Table of Contents

What is insulin?

Insulin is a hormone. It makes our body’s cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.

When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals – their levels of strength vary.

Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal insulin. However, genetic engineering has allowed us to synthetically produce ‘human’ insulin.

Insulin Basics

  • There are different types of insulin depending on how quickly they work, when they peak, and how long they last.

  • Insulin is available in different strengths; the most common is U-100.

  • All insulin available in the United States is manufactured in a laboratory, but animal insulin can still be imported for personal use.

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food.

In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals.

People with type 2 diabetes make insulin, but their bodies don’t respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy.

Insulin cannot be taken as a pill because it would be broken down during digestion just like the protein in food. It must be injected into the fat under your skin for it to get into your blood. In some rare cases insulin can lead to an allergic reaction at the injection site. Talk to your doctor if you believe you may be experiencing a reaction.

Insulin Treatment for Diabetes

Your doctor will work with you to figure out which type of insulin is best for you depending on whether you have type 1 or type 2 diabetes, your blood sugar levels,and your lifestyle.

People with type 1 diabetes cannot make insulin because the beta cells in their pancreas are damaged or destroyed. Therefore, these people will need insulin injections to allow their body to process glucose and avoid complications from hyperglycemia.

People with type 2 diabetes do not respond well or are resistant to insulin. They may need insulin shots to help them better process sugar and to prevent long-term complications from this disease. Persons with type 2 diabetes may first be treated with oral medications, along with diet and exercise. Since type 2 diabetes is a progressive condition, the longer someone has it, the more likely they will require insulin to maintain blood sugar levels.

Characteristics of Insulin

Insulin has 3 characteristics:

  • Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.

  • Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose.

  • Duration is how long insulin continues to lower blood glucose.

Insulin Strength

All insulins come dissolved or suspended in liquids. The standard and most commonly used strength in the United States today is U-100, which means it has 100 units of insulin per milliliter of fluid, though U-500 insulin is available for patients who are extremely insulin resistant.

U-40, which has 40 units of insulin per milliliter of fluid, has generally been phased out around the world, but it is possible that it could still be found in some places (and U-40 insulin is still used in veterinary care).

  • Insulin is required for people with type 1 diabetes and sometimes necessary for people with type 2 diabetes.

  • Syringe is the most common form of insulin delivery, but there are other options, including insulin pens and pumps.

  • Insulin should be injected in the same general area of the body for consistency, but not the exact same place.

  • Insulin delivery should be timed with meals to effectively process the glucose entering your system.

Types Of Insulin

Various types of insulin are used to treat diabetes and include:

  • Rapid-acting insulin: It starts working approximately 15 minutes after injection and peaks at approximately 1 hour but continues to work for two to four hours. This is usually taken before a meal and in addition to a long-acting insulin.

  • Short-acting insulin: It starts working approximately 30 minutes after injection and peaks at approximately 2 to 3 hours but will continue to work for three to six hours. It is usually given before a meal and in addition to a long-acting insulin.

  • Intermediate-acting insulin: It starts working approximately 2 to 4 hours after injection and peaks approximately 4 to 12 hours later and continues to work for 12-18 hours. It is usually taken twice a day and in addition to a rapid- or short-acting insulin.

  • Long-acting insulin: It starts working after several hours after injection and works for approximately 24 hours. If necessary, it is often used in combination with rapid- or short-acting insulin.

Insulin can be given by a syringe, injection pen, or an insulin pump that delivers a continuous flow of insulin.

Insulin Therapy

With the help of your health care team, you can find an insulin routine that will keep your blood glucose near normal, help you feel good, and fit your lifestyle.

Type 1

People diagnosed with type 1 diabetes usually start with two injections of insulin per day of two different types of insulin and generally progress to three or four injections per day of insulin of different types. The types of insulin used depend on their blood glucose levels. Studies have shown that three or four injections of insulin a day give the best blood glucose control and can prevent or delay the eye, kidney, and nerve damage caused by diabetes.

Type 2

Most people with type 2 diabetes may need one injection per day without any diabetes pills. Some may need a single injection of insulin in the evening (at supper or bedtime) along with diabetes pills. Sometimes diabetes pills stop working, and people with type 2 diabetes will start with two injections per day of two different types of insulin. They may progress to three or four injections of insulin per day.

Fine-Tuning Your Blood Glucose

Many factors affect your blood glucose levels, including the following:

  • What you eat

  • How much and when you exercise

  • Where you inject your insulin

  • When you take your insulin injections

  • Illness

  • Stress

What Are the Side Effects of Insulin?

The major side effects of insulin taken for diabetes include:

  • Low blood sugar

  • Lumps or scarring of the area of the body where you’ve had too many insulin injections

  • Rash at the site of injection or over the entire body (rare)

  • Weight gain when you first start using insulin

  • With inhaled insulin, there’s a risk of a sudden tightening of the lungs in people who have asthma or the lung disease COPD.

    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

    • rash and/or itching over the whole body

    • shortness of breath

    • wheezing

    • dizziness

    • blurred vision

    • fast heartbeat

    • sweating

    • difficulty breathing or swallowing

    • weakness

    • muscle cramps

    • abnormal heartbeat

    • large weight gain in a short period of time

    • swelling of the arms, hands, feet, ankles, or lower legs

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

It is important to keep insulin on hand at all times. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An insulin overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions).

What should I avoid?

Do not change the brand of insulin or syringe you are using without first talking to your doctor or pharmacist. Some brands of insulin and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

Avoid drinking alcohol. Your blood sugar may become dangerously low if you drink alcohol while using insulin.

The link between insulin and weight gain

 When you take insulin, glucose is able to enter your cells, and glucose levels in your blood drop. This is the desired therapeutic goal. But if you take in more calories than you need to maintain a healthy weight — given your level of activity — your cells will get more glucose than they need. Glucose that your cells don’t use accumulates as fat.

Insulin Storage and Syringe Safety

Although manufacturers recommend storing your insulin in the refrigerator, injecting cold insulin can sometimes make the injection more painful. To avoid this, many providers suggest storing the bottle of insulin you are using at room temperature. Insulin kept at room temperature will last approximately 1 month.

Remember though, if you buy more than one bottle at a time to save money, store the extra bottles in the refrigerator. Then, take out the bottle ahead of time so it is ready for your next injection.

Here are some other tips for storing insulin:

  • Do not store your insulin near extreme heat or extreme cold.

  • Never store insulin in the freezer, direct sunlight, or in the glove compartment of a car.

  • Check the expiration date before using, and don’t use any insulin beyond its expiration date.

  • Examine the bottle closely to make sure the insulin looks normal before you draw the insulin into the syringe.

If you use regular, check for particles or discoloration of the insulin. If you use NPH or lente, check for “frosting” or crystals in the insulin on the inside of the bottle or for small particles or clumps in the insulin. If you find any of these in your insulin, do not use it, and return the unopened bottle to the pharmacy for an exchange and/or refund.

Syringe Reuse

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 it would be a safe choice for you. If you are ill, have open wounds on your hands, or have poor resistance to infection, you should not risk insulin syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused.

Here are some tips to keep in mind when reusing syringes:

  • Keep the needle clean by keeping it capped when you’re not using it.

  • Never let the needle touch anything but clean skin and the top of the insulin bottle.

  • Never let anyone use a syringe you’ve already used, and don’t use anyone else’s syringe.

  • Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily.

Syringe Disposal

It’s time to dispose of an insulin syringe when the needle is dull or bent or has come in contact with anything other than clean skin.

If you can do it safely, clip the needles off the syringes so no one can use them. 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, and do not recycle your syringe container.

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