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Insulin therapy is commonly known as a treatment for people who have diabetes. But do you know there are actually various types of insulin available? Also, while most diabetic patients inject insulin into their bodies, there are new insulin devices that don’t require injection at all!
Everyone has insulin in their body, because it’s an important hormone that plays a key role in the regulation of blood sugar/glucose levels. Produced by the pancreas, insulin is a crucial player in our body’s metabolism – it allows the cells in the muscles, fat and liver to absorb glucose that is in the blood (usually comes from the food we ingest). The glucose serves as energy to these cells, or it can be converted into fat when needed. Insulin also affects breakdown of fat or protein.
Insulin. Image credit: Theislikerice, CC BY-SA 4.0 , via Wikimedia Commons
If everyone has insulin in their body, then why would some people require insulin therapy, i.e. injecting insulin into their body?
Well, a medical condition called diabetes, as you’ve probably known it, causes people to suffer from a lack of insulin (called Type 1 diabetes, usually developed in children or teenagers) or inability to use their insulin properly (called Type 2 diabetes, usually developed in adults). As a result, people with diabetes cannot process the glucose in their body.
Many diabetic patients do not show symptoms, at least at the beginning of their disease. However, as time goes by, they may suffer from a wide range of symptoms, such as:
Urinate (pee) a lot, often at night
Are very thirsty
Lose weight without trying
Are very hungry
Have blurry vision
Have numb or tingling hands or feet
Feel very tired
Have very dry skin
Have sores that heal slowly
Have more infections than usual
While most Type 1 diabetes patients require insulin therapy, not all patients with Type 2 diabetes would require one. If you have Type 2 diabetes, your doctor may ask you to start an insulin therapy if:
You start to show diabetes symptoms that we mentioned above
Your HbA1c reading is more than 10%, or your fasting blood glucose level is higher than 13.0 mmol/L
Your blood sugar level is still high despite controlling your diet or taking two types of oral medications for diabetes.
People who have diabetes rarely die from it, but usually they die or suffer from its complications, which can include kidney damage that requires dialysis, cardiovascular disease, amputation of legs and blindness. This is why insulin therapy is important, especially for diabetic patients who don’t respond well enough to diet changes or oral medications.
Besides, under the following circumstances, doctor may also put you on insulin therapy for a short period of time:
Acute illness or surgery
Clinically unstable due to compromised metabolism (such as diabetic ketoacidosis, hyperosmolar hyperglycemic state)
People with type 1 diabetes and a proportion of people with type 2 diabetes will need to take exogenous insulin (insulin that is not produced by one’s own body). These exogenous insulin that makes up the insulin therapy are synthetically made in laboratories. Patients inject these insulin into body parts with higher fat content, usually the abdomen area. Such injection is known as subcutaneous injection, or commonly known as ‘sub-cut’.
Watch this video on how to inject insulin.
Fun fact:Insulins are produced using a cool technology known as recombinant DNA technology. The scientists insert a human gene that is responsible for producing insulin into the bacteria, of which the bacteria are cultured and “forced” to manufacture insulin like mini factories.
The insulin currently used in this country is human insulin or insulin analogue. Human insulin was developed through the 1960s and 1970s and approved for pharmaceutical use in 1982. On the other hand, insulin analogue is an improved version of the human insulin – the manufacturing process goes further through changing the order of amino acids. As a result, insulin analogue acts faster or more uniformly than the human insulin in the body, which leads to lesser hypoglycemia episodes and more predictable action, similar to the natural insulin we produce in the body. The downside is that insulin analogues are generally more expensive than human insulin.
Both types of insulin are further divided into prandial, basal and premixed.
Prandial means relating to the eating of food, hence prandial insulin is the insulin administered before eating food. This type of insulin has a short but quick onset of action, and it is especially good at lowering blood glucose level after eating. Prandial insulin is usually administered three times daily (before breakfast, before lunch and before dinner).
Examples of prandial insulin are:
Regular insulin (a type of human insulin)
Actrapid®, Insugen-R® (Administer 30 minutes before meal)
Aspart (a type of insulin analogue)
Novorapid® (Administer 5-15 min before or immediately after meals)
Lispro (a type of insulin analogue)
Humalog® (Administer 5-15 min before or immediately after meals)
Glulisine (a type of insulin analogue)
Apidra® (Administer 5-15 min before or immediately after meals)
Basal insulin, on the other hand, acts slower but longer than prandial insulin. It is used to reduce blood glucose level between meals and throughout the night. Examples of basal insulin are:
NPH/ isophane insulin (an intermediate-acting type of human insulin)
Insulatard®, Insugen-N® (Administer before breakfast or before bed)
Glargine U100 (a type of long-acting insulin analogue)
Lantus®, Basalog® (Administer same time everyday)
Glargine U300 (a type of long-acting insulin analogue)
Toujeo® (Administer once daily at any time of the day, preferably at the same time within 3 hrs before/after usual time.) Note: Glargine U300 and Glargine U100 works similarly, except Glargine U300 leads to less hypoglycemia episode at night (known as nocturnal hypoglycemia)
Detemir (a type of long-acting insulin analogue)
Levemir® (Administer same time everyday)
Degludec (a type of long-acting insulin analogue)
Tresiba® (Flexible once daily injection (maximum interval up to 40 hrs)
Premixed insulin combines both short or rapid-acting insulin (which also is prandial insulin) with intermediate-acting insulin into a single preparation to cover for blood glucose level rise after eating as well as throughout the day. This type of insulin is biphasic, meaning they come as two separate layers, hence it is important to shake the insulin up and down for a few times before using. Examples of premixed insulin are:
Mixtard 30® and Insugen 30/70® - 30% soluble insulin + 70% isophane insulin (Administer 30 - 60 minutes before meal)
Novomix 30® - 30% aspart + 70% protamine aspart
Humalog mix 25/75® - 25% lispro + 75% protamine lispro
Humalog mix 50/50® - 50% lispro + 50% protamine lispro
Co-formulated insulin, on the other hand, combines both short or rapid-acting insulin (which also is prandial insulin) with long-acting insulin. Example of co-formulation is IDegAsp 30 (Ryzodeg®)
There are various ways the doctor can incorporate the different types of insulins into a regimen for diabetes patients. Nonetheless, the most common type of insulin therapy regimen is known as the basal-bolus regimen, which requires 4 injections per day, i.e. once-daily basal insulin injection (usually before bed), and three-times daily prandial insulin injections before meals.
Insulin therapy, if done properly, is safe and effective. However, patients who are on insulin therapy can experience a common side effect, known as hypoglycemia. Hypoglycemia happens when the blood sugar level drops too low. It can result in symptoms such as:
In rare but severe cases, hypoglycemia can lead to seizures, coma or even death. Nevertheless, hypoglycemia should not be the reason for you not to adopt insulin therapy, as it can be easily managed.
Whenever you think you are experiencing hypoglycemia, do the following:
Take 15g of simple carbohydrate/sugar. That’s about 1 tablespoon of honey, 150-200 ml of fruit juice such as orange juice or regular soft drink or 3 tablespoons of table sugar dissolved in water. Carrying sweets or drinking hot milo helps too!
Measure your blood glucose level after 15 minutes.
If the reading shows less than 3.9 mmol/L, take another 15g of simple carbohydrate.
Once you feel better, you may have your usual meal or snack that is due at that time of the day.
If the diabetic patient who suffers from hypoglycemia starts to show altered mental state or confusion, do visit the hospital immediately for further treatment.
If you always experience hypoglycemia despite eating normally and having normal amount of physical activity, consult your doctor.
Patients whose diabetes are not well-controlled despite the usual insulin injection therapy can be put on an insulin pump instead. Insulin pumps do not require injection; instead, it uses a small electronic device that is worn externally to deliver precise doses of rapid-acting insulin to closely match patients’ insulin needs. The cannula (a short metal needle) is inserted beneath the skin to deliver the insulin.
Insulin pump allows for greater flexibility and reduces risk of hypoglycemia. Nevertheless, an insulin pump may have a significantly higher cost, and it needs to be attached to the body all the time.
If you have any questions related to diabetes, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Ministry of Health Malaysia - CPG Management of T2DM 2020
Cover image credit: https://www.diabetes.co.uk/insulin/diabetes-and-injecting-insulin.html
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