July 17, 2012

Back to Diabetes Basics – Part 10


No, I did not leave this for near the last because it is the treatment of last resort for most doctors. I wanted to do my research and leave this series with what I feel is a great topic that needs attention. And, being near the last topic, you may remember more about it.

We know that people with type 1 diabetes can't live without insulin, but the medical community (especially the American Diabetes Association (ADA)) seems to think that people with type 2 diabetes can. In this light, they promote oral medications and if the first one they prescribe does not take care of the problem, they keep stacking oral medications. They will not prescribe insulin until they deplete the oral medications or have no other choice. I say they are causing more harm with this method of treatment than they doing patients good. From the preceding blog, you can see some of the side effects caused by oral medications.

That is not to say that insulin has no side effects, as insulins can. Some people are allergic to the insulins not produced by their own body, and for them insulin can be very toxic. Fortunately, their number is small and sometimes can be overcome with the right introduction and treatment regimen. For an even smaller number some insulins (not analogue insulins) approved and still on the market outside the USA will work for them. The remaining people will never be able to tolerate insulin that they do not produce in their own bodies.

For many years, the insulin used by people with diabetes was produced from the pancreases of pigs and cows. Synthetic human insulin derived from genetically engineered bacteria first became available in the 1980s, and now all insulin available in the United States is manufactured in a laboratory. Although the development of synthetic human insulin was a boon for most people, especially those who were allergic to the animal insulins, a few people find that they can manage their diabetes better using animal insulins.

Although animal insulins are no longer produced in the United States, the FDA allows individuals to import animal insulins for their own personal use. See their Policy on Importation of Drugs (1998) for more information. The Insulin Dependent Diabetes Trust, a nonprofit group in the United Kingdom, has additional information on animal insulins, including contact information for a company in the U.K. that still manufactures them. Explore the site if you need more information.

The major side effect of insulin can be a dangerously low blood sugar level (severe hypoglycemia). A very low blood sugar level can develop within 10 to 15 minutes with rapid-acting insulins. Always have glucose tablets, 6 oz or 8 oz juice drinks, or other suitable fast acting carbohydrates available to treat hypoglycemia. Glucose tablets are the fastest acting and most reliable.

Insulin can contribute to weight gain, especially in people with type 2 diabetes who already are overweight. The myth about weight gain on insulin happens to be fact, although in reality it is muddied up by people. For people with type 2 diabetes, taking insulin can cause weight gain. There are several reasons for this. The one factor that comes to the front is people use insulin as the medication of last resort. Normally this is fought until there is no longer any choice, insulin cannot be postponed as blood glucose levels are out of control and oral medications cannot keep blood glucose levels down.

Because insulin is often the medication of last resort, two factors can cause weight gain. The first is inactivity or sedentary lifestyle. This may be caused by diabetic neuropathy, which makes it difficult to walk more than short distances. The second is people do not reduce the intake of carbohydrates when going on insulin.

Why is the second necessary? Because insulin is necessary, when first started, insulin makes management of blood glucose levels easier. Instead of losing some of your carbohydrates in your urine when your blood glucose exceeded your urinary limits, these carbohydrates are now put to work or stored as fat. This new efficiency in blood glucose management generally causes initial weight gain.

This is the main reason that people starting on insulin should consider reducing the total carbohydrate intake for a period of time while your body adjusts to the efficiency. However, if you are a person that is able to exercise on a regular basis and you do this, your carbohydrate intake may not need to be reduced greatly and may be resumed shortly after starting insulin.

Weight gain is always a possibility for some body types and these people must learn to manage their carbohydrate intake to avoid weight gain. The article did say that you should limit your insulin dosage, which is only possible, if you reduce your intake of carbohydrates. I will also reemphasize their statement of using exercise to aid in insulin use to burn calories and help keep insulin use low. This will aid in preventing weight gain.

Other possible side effects of long-term insulin use include the loss of fatty tissue (lipodystrophy) where the insulin is injected and, in rare cases, allergic reactions that include swelling, or edema.

What can affect insulin? Some factors that affect how fast and how well an insulin dose works are:
  • Where the dose is given. If you give insulin into your abdomen (especially above and to the side of your belly button), the medicine will get into your system more consistently from day to day. If the medicine is given into a muscle or a small blood vessel instead of fatty tissue, the medicine will get into your system faster. This is generally not recommended by most doctors.
  • How much insulin is given. Higher doses of insulin reduce the blood sugar level more than lower doses. Do not overdose!
  • Whether you have exercised before or just after taking insulin. If you have just exercised the muscles in the area where you give your insulin injection, the medicine will get into your system faster.
  • If you apply heat to the area. The medicine will get into your system faster if you take a hot bath or shower, put on a heat pack, or massage the area where you have just given your insulin injection.
  • If you do not drink enough water and you are dehydrated, you will not have as much blood flow to your skin, so insulin will not be absorbed as well as it would be otherwise.

Things to do
  • Label each insulin bottle when it is used for the first time, and discard unused medicine after 30 days. A bottle of insulin may lose its potency after 30 days of use. Most inserts accompanying your insulin will state 28 days.
  • Store insulin properly so that its effectiveness is protected. Storing it in the refrigerator is the ideal place, but preferably not in the door to avoid vibrations when the refrigerator door is opened and closed.
  • When you buy insulin, check the generic or brand names to make sure you are buying the correct type. For example, if you have been using Humulin-R (insulin regular), make sure you buy Humulin-R instead of Humulin-N (insulin NPH).
  • Know when your prescribed types of insulin start working (onset), when they work most (peak), and how long they work (duration).
  • Know how to give an insulin injection.
  • Once you have started using the vial of insulin, it generally is not necessary to return it to the refrigerator. Only return it to the refrigerator if the temperature in the house or apartment will be above 85 degrees Fahrenheit for an extended period of time as this will shorten the life of the insulin or make it unusable.
  • Keep insulin out of direct sunlight and in Frio packs or a cooler with cold packs if it is in a vehicle for any length of time or while traveling or hiking.
The Internet does have some good tips here and if you search, you may find more.

One word of encouragement you should take away is that a move to insulin does not mean you have failed in your diabetes management. Just the fact that you are reading this should mean that you are doing you homework and learning about insulin. True, most doctors use insulin as the medication of last resort and this should not be the rule. Once one or two of the oral medications have not worked, instead of letting your doctor stack on more oral medications, give insulin serious consideration.

Series 10 of 12

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