What Is Different About Insulin Lispro
Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner. Insulin lispro helps keep your blood sugar level from going too high after you eat. To keep your blood sugar level steady, your doctor will probably prescribe either a longer-acting insulin or another drug for you to take each day in addition to the insulin lispro.
If you need to mix insulin lispro with a longer-acting insulin, its best that you mix insulin lispro only with Humulin U or Humulin N, which are brand names for certain longer-acting insulins. Insulin lispro should always be drawn into the syringe first. This will keep the longer-acting insulin from getting into the insulin lispro bottle.
Types of insulin
Each type of insulin works at a different speed and lasts for a different length of time.
Quick-acting, such as insulin lispro , begins to work very quickly and lasts for 3 to 4 hours.
Short-acting, such as Regular insulin, starts working within 30 minutes and lasts about 5 to 8 hours.
Intermediate-acting, such as NPH or Lente insulin, starts working in 1 to 3 hours and lasts 16 to 24 hours.
Long-acting, such as Ultralente insulin, doesnt start to work for 4 to 6 hours, but lasts 24 to 28 hours.
NPH and Regular insulin mixture, two types of insulin mixed together in 1 bottle, starts working in 30 minutes and lasts 16 to 24 hours.
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Insulin For Type 2 Diabetes
If you have type 2 diabetes and your doctor thinks insulin can help you, it doesnt mean you now have type 1 diabetes. You still have type 2 diabetes, but youve changed treatment.
If you have type 2 diabetes, you may not need to use insulin straight away. But some people have very high blood sugar levels when they are first diagnosed. Insulin can be used as a short-term treatment to help quickly bring down your blood sugar levels.
Some people may need to take insulin for a particular reason, like during pregnancy or a severe illness, or after surgery. But you may also need to start it as a treatment if other medications havent helped managed your blood sugar levels or are not appropriate for you.
If you need insulin it isnt your fault and it doesnt mean you havent managed your diabetes well. Its simply another medication that can help to keep you as healthy as possible. Managing blood sugars effectively is really important in reducing your risk of future diabetes complications and insulin may be the most appropriate treatment choice for you. Many people with type 2 diabetes need to use it as treatment at some point.
Its still important to keep going to your appointments and manage your condition with healthy lifestyle choices. Staying active and eating a healthy diet will reduce the risk of complications from your diabetes.
If youre going on holiday:
Page last reviewed: 18 August 2020 Next review due: 18 August 2023
When To Introduce More Complex Insulin Regimens
In some patients, fasting blood glucose concentrations may be quite acceptable and yet HbA1c remains significantly elevated. In this situation, a second dose of insulin is needed, usually given in the morning before breakfast. A small starting dose of medium-acting insulin in the order of 6-12 units would be reasonable.
Other patients who are at the more insulin-deficient end of the type 2 diabetes spectrum may be better starting on a twice-daily insulin regimen. The insulin sparing effects of oral hypoglycaemic drugs would still be present in this situation.
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Insulin And Weight Gain
When first starting insulin therapy, many people complain that they are eating and exercising the same amount as before but gaining weight. This occurs because with insulin, the body is able to use glucose that was previously wasted in the urine. Glucose that is not needed right away for energy is stored as fat. Studies have shown that weight gain may lead people, particularly women, to not follow their prescribed insulin regimen. This is a dangerous practice that can lead to sustained high blood glucose and a higher risk of long-term complications. Weight gain with insulin therapy is not inevitable, but avoiding it or reversing it generally requires eating fewer calories and/or exercising more.
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Why You May Need To Take Insulin
What impacts your need for insulin differs from person-to-person, Dr. Levy says. So, its important to understand what places you at-risk for diabetes complications. The higher your risk, the more you may potentially need to include insulin in your treatment plan. These risk factors include:
But if you dont fall into one of these risk groups, there may be ways that you can avoid taking insulin with certain lifestyle modifications.
The Future Of Insulin
More insulin advances are percolating. There will be new insulins that act even faster. Improvements will be made in the open-loop pumps currently on the market, and efforts continue to develop the so-called artificial pancreas, or closed-loop system that promises, with several different models, to control blood sugar without the person having to do all the thinking.
Work also progresses on alternate ways to take insulin. The second generation of inhaled insulin is on the way with the FDAs approval of Afrezza in 2014. Investigation is ongoing for delivering insulin buccally via the tongue, throat, and cheeks or through a skin patch.
While the progress on new insulin products and delivery systems is encouraging, dont delay starting insulin if your health care provider and your diabetes health status indicate you need it now. The insulin available today is safe and relatively easy to take, and injections are nearly painless. Plus, starting to take insulin sooner rather than later may improve your health quickly and make your life better for many years to come.
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What To Do With The Oral Drugs
The patient is asked to remain on all the oral hypoglycaemic drugs that they are currently taking. The only exceptions are:
- if the patient is taking supra-maximal doses of any of the oral drugs, they are reduced to what is recommended in the product information
- if the patient is suffering from the gastrointestinal adverse effects of metformin, it is reduced to a dose which is tolerated
- if the patient is taking three oral hypoglycaemic drugs including acarbose, the acarbose is stopped as its adverse effects usually outweigh its advantage.
Although the oral drugs have ‘failed’ in the situation of ‘secondary failure’, they are still exerting considerable hypoglycaemic effects. Clinical studies have shown that if either the sulfonylurea or metformin are stopped altogether, then each needs to be replaced by an extra 20-30 units of daily insulin. In other words, the insulin dosage would need to exceed about 60 units a day before improvement in glycaemic control could occur. This would require a more aggressive insulin regimen and titration, making the process of starting insulin much more difficult. If a thiazolidinedione has been used, this could be continued initially at least, as it may also contribute an insulin sparing effect.
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Type 1 Vs Type 2 Diabetes: Whats The Difference
Type 2 diabetes is not the same as Type 1 diabetes. In Type 1 diabetes, your pancreas doesnt make any insulin. In Type 2, your pancreas doesnt make enough insulin, and the insulin it is making doesnt always work as it should. Both types are forms of diabetes mellitus, meaning they lead to hyperglycemia .
Type 2 diabetes usually affects older adults, though its becoming more common in children. Type 1 diabetes usually develops in children or young adults, but people of any age can get it.
Blood Sugar Tests Help You Understand Your Insulin Needs
To learn how well your current treatment plan is working, its important to test your blood sugar according to your doctors recommendations. For example, theyll likely advise you to use home testing equipment to monitor and log your blood sugar each day. Theyll also order A1C tests, which provide information about your average blood sugar levels over the past three months.
If you find it hard to manage your blood sugar levels using your current treatment plan, talk to your doctor. They might recommend changes to your insulin regimen or other prescribed treatments.
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How To Titrate Insulin Dosage And Monitor Progress
A major feature of this regimen is that insulin is added to existing treatment. Glycaemic control should therefore improve immediately and for practical purposes, should not deteriorate. This means that the dose of insulin can be increased relatively slowly, minimising the risk of hypoglycaemia. As described originally, the regimen2 increased the insulin dosage by 4 units a day if the fasting blood glucose exceeded 8 mmol/L on three consecutive days and by 2 units a day if it exceeded 6 mmol/L. We tend to do it slightly slower and adjust insulin dosage according to these glucose thresholds every 1-2 weeks. The slower pace helps to gain the patients confidence and reduces the risk of hypoglycaemia. This titration regimen is of course not cast in stone and there are ongoing trials that are exploring the best options.
After 2-3 months, the patient is likely to be on about 30 units of insulin each day and maximum oral drug therapy. Measuring the HbA1c concentration after this interval helps to quantify the new level of glycaemic control and further increases in insulin dosage can be made accordingly. There is generally a reduction in HbA1c of about 2% and an increase in body weight of several kilograms. If these changes are not evident, one should consider the possibility that the patient has not been taking the insulin regularly or someone unfamiliar with the regimen has reduced or stopped one or more of the oral hypoglycaemic drugs.
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Insulin Management Of Type 2 Diabetes Mellitus
ALLISON PETZNICK, DO, Northern Ohio Medical Specialists, Sandusky, Ohio
Am Fam Physician. 2011 Jul 15 84:183-190.
Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia.