Insulin

People with type 1 diabetes must use insulin.

Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise. However, your doctor may need to also prescribe oral medications (pills) and/or insulin to help you meet your target blood glucose levels.

INSULIN

Insulin is a naturally occurring hormone secreted by the pancreas. Many people with diabetes are prescribed insulin, either because their bodies do not produce insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes).

There are more than 20 types of insulin sold. These insulins differ in how they are made, how they work in the body, and how much they cost. Your doctor will help you find the right type of insulin for your health needs and your lifestyle.

Although it is a common practice to try pills before insulin, you may start on insulin based on several factors, including the following:

·         How long you have had diabetes

·         How high your blood glucose level is

·         What other medicines you take

·         Your overall health

Combination Therapy

Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better.

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.

Types of Insulin

·         Rapid-acting insulin, begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog)

·         Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours. Types: Humulin R, Novolin R

·         Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH (Humulin N, Novolin N)

·         Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine (Lantus)

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination.

In 2015 an inhaled insulin product, Afrezza, became available in the U.S. Afrezza is a rapid-acting inhaled insulin that is administered at the beginning of each meal and can be used by adults with type 1 or type 2 diabetes. Afrezza is not a substitute for long-acting insulin. Afrezza must be used in combination with injectable long-acting insulin in patients with type 1 diabetes and in type 2 patients who use long-acting insulin.

·         Inhaled insulin begins working within 12 to 15 minutes, peaks by 30 minutes, and is out of your system in 180 minutes. Types: Technosphere insulin-inhalation system (Afrezza)

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.

Your area may have rules for getting rid of medical waste such as used syringes. Ask your refuse company or city or county waste authority what method meets their rules. When traveling, bring your used syringes home. Pack them in a heavy-duty holder, such as a hard plastic pencil box, for transport.