Insulin is a hormone secreted by pancreas. It helps in the transport of glucose from blood to the cells, so that glucose can be used for energy production. So, insulin is the best treatment for diabetes. But the problem is that it cannot be given as a tablet because the enzymes present in our stomach break it down. So, it will not be effective. It has to be injected.

 

Who requires insulin treatment?

1. Type 1 diabetic individuals require insulin for controlling their blood sugar since the onset of diabetes ( because they are insulin deficient).
2. In type 2 diabetic patients as well insulin may be required in following situations-
   1. Later stages ( due to loss of beta cells from pancreas and thus insulin deficiency)
   2. During surgery, hospitalized condition or illness.

 

Other factors that decide whether you require insulin or tablets are-

1. Duration of your diabetes ( Longer duration leads to more chances of requiring insulin)
2. Severity of blood sugar rise ( Higher sugars may require insuin for faster control)
3. Other medicines that you are taking
4. Other diseases and your overall health

 

What are the different types of Insulin?

There are different types of insulins depending on their onset of action ( i.e. how quickly they start their action), time to peak levels and their duration of action ( for how long they act).

 

1. Short acting insulin (Regular insulin)– It starts its action in 30 minutes, peaks at about 2 hours and its duration of action is 4-6 hours. Example- Huminsulin (R), Human actrapid, Humalog (lispro), novorapid (aspart), apidra (glulisine).
2. Intermediate acting insulin– It starts its action in 2 hours, peaks at about 6 hours and duration of action is 12-16 hours. Example- NPH insulin.
3. Long acting insulin– Its onset of action is at about 4 hours, its is a peakless insulin and acts for 24 hours. Example- levemir (detemir), lantus (glargine).

 

What are the different methods of insulin delivery?

 

Insulin can be delivered by following methods-

1. Syringe and vial –

You have to draw the insulin from vial each time with a syringe and needle before injecting.

 

2. Insulin pen–

We have both temporary ( A pen where cartridge is pre-filled and pen is discarded after use) and permanent pens     ( a pen where cartridge can be changed after use). Insulin dose has to be dialed on the pen and insulin is injected through the needle. Different types of insulin requires different pens. Also it is important to use both pen and insulin of the same company (otherwise there may be disparity of dose).

 

3. Insulin pump-

They deliver insulin over 24 hours through a catheter placed under the skin.

 

Basic principles of Insulin injection-

 

1. Sites of injection–

Insulin can be injected on many sites-

1. Abdomen- Best site to inject insulin. Fastest action is seen after injection into the abdomen.
2. Upper arms- Slower absorption than abdomen. Also you will need someone to assist while injection on upper arm.
3. Thighs and buttocks- Slowest absorption

 

2. Site rotation-

1. It is important to keep rotating insulin injection site. Do not inject insulin exactly at the same place.
2. Fix up a general area for each insulin injection. For example- give pre-breakfast insulin in the abdomen always, pre-lunch in the thigh and pre-dinner in upper arm. This will give more consistent results.

 

3. Timing–

Timing of injection will depend on the type of insulin you are taking- example short acting insulin will be taken about 20-30 minutes before meals and intermediate and long acting insulins will be taken at a fixed time daily irrespective of meal timing.

 

4. Checking your blood sugar–

In general, a patient who is on insulin for sugar control should monitor his blood sugar more frequently. But you should do it as suggested by your doctor.

 

5. Storage-
   

1. Insulin should be stored in the refrigerator ( in the door). Do not freeze it.
2. The current vial that you are using can be kept at room temperature (during winters) for 1 month.
3. Take it out at least 15 minutes before injection because injecting cold insulin can be painful.
4. Do not expose insulin to direct sunlight.
5. Do not use insulin beyond expiry date.

 

6. Changing the needle/ syringe

1. You can use a needle 4-6 times.
2. Always keep the needles capped when not in use
3. Do not touch the needle to anything else other than clean skin and top of insulin bottle.
4. Do not let anyone use your needle.
5. Do not use a needle used by anybody else.
6. Do not clean the needle with alcohol or spirit. This will remove the coating over needle that helps it to slide into the skin easily.
7. Do not re-use same syringe / needle if you have open wounds or getting frequent infections
8. Dispose off the needle / syringe if it is bent/ dull or has come in contact with anything other than clean skin.
9. To avoid re-use of the needle, destroy it (if you can do that safely) or you can put them in an opaque (not clear) plastic bottle or metal box that closes firmly and then dispose off.

 

7. Check insulin vial before injecting

1. Check for any particles or change of colour.
2. For NPH insulin- check for frosting or crystals inside the bottle.

 

Do not use insulin if any of the above is there.

 

Consult your doctor/ diabetic educator for more information.