Complete Guide with FAQs
Introduction
- Insulin is a hormone produced by the pancreas that regulates blood glucose levels by facilitating the uptake of glucose into cells.
- For individuals with diabetes, particularly type 1 diabetes and advanced type 2 diabetes, insulin therapy is essential to maintain blood sugar control and prevent complications.
- Modern insulin therapies are tailored to mimic natural insulin secretion, offering flexibility and precision in glucose management.
Types of Insulin
1. Rapid-Acting Insulin
- Examples: Aspart (Novolog), Lispro (Humalog), Glulisine (Apidra).
- Onset: 10–30 minutes.
- Peak: 30–90 minutes.
- Duration: 3–5 hours.
- Use: Taken before meals to control post-meal blood sugar spikes.
2. Short-Acting Insulin
- Examples: Regular insulin (Humulin R, Novolin R).
- Onset: 30–60 minutes.
- Peak: 2–4 hours.
- Duration: 5–8 hours.
- Use: Pre-meal dosing for glucose control.
3. Intermediate-Acting Insulin
- Examples: NPH insulin (Humulin N, Novolin N).
- Onset: 1–2 hours.
- Peak: 4–12 hours.
- Duration: 12–18 hours.
- Use: Covers insulin needs for about half a day or overnight.
4. Long-Acting Insulin
- Examples: Glargine (Lantus, Toujeo), Detemir (Levemir).
- Onset: 1–2 hours.
- Peak: Minimal or no peak.
- Duration: Up to 24 hours.
- Use: Provides basal insulin coverage throughout the day and night.
5. Ultra-Long-Acting Insulin
- Examples: Degludec (Tresiba).
- Onset: 1 hour.
- Peak: None.
- Duration: Over 42 hours.
- Use: Basal insulin with extended flexibility in dosing.
6. Premixed Insulin
- Examples: Humalog Mix 75/25, Novolog Mix 70/30.
- Components: Combination of intermediate-acting and rapid- or short-acting insulin.
- Use: Simplifies dosing for those who prefer fewer injections.
Indications for Insulin Therapy
- Type 1 diabetes: Essential for survival.
- Type 2 diabetes: Used when oral medications and lifestyle modifications fail.
- Gestational diabetes: For pregnant women with uncontrolled blood sugar.
- Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
- Temporary use in hospitalized patients or those with severe hyperglycemia.
How to Administer Insulin
Delivery Methods
- Syringes: Traditional method for insulin injections.
- Insulin Pens: Prefilled or refillable devices for ease of use.
- Insulin Pumps: Continuous subcutaneous insulin infusion with customizable basal and bolus doses.
- Inhalable Insulin: Rapid-acting insulin in powder form (e.g., Afrezza).
Injection Sites
- Abdomen, thighs, upper arms, and buttocks.
- Rotate sites to prevent lipodystrophy (fat deposits or breakdown).
Monitoring and Adjustments
- Regular blood glucose monitoring is essential.
- Adjust doses based on blood sugar levels, meal patterns, physical activity, and illness.
- Use of continuous glucose monitors (CGMs) can improve glucose control and reduce hypoglycemia.
Side Effects
Common Side Effects
- Hypoglycemia (low blood sugar).
- Weight gain.
- Injection site reactions, such as redness or swelling.
Rare but Serious Side Effects
- Severe hypoglycemia leading to confusion, seizures, or loss of consciousness.
- Allergic reactions to insulin or preservatives.
- Lipodystrophy from repeated injections at the same site.
Patient Counseling Points
- Take insulin as prescribed and never skip doses without consulting your doctor.
- Learn to recognize and manage hypoglycemia symptoms (e.g., shakiness, sweating, confusion).
- Keep a consistent eating schedule and match insulin doses to carbohydrate intake.
- Always carry a source of fast-acting glucose (e.g., glucose tablets, juice).
- Store insulin properly: unopened vials/pens in the refrigerator; opened ones can be kept at room temperature for a limited time (check manufacturer’s instructions).
Use in Children
- Insulin pumps are often preferred for children due to flexibility.
- Education for caregivers and school staff is critical to prevent and manage hypoglycemia.
Use in Pregnancy
- Insulin is the safest option for managing blood sugar during pregnancy.
- Long-acting insulins like detemir or glargine may be used under supervision.
Use in Elderly
- Simplified regimens are often preferred to reduce hypoglycemia risk.
- Regular monitoring of kidney function is necessary to adjust doses appropriately.
FAQs About Insulin
Q1: What is insulin, and why is it important?
- Insulin is a hormone that helps regulate blood sugar by allowing glucose to enter cells.
Q2: How does insulin therapy work?
- It replaces or supplements the body’s insulin to control blood sugar levels.
Q3: Can insulin cure diabetes?
- No, insulin manages diabetes but does not cure it.
Q4: What is the difference between rapid-acting and long-acting insulin?
- Rapid-acting insulin works quickly to control blood sugar after meals, while long-acting insulin provides steady coverage throughout the day.
Q5: How do I store insulin?
- Unopened insulin should be refrigerated. Opened insulin can usually be stored at room temperature for up to 28 days.
Q6: Can insulin cause weight gain?
- Yes, insulin can lead to weight gain, especially if calorie intake is not balanced.
Q7: How do I manage insulin-induced hypoglycemia?
- Treat with 15–20 grams of fast-acting carbohydrates like juice or glucose tablets.
Q8: Can insulin be taken orally?
- No, insulin is not effective when taken orally because it is broken down in the digestive system.
Q9: How often should I check my blood sugar on insulin?
- Frequency depends on the regimen but typically includes before meals, after meals, and at bedtime.
Q10: What is the role of insulin pumps?
- Insulin pumps provide continuous insulin delivery and greater flexibility in managing blood sugar.
Q11: Are there alternatives to insulin for type 2 diabetes?
- Yes, oral medications and non-insulin injectables, but insulin may be necessary as the disease progresses.
Q12: Can I exercise while on insulin?
- Yes, but monitor blood sugar closely as exercise can lower glucose levels.
Q13: Can insulin cause allergic reactions?
- Rarely, but reactions like swelling, redness, or rash at the injection site can occur.
Q14: What happens if I miss an insulin dose?
- Take it as soon as you remember unless it’s close to the next dose. Consult your doctor for advice.
Q15: Is insulin safe for long-term use?
- Yes, when used as prescribed, it effectively manages diabetes over the long term