Sunday, April 17, 2016

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 based on several factors, including the following:

· How long you have had diabetes

· How high your 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 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 , beta cells make the insulin. With each meal, beta cells release insulin to help the body use or store the it gets from food.

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

People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with 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 in food. It must be injected into the under your skin for it to get into your blood. In some rare cases insulin can lead to an allergic reaction at the site. Talk to your doctor if you believe you may be experiencing a reaction.

Types of 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 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

· 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)

· 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 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 more painful. To avoid this, many providers suggest storing the bottle of insulin you are using at room temperature. 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 .

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.

Tight Diabetes Control

Keeping your levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many of diabetes, giving you extra years of healthy, active life.

But tight control is not for everyone and it involves hard work.

What Does Tight Control Mean?

Tight control means getting as close to a normal (nondiabetic) as you safely can. Ideally, this means levels between 70 and 130 before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin () level less than 7 percent. The target number for glycated hemoglobin will vary depending on the type of test your doctor's laboratory uses.

In real life, you should set your goals with your doctor. Keeping a normal level all the time is not practical. And it's not needed to get results. Every bit you lower your blood glucose level helps to prevent complications.

How Does It Help?

No one knows why high glucose levels cause complications in people with diabetes. But keeping glucose levels as low as possible prevents or slows some complications.

For the Diabetes Control and Complications Trial (DCCT), researchers followed 1,441 people with for several years. Half of the people continued standard diabetes treatment while the other half followed an intensive-control program. Those on intensive control kept their blood glucose levels lower than those on standard treatment, although the average level was still above normal.

The results? Here's what they found in the tight-control group as compared with the standard-treatment group:

· Diabetic eye disease started in only one-quarter as many people.

· Kidney disease started in only half as many people.

· Nerve disease started in only one-third as many people.

· Far fewer people who already had early forms of these three complications got worse.

Living With Tight Control

To get tight control, you must do the following:

· Pay more attention to your diet and exercise.

· Measure your blood glucose levels more often.

· If you take , change how much you use and your schedule.

Getting Intense With Insulin

In , you provide yourself with a low level of insulin at all times and take extra insulin when you eat. This pattern mimics the release of insulin from the normal .

There are two ways to get more natural levels of insulin: multiple daily injection therapy and an . Both are good methods. Your choice should depend on which best fits your lifestyle.

In multiple daily injection therapy, you take three or more insulin shots per day. Usually, you take a shot of short-acting or before each meal and a shot of intermediate- or at bedtime.

With an insulin pump, you wear a tiny pump that releases insulin into your body through a plastic tube. Usually, it gives you a constant small dose of Regular insulin. You also have the pump release extra insulin when you need it, such as before a meal.

With either method, you must test your blood glucose levels several times a day. You need to test before each shot or extra dose of insulin to know how many units to take and how long before eating to take it. Also, you may want to test 2-3 hours after eating to make sure you took enough insulin. You must adjust your insulin dose for how much you plan to eat and how active you expect to be.

Getting Started

You do not need to figure these things out on your own. Whatever method you choose, your health care team (your doctor, , , and other health care professionals) should spend a lot of time teaching you about it. Your team will help you make guidelines for how much insulin to take and when.

You will also come up with guidelines for eating and exercising. These guidelines may change several times as you test them out.

You shouldn't try tight control on your own. A good health care team is a must. Choose a doctor who understands diabetes well or is willing to learn for your sake. Your doctor should have ties with other health professionals you need, such as dietitians and a mental health worker.

If you live in a small town, look at your options carefully. You may be better off driving to a city to see a specialist.

Keeping It Going

Starting a program of tight control is exciting. But it can also be overwhelming. How do you keep from running out of energy?

Here are some tips:

· Start slowly.
For example, you might start by checking your blood glucose more times each day. Get used to that first. Then start multiple daily injections. Once you're used to those, add your new exercise program and make the changes in your diet.

· Be honest.
If you are newly diagnosed with diabetes, look honestly at yourself. Are you still angry and depressed that you have diabetes? If so, you already have a big challenge facing you. You may want to wait to try tight control until after you've come to terms with the changes in your life.

· Keep your goals realistic.
No matter how hard you try, your blood glucose readings will not be perfect every time. If they are often too high or too low, you should talk to your doctor about whether your plan needs to be adjusted. But if "wrong" levels happen only sometimes, that's life. With practice, you will become more skilled at choosing the right insulin doses for various situations.

· Take a break.
If you need to, take a breather from the new routine. Having some time off may make it easier to stick to your plan when you start again.

Pluses and Minuses

One big reason to try tight control is to prevent complications later. But tight control has effects you can enjoy right now:

· You will probably feel better and have more energy.

· You can vary your activities more.

· You're not locked into having your meals at the same time each day.

· It can reduce the risk of birth defects.

But the DCCT found two major problems with tight control:

· Hypoglycemia
People on tight control had three times as many low blood glucose reactions (hypoglycemia). You will need to be alert to the symptoms of so that you can treat yourself quickly. Also, you should always check your blood glucose levels before you drive. If you often have low blood glucose reactions when you try tight control, talk to your doctor. You may need to ease up on your goals or go back on standard therapy for a while.

· Weight Gain
People on tight control gained more weight than people on standard insulin treatment. The average in the DCCT was 10 pounds. If you are concerned about putting on pounds, work with your dietitian and doctor to devise a meal and exercise plan to prevent it.

You should also consider the cost:

· You will need to see your health care team more often.

· Pumps cost thousands, and pump supplies run $60 to $80 a month

· Multiple injection therapy is much cheaper, but you will still use more supplies, like test strips and syringes, than before.

What About Type 2 Diabetes?

The DCCT studied only people with type 1 diabetes. But doctors believe that tight control can also prevent complications in people with .

Most people with type 2 diabetes do not take insulin. You may be wondering how you can achieve tight control without it.

One way is to lose weight. Shedding excess pounds may bring your glucose levels down to normal. The key to losing weight and keeping it off is changing your behavior so that you eat less and exercise more. Your doctor should work with you to find an eating and exercise plan you can stick to.

Even if you don't need to lose weight, exercise is helpful in controlling your blood glucose levels. It makes your cells take glucose out of the blood.

You will need to check your blood glucose regularly. You should decide with your doctor how often. Once a day or even once a week may be enough for some people with type 2 diabetes.

If exercise and good eating habits are not enough to keep your glucose under control, you doctor may prescribe pills. And if these don't work, you may need to take insulin. People with type 2 diabetes should talk to their doctors before starting tight control.

Tight Control Is Not for Everyone

Tight control is not safe for everyone with diabetes.

Children should not be put on a program of tight control. Having enough glucose in the blood is vital to brain development. Some doctors say that tight control should wait until a child reaches 13; others say after the age of 7 is okay.

Elderly people probably should not go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.

Some people who already have complications should not be on tight control. For example, people with end-stage kidney disease or severe vision loss probably should not try it. Their complications are probably too far along to be helped. Some people who have coronary disease or disease should not try tight control.

People who have probably should not go on tight control

Hyperglycemia

Hyperglycemia (High Blood Glucose)

Hyperglycemia is the technical term for high blood (blood ). High happens when the body has too little insulin or when the body can't use properly.

What Causes Hyperglycemia?

A number of things can cause :

· If you have type 1, you may not have given yourself enough insulin.

· If you have type 2, your body may have enough insulin, but it is not as effective as it should be.

· You ate more than planned or exercised less than planned.

· You have stress from an illness, such as a cold or flu.

· You have other stress, such as family conflicts or school or dating problems.

· You may have experienced the (a surge of hormones that the body produces daily around 4:00 a.m. to 5:00 a.m.).

What are the Symptoms of Hyperglycemia?

The signs and symptoms include the following:

· High blood glucose

· High levels of sugar in the

· Frequent urination

· Increased thirst

Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid problems associated with hyperglycemia.

How Do I Treat Hyperglycemia?

You can often lower your by exercising. However, if your blood glucose is above 240 , check your urine for ketones. If you have ketones, do not exercise.

Exercising when ketones are present may make your blood glucose level go even higher. You'll need to work with your doctor to find the safest way for you to lower your blood glucose level.

Cutting down on the amount of food you eat might also help. Work with your to make changes in your meal plan. If exercise and changes in your diet don't work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it.

What if it Goes Untreated?

Hyperglycemia can be a serious problem if you don't treat it, so it's important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic ) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy.

When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood, which can lead to ketoacidosis.

Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:

· Shortness of breath

· Breath that smells fruity

· Nausea and vomiting

· Very dry mouth

Talk to your doctor about how to handle this condition.

Medical IDs

Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.

In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves.

Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency.

How Can I Prevent Hyperglycemia?

Your best bet is to practice good diabetes management and learn to detect hyperglycemia so you can treat it early — before it gets worse.

Hypoglycemia

Hypoglycemia (Low Blood Glucose)

Hypoglycemia is a condition characterized by abnormally low blood (blood ) levels, usually less than 70 . However, it is important to talk to your health care provider about your individual targets, and what level is too low for you.

Hypoglycemia may also be referred to as an , or shock.

Hypoglycemic symptoms are important clues that you have low blood glucose. Each person's reaction to is different, so it's important that you learn your own signs and symptoms when your blood glucose is low.

The only sure way to know whether you are experiencing hypoglycemia is to check your blood glucose, if possible. If you are experiencing symptoms and you are unable to check your blood glucose for any reason, treat the hypoglycemia. Severe hypoglycemia has the potential to cause accidents, injuries, , and death.

Signs and Symptoms of Hypoglycemia (happen quickly)

· Shakiness

· Nervousness or anxiety

· Sweating, chills and clamminess

· Irritability or impatience

· Confusion, including delirium

· Rapid/fast heartbeat

· Lightheadedness or dizziness

· Hunger and nausea

· Sleepiness

· Blurred/impaired vision

· Tingling or numbness in the lips or tongue

· Headaches

· Weakness or fatigue

· Anger, stubbornness, or sadness

· Lack of coordination

· Nightmares or crying out during sleep

· Seizures

· Unconsciousness

Treatment

Consume 15-20 grams of glucose or simple carbohydrates
Recheck your blood glucose after 15 minutes
If hypoglycemia continues, repeat.
Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away.

15 grams of simple carbohydrates commonly used:

· glucose tablets (follow package instructions)

· gel tube (follow package instructions)

· 2 tablespoons of raisins

· 4 ounces (1/2 cup) of juice or regular soda (not diet)

· 1 tablespoon sugar, honey, or corn syrup

· 8 ounces of nonfat or 1% milk

· hard candies, jellybeans, or gumdrops (see package to determine how many to consume)

Glucagon

If left untreated, hypoglycemia may lead to a seizure or unconsciousness (passing out, a coma). In this case, someone else must take over.

Glucagon is a that stimulates your to release stored glucose into your bloodstream when your blood glucose levels are too low. Injectable glucagon kits are used as a medication to treat someone with diabetes that has become unconscious from a severe insulin reaction. kits are available by prescription. Speak with your health care provider about whether you should buy one, and how and when to use it.

The people you are in frequent contact with (for example, family members, significant others, and coworkers) should also be instructed on how to administer glucagon to treat severe hypoglycemic events. Have them call 911 if they feel they can't handle the situation (for example, if the hypoglycemic person passes out, does not regain consciousness, or has a seizure, if the care taker does not know how to inject glucagon, or if glucagon is not available).

If glucagon is needed:

Inject glucagon into the individual's buttock, arm or thigh, following the manufacturer's instructions.
When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
If you have needed glucagon, let your health care provider know, so they can discuss ways to prevent severe hypoglycemia in the future.

Do not:

· Inject insulin (will lower blood glucose even more)

· Provide food or fluids (individual can choke)

· Put hands in mouth (individual can choke)

Hypoglycemia Unawareness

Very often, hypoglycemia symptoms occur when blood glucose levels fall below 70 mg/dl. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness. People with are also less likely to be awakened from sleep when hypoglycemia occurs at night.

Hypoglycemia unawareness occurs more frequently in those who:

· frequently have low blood glucose episodes (which can cause you to stop sensing the early warning signs of hypoglycemia)

· have had diabetes for a long time

· tightly control their diabetes (which increases your chances of having low blood glucose reactions)

If you think you have hypoglycemia unawareness, speak with your health care provider. Your health care provider may adjust/raise your blood glucose targets to avoid further hypoglycemia and risk of future episodes.