July 18, 2012

Back to Diabetes Basics – Part 11


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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