How Are The Insulins Commonly Classified
Nowadays, the insulins available for use are generally classified based on their predicted onset and duration of action, as outlined below. The common classifications are: Long-acting analogue Analogues are insulins where the natural amino acid sequence has been modified to either promote faster or slower action than with natural insulin. Please note that the commercial brand names of the insulin products can vary internationally. Reasons for the variation in onset and duration of action of the same insulin class in different people will be explored during Weeks 3 and 4. Rapid acting analogue Insulins where the natural amino acid sequence has been modified to promote faster action than with natural insulin Should all be taken just before or with food Onset of action: Within 15 minutes Duration of action: 3-5 hours All times can vary from person to person Types of rapid acting analogue: Insulin aspart Insulin lispro Insulin glulisine Short acting or neutral Insulin either human or derived from animals Should all be taken 20-30 minutes before food Onset of action: Within 30 minutes Duration of action: 6-8 hours All times vary from person to person Types of short acting/neutral: Human insulin Human insulin Human insulin Derived from cows Derived from pigs Medium or intermediate and long-acting (IContinue reading > >
How Do You Choose The Right Syringe For Injecting Insulin
If your highest dose is near the syringe’s maximum capacity, consider buying the next size up in case your dosage increases
If you measure your doses in half units, be careful to choose an appropriate syringe that has the right measurements
When youre traveling, make sure to match your insulin strength with the correct size syringe if you purchase new syringes in an unfamiliar place
Just as there are different sizes of syringes for administering insulin, there are also varying sizes of insulin needles. Shorter needles usually mean less sting when injecting. The downside is that the shallower the injection is, the longer it takes for the insulin to work. Your doctor will help you find the balance thats best for you.
How Long Does Insulin Last
Insulin comes in vials, insulin pens, and in the case of Afrezza, which is an inhaled insulin, it is available in cartridges. These are some considerations to make sure you take care of your insulin appropriately:
- Insulin manufacturers recommend you keep your insulin in the refrigerator. Make sure you remove it from the refrigerator prior to using it. Injecting cold insulin may be painful.
- Once you open your insulin vial, discard it after 28 days.
- If you are using an insulin pen, read the pen insert for instructions. Most brands suggest 28 days.
- Afrezza inhaler must be replaced every 15 days from the day you start using it. Sealed blister cards and strips in use stored at room temperature must be used within 10 days. Opened strips stored at room temperature must be used in 3 days.
- Keep insulin away from extreme heat or cold
Calculating Insulin Dosage
Bolus or prandial insulin is administered before meals to reduce post-meals spikes. The amount of insulin is based on the following:
- Blood glucose value
- Physical activity
- How much insulin is already on board
- Other medications
- Insulin to carbohydrate ratio
Fast-acting insulins can also be used to lower blood glucose levels when there is hyperglycemia, or high blood sugar. If you have diabetes and your blood glucose is above 240mg/dl, you may be experiencing hyperglycemia.
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How Do I Take It
Many people get insulin into their blood using a needle and syringe, a cartridge system, or pre-filled pen systems.
The place on the body where you give yourself the shot may matter. You’ll absorb insulin the most evenly when you inject it into your belly. The next best places to inject it are your arms, thighs, and buttocks. Make it a habit to inject insulin at the same general area of your body, but change up the exact injection spot. This helps lessen scarring under the skin.
Inhaled insulin, insulin pumps, and a quick-acting insulin device are also available.
Who Could Be Prescribed One Type Of Insulin
Some people are prescribed just one kind of insulin a combination of a fast acting one and a slower acted one, mentioned above. This is known as mixed insulin.
Some people with type 2 or gestational diabetes may only be prescribed a slow acting as this may be enough to help manage their blood sugars in combination with other treatments.
And if you use an insulin pump rather than injecting insulin, youll only need to use fast acting insulin. Your pump will be set up to release small amounts of this insulin all the time and you tell the pump to give extra boluses when you need it.
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Principles Of Management Of T1dm
Management of T1D involves a multidisciplinary framework that includes the following:
Total amount of prandial insulin: 4+2= 6 units
Insulin Titration and Pattern Adjustments
Reviewing blood glucoses and recognizing patterns is one of the most important aspects of diabetes management, allowing for timely and appropriate adjustments in insulin dose, food intake, and managing physical activity. Pattern management is aided by valuable tools such as SMBG with information obtained through download software or logbooks and CGM data. These tools can be used in order of priority, for assessment of hypoglycemia, hyperglycemia, glycemic variability, frequency of SMBG readings, etc.
The Difference Between Fast
Posted on September 07, 2021 at 12PM
Just like any drug, insulin has its activity profile that is measured in three numbers which include onset, peak, and duration. These are also known as the characteristics of insulin and they help to know the differences between fast-acting insulin and slow-acting insulin.
Fast-acting insulin is used due to its fast peak. The insulin acts within a short time to reduce the level of sugar in the blood. Slow-acting insulin, on the other hand, is preferred for its long duration. Its effect in reducing the level of sugar in the blood lasts for several hours.
If you have insulin problems and it needs to be taken frequently, then you will need to go for slow-acting insulin.
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Indications Dosing And Administration
Insulin lispro is available only by prescription and is indicated for the management of hyperglycemia in patients with diabetes mellitus. Guidelines for glycemic control are listed in Table 4.20,21 Because of its more rapid onset and shorter duration of action, insulin lispro should always be part of a regimen that includes a longer-acting human insulin,5 except when continuous subcutaneous insulin infusion therapy is used.22
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Based on product information from Eli Lilly and Company, the dosage of insulin lispro should be individualized, with therapy initiated as outlined in Table 5. Patients who use insulin lispro should monitor their blood glucose levels frequently, especially their postprandial levels. The U.S. Food and Drug Administration has not approved insulin lispro for continuous subcutaneous infusion therapy, although this method has been used in clinical studies. Insulin lispro also is not approved for intravenous or intramuscular administration.
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
What Are The Drawbacks To Insulin Treatment For Diabetes
The biggest issue with insulin right now is lack of affordability. A box of rapid-acting insulin can cost $400 without insurance. As so many people continue to lose their health coverage, its becoming an enormous problem, Dr. Zilbermint says.
Consistently rising costs have led some patients to ration their insulin, which can be dangerous and even deadly. The cost of testing strips is also an issue, and both have led to a black market in testing strips and insulin. Its illegal, says Dr. Zilbermint, but its happening.
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Just Say No To The Sliding Scale
Rapid-acting insulins are also effective for use as a corrective measure, aka correction factor , to maintain optimal blood glucose targets for patients in hospital. This approach replaces the commonly used insulin sliding scale. Sliding scales represent a reactive, rather than a proactive, approach to blood glucose control. They deliver variable amounts of insulin at variable times, generally resulting in those swinging blood glucose levels. Instead, the use of a rapid-acting insulin CF at mealtimes alongside an established diabetes medication regimen will result in much smoother blood glucose control. The application of this principle will be explained for each hospital setting.
Derek G. Waller BSc , DM, MBBS , FRCP, Anthony P. Sampson MA, PhD, FHEA, FBPhS, in, 2018
Implantation Of Encapsulated Islets
Some of the limitations of islet transplantation currently include the limited availability of donors and the need for long term immunosuppression to prevent rejection of the transplanted graft. Protecting the islets from the immunologic environment may allow both the use of non-human islets for transplantation and minimize or eliminate the need for systemic immunosuppression. Thus, the encapsulation of islets to attain these goals has been sought for several years but unfortunately this technology is still not at the stage to make it to the clinical arena. Although initial attempts at encapsulation of islets resulted in damage of the capsule by local tissue responses, newer techniques allowing for conformal coating of human islets have shown promising results in pre-clinical models and are currently being explored .
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What Is Insulin Made Of
Insulin is made in different ways. The insulin molecule is like two joined strings of beads.
You and your healthcare team will discuss which insulin you can take.
Human insulin This is synthetic and made in a laboratory to be like insulin made in the body. Analogue insulin This is also synthetic and made in the laboratory but scientists have managed to alter the position of some of the beads to create genetically engineered insulin known as analogues. Animal insulin This isnt used much anymore, but some people find that purified insulin from animals works best for them. It comes from cows or pigs.
What Causes Someone To Be Prescribed Insulin
If your body doesnt make insulin or doesnt make enough, you are eventually diagnosed with type 1 diabetes. It used to be called juvenile diabetes, but new estimates show that as many as half of people with type 1 diabetes are not diagnosed until adulthood. On the other hand, if your body doesnt use insulin properly, you have type 2 diabetes.
While people with type 1 diabetes need to take insulin to survive, many people with type 2 are able to stave off insulin use or even avoid it altogether by exercising, losing weight, adapting healthier eating habits, or using other prescription medications.
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Do I Need To Be Administered With More Than One Insulin
Your doctor is in the best position to determine if you need more than one insulin.
Some type 2 patients may be required to use slow-acting insulin to put their blood sugar level under control, while others may need both meal-time and slow-acting insulin to effectively control their blood sugar level.
Patients using an insulin pump will need to use fast-acting insulin. The pump can give a slow and steady dosage of insulin to take you through the day the same way slow-acting insulin would do. It is, however, advisable to have slow-acting insulin as a backup in case the pump fails.
How Do Different Types Of Insulin Work
Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.
Insulin is a hormone made by the pancreas that allows your body to use sugar from carbohydrates in the food that you eat for energy or to store glucose for future use. Diabetes is a health condition in which the body is unable to regulate blood sugar on its own through insulin. There are two distinct types of diabetes:
Type 1 Diabetes :T1D, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Different factors, including genetics and some viruses, may contribute to T1D.
Type 2 Diabetes :T2D is a chronic condition that affects the way your body metabolizes sugar. In T2D, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain normal glucose levels. Genetics and environmental factors, such as being overweight and inactive, have been established as contributing factors.
All patients with T1D and patients with more serious forms of T2D need to take insulin medications to help their body regulate blood sugar.
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Timing Of Prandial Insulin Injections
The onset of action of regular insulin is approximately 30 minutes while insulin aspart/glulisine/lispro can be detected systemically within 15 minutes after a subcutaneous bolus is given. The timing of the pre-meal insulin bolus can be reduced when the measured glucose level is low and lengthened when hyperglycemia is present before eating. To best match the insulin action with the glycemic effect of meals, regular insulin is optimally given 30 minutes before the meal and the rapid-acting insulins 15-20 minutes before the meal. Insulin pumps and multi-dose insulin injection regimens using basal analog insulin combined with a rapid-acting insulins provide patients with the greatest flexibility of varying the time of meals without sacrificing an increased risk of hypoglycemia, when compared with NPH-based insulin regimens.
What Are The Different Types Of Insulin
The American Diabetes Association characterizes insulin by how fast it works. But everyones body is different. If you have diabetes, you should expect deviations in the amount of time any medication takes to reach your bloodstream. Here are a few useful terms related to how fast and how long insulin acts in your body:
Onset is defined as the length of time before insulin hits your bloodstream and begins to lower blood glucose.
Peak is the time during which insulin is at its maximum effectiveness at lowering your blood glucose levels.
Duration is the length of time insulin continues to lower your blood glucose levels.
These are the five main types of insulin that doctors prescribe:
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Limitations And Additional Considerations
Additional considerations when evaluating the option of using a faster-acting insulin include the patients age and pregnancy status, the ease of acquisition and cost of the medication, and the medications long-term clinical and safety outcomes. Although faster aspart is approved for use in both children and adult patients , URLi is only approved for use in adult patients at this time it has not yet been studied in children, and therefore its safety and efficacy in children with type 1 or type 2 diabetes are unknown .
Medication acquisition and costs should be considered when initiating or adjusting therapy. The costs of the ultra-rapid-acting insulin analogs are similar to those of rapid-acting insulin analogs . For patients who have medication acquisition issues or for whom cost is a primary concern , clinicians may consider prescribing more affordable bolus insulins such as regular human insulin, including the Walmart-branded ReliOn Novolin regular insulin or the biosimilar insulin lispro analog Admelog . For patients with commercial or government insurance, the drug formulary should be reviewed first to select the plans preferred bolus insulin agent.
In collaboration with patients and caregivers, other important factors should also be taken into consideration when starting or switching to a particular bolus insulin and delivery device.
Management Of Special Populations
Adults with T1D now span a very large age spectrumfrom 18 to 100 years of age and beyond. These individuals are unique in that they usually have lived with a complex disease for many years . An understanding of each individuals circumstances is vital and management often requires assessment of medical, functional, mental, and social domains. The ADA emphasizes that glycemic targets should be individualized with the goal of achieving the best possible control while minimizing the risk of severe hyperglycemia and hypoglycemia .
Glycemic goals in older adults vary. Most older adults with T1D have long-standing disease . Additionally, there is a wide range of health in older individuals, with some patients enjoying good functional status and no comorbid conditions, while others are limited by multiple comorbidities as well as physical or cognitive impairments. Older T1D patients may develop diabetes related complications which pose a challenge in disease management. Insulin dosing errors, hypoglycemia unawareness, and inability to manage hypoglycemia when it occurs may result from physical and cognitive decline. Special attention should be focused on meal planning and physical activities in this population. Severe hyperglycemia can lead to dehydration and hyperglycemic crises . Issues related to self-care capacity, mobility, and autonomy should be promptly addressed.
INPATIENT MANAGEMENT AND OUTPATIENT PROCEDURES
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Sodium Glucose Cotransporter 2 Inhibitors
SGLT2 is a protein expressed in the proximal convoluted tubule of the kidney and is responsible for re-absorption of filtered glucose. Inhibition of SGLT2 prevents glucose reabsorption in the PCT and increases glucose excretion by the kidney. SGLT1 is the major intestinal glucose transporter. SGLT1 inhibition also increases postprandial release of the gastrointestinal hormones GLP-1 and polypeptide YY, probably by increasing delivery of glucose to the distal small intestine, thereby regulating glucose and appetite control. Notably, the action of these agents is insulin-independent, therefore this class of drugs has potential as adjunctive therapy for T1D. Additionally recent clinical trials have also demonstrated improvements in cardiovascular outcomes trials as well as reductions in renal outcomes in T2D therefore, there is significant interest for use in T1D. Early small studies of SGLT2 inhibitors in T1D showed promising results with evidence of decreased total daily insulin dosage, improvement in fasting glucose and A1C, measures of glycemic variability, rates of hypoglycemia and body weight .
Common side effects associated with this class of drugs include genital and urinary infections. Euglycemic diabetic ketoacidosis has been recognized in patients with T1D due to glycosuria masking hyperglycemia but with a catabolic state with ketonemia .