Insulins
It is often difficult to know which is
the official term for the different types of insulin. One author will
use one set of terms and a different author uses another set of
terms. Then when you get out the magnifying glass and decipher the
text on the materials supplied with the insulin, you will
occasionally see a third set of terms. For someone new or even
experienced with using insulin, this can be a little confusing.
Since I do not have but two types of
insulin that I use, I cannot find the terms best used in the
materials supplied with many of the insulins so if you have other
types, do not hesitate to add comments with the terms used. The best
chart I have found to-date for the terminology is this in WebMD. An
incomplete listing of terms can be found here on the Joslin site and
I will add other terms that I have been taught from various sources.
The medically correct terms listed here
are from many sources and the most often used. I have added other
terms I have been taught or that I have learned over the years.
- Onset refers to when the insulin starts to work. I was taught Begins or Activates.
- Peak refers to when the insulin works hardest. I was taught Effective Period and Period of Maximum Effectiveness.
- Duration refers to how long the insulin works. I was taught Length of Usefulness.
- Official sources list nothing about when insulin ends and I was taught End.
Next, we need to consider the types of
insulin:
- Rapid-acting - I learned fast-acting insulin.
- Short-acting - This was never explained to me and I lumped it with fast-acting,
- Intermediate-acting - I learned this as 12-hour insulin.
- Long-acting - I learned this as 24-hour insulin.
- Pre-mixed - I learned was mixed insulin.
Now that you have an idea of the
different terms used, understand that this applies to the average
person with diabetes. All the directions and times used are for the
average person. I take Lantus, which is a 24-hour insulin. I cannot
count on this as through experience and my body chemistry, I have
learned that I have an 18 to 20 hour effective period of insulin use.
Others have no problem of Lantus lasting for 22 to 24 hours. I
believe your own body chemistry has some effect on the effective
period insulin will last.
After discussing this with my
endocrinologist after changing times for injection and always having
problems at the end of the 24-hour period, we decided to split my
Lantus injection and take half the dosage twelve hours apart. To many
this is stacking insulin; however, this has eliminated the dawn
phenomenon for me and leveled out the total day for me. For some
people this does not work.
If you look at this chart in NIDDK, you
will see that Novolog duration is 3 to 5 hours. I normally get the 3
1/2 hours and no further benefits. For every person, you will need to
monitor carefully your results to determine if you are in the average
group, or if you fit another area.
I never thought that being my own lab
rat would be any fun, but over the years, I have learned otherwise.
More than once my own experiments have proven beneficial in managing
my diabetes more effectively. This does not mean that I have not
needed to repeat experiments, as I have. Sometimes, I need to make
adjustments and other times they become temporary. Each person has
to find his or her own level of comfort and tolerance.
Some weeks are great and sometimes days
can become a nightmare trying to discover what needs to be adjusted.
Keeping a positive attitude and realizing that some times an answer
will not be discerned is important. Do not be taken aback when later
you realize what happened. Just remember for the next time.
Two excellent insulin charts are
available here and here. I will not reproduce them and urge you to
bookmark them or print them out. The times shown in the chart are
estimates. Your onset, peak, and duration times may be different.
You should work with your health care professionals to come up with
an insulin plan that works best for you. Learn the principles of
insulin use and how they affect your body. Like oral medications,
learn how you manage insulin and know that if you skip a meal, do not
inject any of the rapid-acting or short-acting insulins as you are
just asking for an episode of hypoglycemia.
Your doctor should work with you to
prescribe the type of insulin that is best for you and your diabetes.
Deciding what type of insulin might be best for you will depend on
many factors, including:
Your body's individualized response to
insulin. How long it takes insulin to be absorbed in the body and
remain active in the body varies slightly from person to person.
Here again, one-size-does-not-fit-all.
Your own lifestyle choices -- for
instance, the type of food you eat, if or how much alcohol you drink,
or how much exercise you get -- are all factors that influence your
body's processing of insulin. Also taken into consideration should
be the insulin resistance factor. If your doctor does not talk about
this before prescribing, try to discuss this. This could make
adjusting to insulin easier.
How willing you are to give yourself
multiple injections per day. Many people with type 1 diabetes prefer
insulin pumps and use them almost exclusively. That is their choice
and I personally prefer the multiple daily injections and not having
to worry about tubing or extra equipment being attached to my body.
How frequently you are willing to check
your blood sugar level? I have been considering a continuous glucose
monitor (CGM), but it is another piece of equipment to deal with. I
will leave these decisions to each individual. If you choose to use
a CGM, know that most readings are approximately 20 minutes behind
what is actually happening. You should be looking at trends and
acting on them. Always use your blood glucose meter to verify what
the CGM is telling you.
Your age, and your blood sugar
management goals are important considerations.
Follow your health care provider's
guidelines on when to take your insulin. The time span between your
insulin shot and meals will vary depending on the type of insulin you
are taking.
In general, however, you should
coordinate your insulin injection with when you want to eat. From
the charts, the "onset" column provides useful information.
Again, the "onset" refers to when the insulin will begin
to work in your body. You want the insulin to begin working in your
body at the same time your food is being absorbed. This timing will
help avoid low blood sugar levels. I suggest printing out the chart
you prefer and have it handy until you learn the timing.
One instruction I have not seen, but
have learned over time, is a correction calculation when your blood
glucose level is higher than planned either at the end of the
duration, or prior to your next meal. Since this will vary for each
person, I will only urge you to discuss this with your doctor and
then work on refining from that point. I have my correction ratio
figured out for myself, but you need to work with your doctor to
refine how you arrive at your correction dosage of insulin.
For more information about when to take
insulin, read the "dosing and administration" section of
the insulin product package insert that came with your insulin
product or talk with your doctor. Sometimes a doctor can think one
thing and say another unintentionally, so please do not be afraid to
ask. This is also a method of reinforcing what you need to do for
best diabetes management.
On July 5, 2012, David Mendosa posted
an excellent article about the value of being aggressive at the
beginning with insulin and preserving the function of the pancreas
for many years. This is worth reading even if you were just
diagnosed with prediabetes or diabetes.
One WARNING is in order. If you
are taking insulin with an oral medication, you are more susceptible
for having hypoglycemia. Make sure you understand the symptoms and
be prepared to test more frequently.
Series 11 of 12
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