What is Insulin?

Insulin is a hormone that is produced from the pancreas, a gland in the stomach. When we eat, glucose is absorbed from the stomach and enters in the blood. The glucose must enter into the cells to make energy and Insulin helps glucose to enter the cells. In people with type 1 Diabetes, pancreas does not produce Insulin and in type 2 Diabetes Insulin does not work efficiently as it normally should and also the amount of Insulin comes out of the pancreas is less.

How do we get Insulin?

Once upon a time, we used to get Insulin from slaughterhouse, i.e., from pancreas of dead animals. Now we are preparing Insulin in the laboratory by sophisticated technologies (DNA recombinant) and no way they are connected to animals or human. The names are animal or human because by structure they are same as of beef (bovine), pork (porcine) and man (human) Insulin. So the chance of contaminating any infectious disease by Insulin does not arise.

Who with Diabetes needs Insulin?

In type 1 Diabetes Insulin is a must for living. In type 2 Diabetes we advice Insulin in certain situations like pregnancy, during and after surgery, severe infection and for some reason or other when you are not able to eat. Obviously, when tablets do not work, you need Insulin for better Diabetes control.

Is Insulin better than tablet for people with type 2 Diabetes?

Now, this is a very interesting question. There are several advantages of Insulin. Insulin is the most natural thing that you can have. In that way tablets are not natural. Recent research indicates that Insulin from the beginning or at least for some time at the beginning not only helps in controlling Diabetes better but also maintain pancreatic function in the long run. Only problem is that till today we need to take Insulin only by injection.

Obviously a time would come in type 2 diabetes when tablets will not work, and you need to take Insulin.

What are the different types of Insulin?

The idea of giving insulin is to mimic the normal insulin secretion by the body. Normally there is a certain amount of insulin secreted to meet the glucose produced by the liver and this is called as basal insulin in addition to insulin which is being released to meet the requirements during each meal and this is called as prandial insulin.

Name	Onset of action	Peak effect	Duration of action
Short acting	30mins	4 hrs	6hrs
Intermediate acting	90mins	4-12hrs	16-20hrs
Short acting Analoges	15mins	30-90mins	3-5 hrs
Long acting analoges	Peak less and works for approx 24 hrs
Premix insulin	Various combinations of 30% short and 70% long acting, 25% short and 75% long acting, 50% short and 50% long acting

How many times a day I need to take Insulin?

This depends on the Insulin regimen your doctor advices; there are several regimens we use. The best regimen is to use three short acting insulin before main meals and a longer acting insulin at bedtime to take you through the night. The problem of this regimen is you need to take four injections a day. We have now insulin available in a mixed form which can be injected two times a day, before breakfast and dinner. If you are on a combination of Insulin and tablet, you can manage with one injection a day. In that case the best time to take Insulin is before dinner, not before breakfast. Recently, we have a longer acting insulin is available which works for 24 hours.

I have type 2 Diabetes; do I need to take Insulin always once I have started?

There is absolutely no reason to think like this. As we have told above, Insulin can improve pancreatic function and if the control is very good with a relatively small dose of Insulin, you can stop and start tablets to see the effects. If not successful, we can always restart Insulin. This, at least, will convince you that your body needs Insulin.

Can I take tablets along with Insulin?

Yes, tablets can be taken with Insulin. With combination treatment the dose of Insulin can be less and so is the cost. Also, with a combination the number of Insulin injection may be less, i.e., you might manage with one injection a day – usually a basal insulin. This combination is very well practiced all over the world. This is called the BIDS (Bedtime Insulin Daytime Sulfonyluria) regimen

What should be the correct dose Insulin?

There is no correct dose of Insulin; the dose depends on what your body needs. We should aim for good control, whatever the dose of Insulin you require, no point in half-hearted treatment.

Can I adjust my Insulin dose?

Absolutely, yes. Our idea is to make you comfortable with the adjustment. You know your body best, so you can adjust. It is advisable to go slow, say by 2 to 3 units at a time rather than by changing the dose too quickly.

What is the best time to take injection?

The best time to take ordinary Insulin is 30 minute before food, in that way the level of Insulin and sugar in blood after food match well. But in case you have eaten already, it is better to take the injection immediately after rather than not taking. There is a new but costly Insulin available (Aspart, Lispro), which can be injected immediately before food, i.e., you do not need a gap as it works faster than ordinary Insulin.

Where should I take injection?

You can take Insulin in outer sides of arms and thighs or in the tummy. Injection in the tummy probably is the best one as the area is big, injections are less painful and you can see very easily where you are injecting. The needle we use is very small and it can never go inside the tummy, the injection will always be in the front wall. Many people are worried that they will inject in the intestine or big blood pipes inside!

How can I go to doctor or nurse for injection everyday?

You shouldn’t, you need to inject yourself. It is our duty to teach you how to inject Insulin. There is always a fear initially, but everybody manages well once they learn. Insulin injection is less painful when you inject yourself rather than a doctor or nurse injecting.

Are there any side effects of Insulin?

Insulin is a natural hormone, so side effect is not expected. Sometime we do see skin allergy with animal Insulin, but this is rare. There is a chance of little gain in weight, most of the cases that is due to better control (you loose weight when sugar is uncontrolled and you gain your lost weight back when your control improves). Low sugar (Hypo) can occur and that is mainly due to mismatch or miscalculation of diet and Insulin.

What is the difference between U-40 and U-100 Insulin?

This is the concentration of Insulin; U-40 means there are 40 units of Insulin in one ml of the solution and in U-100 100 units. Unfortunately both concentrations are available in India but steps are being taken for only U-100 to be available in future. You must make sure your syringe is of the same type, i.e., 40 or 100 capacity, otherwise you will be injecting totally different amount of Insulin and that can be dangerous. For example, if you draw U-100 Insulin with a U-40 syringe, you will be taking two and a half times more Insulin than you are intended to (if you are planning for 20 units you will be taking 50 units).

Can I not take Insulin without injection?

We all are waiting for the day when Insulin can be given without injection. It is encouraging that plenty of research is on the pipeline to find out an Insulin delivery system without injection. But for now we need to inject Insulin.

Which Insulin is better, animal or human?

Two types of animal Insulin are available, one is bovine and the other is porcine. They have slight structural difference with human Insulin. So far the efficacy is concerned, there is little difference. Allergy to human Insulin is very rare but can happen with animal Insulin.

The main reason for using animal Insulin was the cost, now that the cost of human Insulin has dropped, we rarely use animal Insulin.

What is the advantage of Insulin Pen?

Pen Insulin is very convenient to carry and very helpful for working class people. Insulin is the same but the delivery system is different. It is little costlier than conventional Insulin.

What happens if I miss an injection?

Do not panic, if you have done so. You are not the first person. Try not to forget, it alters your control very much. If you have an access to check sugar either in lab or by pricking your finger, please do so that you know where do you stand and take appropriate step.

Are there any other new medications available for Diabetes?

The search for a new medicine for Diabetes is a never ending process. A new medicine is available which belongs to the incretin family. Incretins are a type of gastrointestinal hormone that cause an increase in the amount of insulin released from the beta cells of the islets of Langerhans after eating, even before blood glucose levels become elevated. They also slow the rate of absorption of nutrients into the blood stream by reducing gastric emptying and may directly reduce food intake. As expected, they also inhibit glucagon release from the alpha cells of the Islets of Langerhans medicines is called as GLP1 analogue. The advantage is that it is weight neutral, but it has to be taken in the form of an injection