin is absorbed into your bloodstream.

Inhaled insulin

There is no doubt that the launch of inhaled insulin this year (2006) is a breakthrough in the treatment of diabetes. However, it will not be suitable for all people with diabetes and how popular it will become remains to be seen.

This is because the only type of insulin that can be delivered in this way at the moment is a short-acting type. This means that most people with type one diabetes will still need to use injections to administer their intermediate or long-acting insulin.

The inhaled insulin can't be use by people who smoke, or who have lung diseases like asthma or COPD.

There are also still some concerns over the long-term effects on the lungs of inhaling insulin.

The National Institute for Health and Clinical Excellence (NICE) are still reviewing their recommendations on who should use inhaled insulin. At the moment, their draft guidance recommends that it should only be used by people who have a genuine needle phobia diagnosed by a psychiatrist or psychologist, or who have severe persistent problems with injection sites.

What can I do myself?

Learn the proper way to inject yourself from the start.

Your specialist diabetes nurse may also want to lower your blood sugar level to a hypoglycaemic range on purpose. This way you will know:

the warning symptoms of a hypoglycaemic reaction

how to get your blood glucose level up again.

Measure your blood sugar every day to learn how to react to eating, exercise and changes in insulin dosage. This is the only way to get a good feel for, and control of, blood glucose levels.

Initially your doctor can help you adjust the insulin dose to suit your lifestyle. Later you will know enough about your condition to do this alone.

How do I know when to adjust insulin?

Good advice

Good blood sugar control is essential.
But the harder you try to keep blood sugar low, the greater the risk of a hypoglycaemic attack.
You need to strike a balance between strict glucose control and the need to avoid hypos.

More short-acting insulin is usually needed when:

eating more than usual

doing less physical activity, eg taking the car to work instead of riding a bike.

Less short-acting insulin is needed when:

eating less doing more physical activity.

The dose of long-acting insulin should not be adjusted as a short-term measure - for example if the blood sugar level is high on one occasion only.

This is because a change in dose doesn't change the body's glucose levels immediately and can affect sugar levels in the next few days.

Targets for insulin treatment

The aims of treating diabetes are not the same for everyone.

In a young or middle-aged person with a long life expectancy, good control of the diabetes will reduce the risk of long-term complications developing. But this will require fairly intensive monitoring and adjustment of the diabetes.

Good control in Type 1 diabetes would be blood glucose consistently between 4mmol/l and 7mmol/l.

This should result in a HbA1c level (long-term glucose level) of 7 per cent or less.

In an elderly person or someone with a limited outlook for other medical reasons, it may be inappropriate to be so precise with insulin treatment.

Instead, controlling diabetes symptoms by reducing blood sugar levels may be all that's required.

Less strict control, so blood glucose is around 10 mmol/l, may be good enough to stop symptoms such as thirst and the frequent desire to pass urine.