Insulin Preparations & Insulin Treatment
Insulin is the hormone that helps our body use glucose (sugar). In diabetes, the body is unable to use glucose because of deficiency or ineffectiveness of insulin. In type 1 diabetes, the body can not make insulin. In type 2 diabetes, the body can make insulin but does not respond to it (called insulin resistance). Treatment with insulin is needed in all type 1 diabetes patients, and in many type 2 diabetes.
The normal pancreas makes a small amount of insulin at all times (called,” basal insulin”). A significantly greater amount of insulin is produced for one or two hours upon ingestion of food to help the body utilize sugar or carbohydrates released from digested food (called “bolus” or “prandial” insulin).
Depending on the type and severity of diabetes, your physicians will recommend different insulin regimens (INSULIN PLANS). These may or may not be given with oral diabetes medicines.
Commercially available insulin can be broadly divided into two kinds:
- SLOW ACTING (LONG-ACTING):
Include insulin preparation that starts acting gradually and lasts for 12-24 hours. Examples include LANTUS®, LEVEMIR®, TOUJEO®, TRESIBA®) or NPH (Humulin or Novolin-N). NPH lasts for about 12 hours and may have a slight peak at 6 hours, which may increase the probability of hypoglycemia (low blood glucose). The other insulins last longer and usually may be given once a day (morning or at night)
- FAST (SHORT) ACTING:
These preparations are taken before major meals and because of rapid action, they prevent blood glucose from rising after meals. Examples include Humolog®, Novolog®, Fiasp®, Lyumjev® or Apidra®. This group starts acting within 10-15 minutes and should generally be taken before eating.
Humulin-R® or Novolin-R® are older preparations (also called Regular insulin) that take 20-30 minutes to work and may last longer in your system.
- PREMIXED INSULIN:
Sometimes the slow and fast insulin is mixed in formulations such as Humulin 70/30 or Novolin 70/30 (NPH and regular insulin) and Humalog 75/25 or Novolog 70/30 (NPH and Humalog/Novolog). These preparations are simple to use. In many patients, they can not get comparable results to more complicated insulin plans. Meal timing and exercise levels have to be kept similar from one day to another with these preparations.
- Once daily plans:
In some patients with type 2 diabetes, slow insulin (e.g. Lantus® or Levemir®) is used to supplement oral medications (diabetes pills) and control blood sugars. This method is useful when sugars are only moderately high and the pancreas can still make some insulin. These patients are often taking anti-diabetic pills during the daytime. In this scenario, a slow-acting Insulin injection is given at bedtime. Your physician may recommend starting a small dose (e.g. 10 units at bedtime) and may suggest, that you increase the dose by 2 units every 3 days until the fasting sugar is < 120 mg/dl. Good sugar readings in the morning may allow the diabetes pills to be more effective during the day.
- Twice daily insulin:
For some patients with type 2 diabetes, twice daily injections of a combination of ‘slow’ and ‘fast’ insulin may allow fairly good control of blood sugars. Typically a dose of pre-mix insulin(70/30 insulin) is given 10-15 minutes before breakfast and another dose before the evening meal.
- Intensive insulin plan:
The best method to control diabetes via insulin is by administrating the “fast” insulin before each meal (e.g. Humalog®, Novolog®) usually given 5-10 minutes before major meals and “slow” insulin once daily (Lantus, Tresiba or Levemir) is given once daily, usually at bedtime). This combination mimics natural insulin release and allows the most flexibility. With the help of diabetes educators, you may learn how to count CARBS in your meals and take a proportional dose of ‘fast’ insulin to cover that meal. An additional sliding scale may be given to cover high blood sugar (please note that Humalog or Novolog is given to cover CARBS and high blood sugars).
INSULIN DOSE ADJUSTMENTS:
The patients must check their blood sugars regularly (2-4 times a day). This will allow the doctor to adjust insulin doses and also to detect hypoglycemia (low blood sugar). After receiving in-depth training, some patients may be able to make minor adjustments in their insulin doses to get BG readings within the target range. Here are some examples:
- For patients taking Lantus (or other slow-acting insulin preparations) at night, the dose can be increased by ~2 units every 3-5 days if the fasting BG (early morning/ before breakfast) is >130-140 mg/dL.
- If BG is already high at bedtime, then the evening (dinner) dose of diabetes pills or evening (pre-dinner ) insulin may need to be increased.
- For patients taking premixed insulin (70/30):
- If BG is high at lunch and dinner time (>140-175 mg/dL), the morning dose may be increased by 2 units (after 3-5 days of observation).
- If BG is high at bedtime (>140 mg/dL) or in the fasting state (>140mg/dL), the dinner dose of 80/30 insulin may be increased by 2 units
(after 3-5 days of observation).
- Similarly, if BG is low (<70 mg/dL), a reduction of insulin dose may be necessary.
Diabetes is a chronic disease. By taking charge, you can control it and prevent all of the complications of diabetes. American Diabetes Association (www.diabetes.org) has many publications and other tools that may help you control your diabetes. Good luck!!
This information is for general knowledge & is not a substitute for medical advice your doctor recommends.
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