Insulin is a hormone that is produced from the pancreas, a gland in the tummy. 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, the 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.
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).
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.
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 bolus/food-related 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 Analogue | 05mins | 30-90mins | 3-5 hrs |
| Long acting analogue | Peak less and works for approx 20 to 40 hrs | ||
| Premix insulin | Various combinations of 30% short and 70% long acting, 25% short and 75% long acting, 50% short and 50% long acting | ||
This depends on the Insulin regimen your doctor advices; there are several regimens we use (see picture). The best regimen is to use three short acting insulin before main meals and 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.
Normally Insulin is secreted continuously – one is called Basal Insulin (or baseline) and the other is Bolus Insulin (or prandial, meal-related), it increases when we eat. When we use Insulin in people with Diabetes we try to use this knowledge.
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 and your doctor that your body needs 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.
The best time to take human Insulin is 20 to 30 minute before food, in that way the level of Insulin and sugar in the 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 are new Insulin’s available (Aspart, Lispro), which can be injected immediately before food, i.e., you do not need a gap as it works faster than human Insulin.
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!
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 lose 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.
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 access to check sugar either in the lab or by pricking your finger, please do so that you know where do you stand and take the appropriate step.
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