Different Types of Insulin

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Different Types of Insulin

How Insulin Works

Insulin is like a key that opens up the locks on your body's cells so that glucose (blood sugar) can get inside and be used for energy.

Insulin Helps Glucose
Get Into Your Body's Cells

If the glucose can't get into your cells, it builds up in your blood stream. If left untreated, high blood glucose can cause long-term complications.

Additionally, when blood sugar reaches a certain level, the kidneys try to get rid of it through urine - which means that you'll need to urinate more often. Frequent urination can make you feel tired, thirsty, or hungry. You may also start losing weight.

Your body also gets energy from a complex sugar called glycogen, which is stored in your liver and muscles. The liver converts glycogen to glucose and releases it into your bloodstream when you're under stress and/or when you're extremely hungry. When enough insulin is present, muscles can use their glycogen for energy, but cannot release it directly into the blood.

In type 2 diabetes, the liver releases too much glucose, especially at night (when the liver normally releases some glucose), resulting in high blood sugar levels in the morning. Insulin injections help bring down the amount of glucose released by the liver during the night, bringing morning blood sugars levels back to normal. Carbohydrates are broken down into glucose, which is the "fuel" that gives our bodies energy. Insulin's important job is to help glucose get into the body's cells.

Insulin Helps Build Muscle

When you've been sick or injured, or if you're recovering from surgery, insulin helps you heal by bringing amino acids (the building blocks of muscle protein) to your muscles. Amino acids repair muscular damage and help them regain their size and strength. If there isn't enough insulin in your body when your muscles have been injured, amino acids can't do their job, and your muscles can become very weak.

Where Insulin Comes From

Almost all of the insulin sold in the United States today is what is known as "human insulin." Developed by scientists, this laboratory-created insulin is made by DNA recombinant technology and is very similar, really identical, to insulin from a human pancreas. It's available in varieties that are designed to start working within just a few minutes or last for many hours, giving insulin users a lot of control over their blood sugar levels. (Before the introduction of human insulins, people used insulin from beef and pork sources.)

Insulin can't be taken as a pill or capsule because the digestive juices in the stomach ruin its effectiveness. Oral insulin pills might be a reality someday, but right now the only way to take insulin is by injecting it directly into the layer of fat just below the skin. Most people inject insulin with a syringe or insulin pen, although other methods are available.

Insulin Strengths: U-40 and U-100

In the United States, insulin is labeled "U-100," which means there are 100 units of insulin per milliliter of fluid in the vial. Some insulin is also available in U-500 strength. This form of insulin is only for people with marked insulin resistance who take doses of more than 200 units per day.

People traveling outside the United States must bring enough U-100 insulin and syringes to last the entire trip, because insulin in some other countries is sometimes sold in U-40 strength. If emergency insulin is needed and the only choice available is U-40 insulin, syringes marked for U-40 should be used as well. Syringes for U-40 insulin have a red cover and red scale, rather than the orange needle cover and black scale of U-100 syringes.

All insulin pens throughout the world are U-100. In an emergency, you can purchase insulin pen cartridges and draw the insulin from them (you don't need to inject air into a cartridge). Since a unit of insulin is always a unit of insulin, you should take the same dose of insulin with either U-100 or U-40. If you need more help, a pharmacist or healthcare professional can assist you in determining the proper dosage.

Basal and Bolus Insulins

The pancreas naturally secretes insulin in two different ways:

A slow, continuous trickle of insulin that stays at a low level in the blood at all times (known as "basal insulin").

Large bursts of insulin that are released when your blood sugar rises, typically after meals (known as "bolus insulin").
While people with type 1 diabetes need a treatment program that gives them both basal and bolus insulin, the treatment for people with type 2 varies and usually changes over time:

Some people with Type 2 only need basal insulin injections (often just a single shot at bedtime) because their pancreas can still provide the extra insulin needed for meals.

Some people with Type 2 need both basal and bolus insulin.

Many people with Type 2 don't need any insulin injections.

Injections of rapid-acting and short-acting insulins provide the bolus insulin supply needed after meals. Conversely, injections of intermediate-acting and long-acting insulin mimic the body's natural basal supply.

Insulin Performance Categories

The chart below describes the features of different kinds of insulin. Here are some quick definitions to help you understand some of the terms:

Onset of action: how fast the insulin starts to work after injection.

Peak: when the insulin works the hardest.

Duration: how long it continues to work.

Note: The information in the charts below refers to human U-100 insulin only.
See chart on web site.

Your personal treatment program might include more than one type of insulin to be used at different times of the day, at the same time each day, or even in the same injection.

In addition to the insulin types listed above, you can purchase vials, prefilled pens and cartridges of insulin that have two types of insulin already mixed together in a set proportion.

If the insulin mix that your regimen calls for isn't available as a pre-mix, you'll have to do the mixing yourself because you can't adjust the dosage of one of the insulins in a pre-mix without also adjusting the dosage of the other.

Storing and Handling Insulin

Always read the instructions that come with your insulin. Bottles of insulin, either open or unopened, generally last for one month when stored at room temperature (59 to 86?F). A bottle is considered open if its seal has been punctured. If you remove the cap but don't puncture the seal, the bottle is still considered unopened.

If stored in a refrigerator, unopened bottles are good until the expiration date printed on the bottle. Opened bottles that are stored in a refrigerator should be used within one month of being opened. Many people store their unopened bottles in the refrigerator and keep open bottles at room temperature because they find it uncomfortable to inject cold insulin.

Don't use bottled insulin past the expiration date printed on the label. And no matter what the expiration date is, throw away a bottle one month after you open it. To help you keep track, write the date that you opened the bottle on the bottle's label.

With insulin pens and their cartridges, storage life ranges from seven days to one month.

Troubleshooting

There are two ways to tell when insulin is no longer good: poor performance and unusual appearance.

If your blood sugar stays high even though you're following your treatment plan, your insulin may have lost its effectiveness. Poor performance could be due to two things:

Your insulin bottle has been open for more than 28 days.

You have a lot of punctures in the rubber stopper because you take very small doses of insulin and you're getting close to the end of the bottle.
If your insulin has an unusual appearance, it's probably no longer effective. Here are some warning signs:

Your insulin is cloudy when it is supposed to be clear.

Your insulin is supposed to be cloudy but it has clumps, even after rolling it between your palms.

Your insulin looks stringy.

Your insulin has changed in color.

If you think your insulin has gone bad, don't take any chances: throw the bottle away immediately and open a new one.

Smart Tips for Insulin Storage

Protect your insulin (bottles, pens, and cartridges) from extremes of hot and cold.

Keep insulin out of direct sunlight (for example, don't store it on a sunny window sill).

Never store your insulin in the freezer - once insulin is frozen, it loses its potency.

Don't store your insulin near radiators, heat vents, ovens, air conditioners, etc.

Don't leave your insulin in a closed car during very warm or cold months.

If you're going to be outdoors for a while in hot or cold weather, store your insulin in an insulated case.

1. INJECTING INSULIN IS PAINFUL.
False. Most new insulin users are pleasantly surprised when their first shot ends up hurting much less than they expected. It has become more comfortable to inject insulin because of the needles, which are smaller and thinner than ever. In fact, BD needles not only make injecting virtually pain-free, but they also make it easy, too:

BD offers syringes with barrel sizes to match your exact dose.


BD offers a wide variety of convenient and comfortable pen needles.


BD has created helpful Injection Demonstrations and instructions to make the injection process comfortable and easy to understand.
A twinge of soreness from time to time is normal, but if you frequently feel a sting while injecting, try the following:

Check with your doctor to make sure that your injection technique is correct.


Wait until the alcohol from the swab has dried completely on your skin before injecting.


Be sure you are not bending the needle when you remove the cap. Needle caps should be removed by first twisting and then pulling them straight off.


Inject your insulin when it is at room temperature. Cold insulin hurts.


Keep the muscles in the injection area relaxed during injection.


Never use your needles more than once. Reusing a needle can bend or dull the tip, which will increase the pain, and could cause it to break off and become lodged in your skin.


Larger insulin doses hurt more than injections of small amounts. To minimize injection pain, ask your doctor if you can try injecting more frequently throughout the day with a smaller amount of insulin.


Penetrate your skin quickly. If this is hard to do, consider using an automatic injection device that will put the needle in your skin for you, such as the
BDÙ Inject-Ease ? Automatic Injector device.


Avoid injecting into muscle by pinching up your skin before injecting and injecting into the fold of skin that you pinch up.


Speak with your doctor about using a different needle size or injection device.


Speak with your doctor about injecting into other parts of your body.


Only use BD needles and syringes to inject your insulin. The fine diameters, sharp points, and lubricated coatings of BD's high-quality needles and syringes make your injections as comfortable and pain-free as they can be. (If BD products are not covered by your insurance, contact us and let us know.)

2. IF I BEGIN USING INSULIN, I WILL HAVE TO TAKE IT FOR THE REST OF MY LIFE.
For people with type 1 diabetes, this is true. For some people with type 2 diabetes, depending on the stage of their disease, insulin therapy may be a temporary treatment that is only necessary during periods of illness and other stress.

Many insulin users find that by controlling their diet and following an exercise program, they can reduce the amount and type of insulin and/or medication that is needed. Sometimes losing as little as 10 pounds can make a big difference in a person's insulin requirements, though this does not work for everyone.

For people whose diabetes is caused by pregnancy, illness, or another temporary condition, insulin treatment can usually be stopped once the cause of the disease has been resolved.

But whatever kind of diabetes you have, keep in mind that insulin can help you achieve your blood glucose target, which will make you feel better and have more energy. In fact, many people who were at first intimidated by insulin therapy find that it makes them feel so much healthier, they wish they had started it earlier. You may not be able to stop insulin therapy whenever you want, but that is because your condition requires it, not because it is addictive. Remember, insulin is a hormone, so it is not "habit-forming" or addictive.



3. IF I HAVE TO BEGIN INSULIN THERAPY, IT MEANS THAT MY DIABETES IS GETTING WORSE.
False. If your doctor tells you that you need insulin therapy in order to control your diabetes, that does not mean you are doing anything wrong or your condition is getting worse. Insulin is simply a tool to help you better manage your blood sugar level.

Your blood sugar level can be controlled through a combination of insulin therapy, diet, and exercise. (In fact, many people with type 2 diabetes follow a regimen called combination therapy that uses pills along with insulin.) Without insulin treatment, however, your blood sugar may rise and you will be at greater risk for developing the serious complications associated with diabetes.

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4. TAKING INSULIN WILL MAKE MY LIFE MORE COMPLICATED.
True. But the additional work of taking proper care of your diabetes today will help prevent the complications of diabetes in the future and help you to live a healthier longer life.

For your insulin therapy to be effective, you will need to make certain changes in your lifestyle. For example, you should:

Eat the right foods
Exercise regularly
Test your blood glucose regularly
Take your diabetes medications as prescribed
If you do these things, you may find that your daily routine calls for more discipline than you are used to. But once you commit to these healthy changes, you will also find that the benefits of feeling better and having more energy are well worth the effort.



5. I AM AFRAID OF NEEDLES. HOW AM I SUPPOSED TO STICK MYSELF?
At first, many people are nervous about injecting themselves with insulin, so you are not alone. If you are worried about the injection hurting, don't be: today, insulin needles, especially the BD line of small, comfortable, high quality needles, are not like the larger, more painful ones that you remember from when you were a kid.

Once you have gotten past that first shot and the insulin begins to take effect, you should begin to feel better and have more energy. That is why your doctor prescribes insulin for you - it is the best way to get control over your diabetes.

If you are still a little uneasy, try these helpful injection relaxation tips:

Take a deep breath before injecting.


Visualize a calm, relaxing scene, like a sunset or a favorite vacation spot.


Picture an enjoyable experience (like going outside to start your day) that you can do once you finish injecting.
The BD Injection Demonstration is an animated, step-by-step explanation of the process of injecting insulin.


6. INSULIN WILL MAKE ME GAIN WEIGHT.
Many people find that they do put on a few pounds when they begin taking insulin. This is also true if they take oral medications that stimulate the pancreas to produce extra insulin.

The reason for this is simple: when your blood sugar was too high, many of the calories you ate were flushed out of your system in your urine. But since insulin therapy turns those calories into energy for your body's cells, all those lost calories are now being absorbed - which leads to weight gain.

To prevent weight gain, follow a meal plan that has only the necessary amount of calories that your body needs to function, and start an exercise program. By combining these steps with your insulin therapy, you should begin to lose any weight that you gained.

If the weight is not coming off as fast as you would like, you may have to make some other changes, which can include:

Developing a meal plan with the help of a dietitian.

Increasing your exercise level.

7. INSULIN CAN MAKE ME GO BLIND.
False. There is absolutely no evidence that insulin treatment causes blindness. In fact, it is almost the opposite that is true: if you do not control your diabetes, you can eventually lose your eyesight. The Diabetes Control and Complications Trial showed that proper treatment of diabetes with insulin reduced the risk of eye disease by as much as 76%.

Over a long period of time, high blood sugar levels can damage the small blood vessels of the retinas in your eyes. This condition, known as diabetic retinopathy, can cause loss of vision and eventually lead to total blindness as it progresses. (Note: if you already have retinopathy and you blood sugar levels are lowered too quickly, your vision can be affected. Be sure to talk to your doctor about this.)

Fortunately, diabetic retinopathy - which is the leading cause of blindness in the United States - is totally preventable if it is discovered early and treated quickly. Be sure to visit an eye doctor once a year to make sure you are okay.

8. I MIGHT GO INTO INSULIN SHOCK
Insulin shock is a term that was previously used to describe hypoglycemia (also called low blood sugar reactions, or insulin reactions). By testing your blood sugar and treating low blood sugar at the first sign of trouble, you can minimize the effects of hypoglycemic reactions and have more control over your diabetes.

9. PEOPLE WILL THINK I AM A DRUG ADDICT IF I CARRY A SYRINGE.
If you have told your friends, family, and co-workers about your diabetes, they will know you are injecting insulin and are not a drug addict. However, some uninformed people have been known to jump to the wrong conclusion when they see a person with diabetes injecting insulin.

If you are asked why you have a syringe, all you have to say is "I have diabetes and I have to inject insulin." If this person insists on asking questions or making comments that are pushy or tacky, try to end the conversation as quickly and politely as you can.

Fortunately, most people are aware of what insulin injection is, so you should not run into this problem. And if you would rather not tell anyone about your condition, try carrying your supplies in a zippered case and injecting in private.