Insulin is a hormone produced by your pancreas whose primary function is to lower blood sugar. It does this by binding to insulin receptors on the cell wall which open glucose transporters. Once the glucose transporters are opened by the action of insulin, glucose can flow freely from the blood into the cell.

If you are insulin dependent your body relies on insulin injections in order to function correctly. This is either because your pancreas is not secreting any insulin, as in type 1 diabetes), or else the insulin that your pancreas is making is not doing its job properly, as in type 2 diabetes.

Insulin Basics

Before we jump into discussing the various insulin regimens, I need to first explain two terms which you will come across frequently:

Basal insulin – This is the injection of a long-acting insulin which mimics the insulin secretion of the pancreas. A single basal shot of insulin continues to act slowly throughout the day, therefore you only need to inject it once or twice daily. These long-acting insulins are “peakless” which means that they try and maintain the same glucose level throughout the day, unlike the fast acting insulins which result in a rapid decrease in blood sugar.

Bolus insulin – A bolus is a medical term for a single dose. Bolus insulin is given when you eat food in order to counteract the rapid increase in blood glucose after a meal. Bolus insulins are typically fast-acting, some of which start bringing down blood glucose in a matter of minutes. They do not remain in your system for long, being metabolized and excreted out of the body usually within a few hours.

So, to summarise… basal insulin keeps your blood sugar stable in the absence of food, but when you eat you need to take a bolus of fast acting insulin in order to counteract the sudden increase in blood sugar which comes from the breakdown of carbohydrate into glucose.

When Is Insulin Needed?

Insulin is always necessary for the treatment of type 1 diabetes, because there is a complete lack of the hormone in these patients. Type 2 diabetics do not usually require insulin until the disease has progressed to a point where the patient has become highly resistant to insulin, or when oral antidiabetic medications are no longer enough to keep blood glucose levels down.

A patient with insulin dependent type 2 diabetes has to use insulin in the same way as type 1 diabetics. However, there is a difference in that type 2 diabetics usually have to take much larger doses of insulin than type 1 patients because they have become so resistant to the effects of insulin.

For many type 2 diabetics, the addition of a long acting (basal) insulin such as Lantus or Levemir is usually enough to provide enough help to assist the body’s own insulin in doing its job. If this is still not effective enough, a basal dose can be taken in addition to fast acting boluses of insulin at mealtimes.

Insulin Mixtures

These come premixed under certain brand names, a popular one is a 70/30 mix (70% long acting, 30% fast acting) called humulin or mixtard. These are usually taken before breakfast and supper.

However, the combination of basal and bolus injections provides much tighter glucose control and is a more flexible system than taking premixed insulin. This is because you can vary the amount and timing of the bolus to match what type of food you eat and when you eat it.

With mixtures of insulin such as the 70/30 mix, you have to take it on a rigid schedule, and you can only eat a certain number of carbohydrates each day and at a scheduled time. You are not able to vary the timing of the injections because they contain both slow acting and fast acting insulin, and you are not able to eat more or less food depending on how hungry you are that day.

How to Inject Insulin

Depending on the insulin regime prescribed by your doctor, you may have to inject insulin via a traditional syringe. However, the majority of patients now are using injection pens which come pre-filled with insulin as they are much easier to use. In either case, the following basics apply:

Step 1: If using a syringe, roll the insulin vial (or the syringe itself if it has been pre-filled) between the palms of your hands a number of times before filling the syringe to redistribute any particles that may have settled to the bottom. This ensures an even concentration of insulin in each dose. The same applies to insulin pens, but they should also be shaken as most pens have a small glass ball inside which can move around and mix the insulin thoroughly.

Step 2: Choose an injection site and pinch the skin slightly. Position the syringe or pen so that the insulin is injected under the fatty layer of the skin. Note that a 45 degree angle is best for children and adults who are very thin, otherwise a 90 degree angle may be more appropriate.

Step 3: You should rotate your injection site regularly. Insulin is best absorbed through the abdominal area so rotating injection sites in this area is ideal. You could visualize your abdomen as a grid of 8 squares. Assign to each square a particular day and change to a new one each day of the week.

Insulin Injection Tips

1. Subsequent injections should be delivered at least 1 inch away from the previous injection site.

2. It is not necessary to disinfect the injection site with an alcohol swab as long as your skin is clean.

3. If necessary, insulin may be injected through clothing, but this is not recommended.

4. Never shake a vial of insulin as this creates air bubbles which can clog the syringe.

5. Never mix one type of insulin with another in a single syringe. This can make it’s effects erratic.

6. Try not to inject insulin into muscle tissue. It is painful and the insulin is absorbed too quickly and cause hypoglycemia.

Insulin Pumps

Insulin pumps are normally used in type 1 diabetes however they can work as effectively for insulin dependent type 2 diabetics also.

Some advantages of using an insulin pump include:

You change your infusion site once every 3 days, so if you have a dislike of needles, insulin pumping is better than having to inject yourself times a day.

You will use less insulin with a pump than on injections. Insulin pumps only use fast acting insulin which is more efficient than the slow acting types. Typically you use 20% less insulin when using a pump.

Because you have more control of the amount of insulin you take, if you are motivated, you can achieve much lower HbA1c (glucose average) than with injections. This improved control is due to the fact you can take doses that are not whole units, but fractions of a unit.

A new development in the area of insulin pumps is the advent of the artificial pancreas. This device combines an insulin pump with a continuous blood glucose meter, and automatically calculates how much insulin you need, minute by minute. This device is not currently on the market, but foundations such as the JDRF have invested a lot of money into it’s R&D. Human trials are currently underway.

Is an Insulin Pump Right For Me?

Not everyone is suited to pump therapy, and it usually reserved for cases of type 1 diabetes or insulin dependent type 2 diabetes. In order to be successful at using an insulin pump:

You need to be good at counting carbohydrates. You have to manually program the pump with the number of carbohydrates you are going to eat. It then calculates the dose of insulin to give you.
You need to be comfortable working with technology. If you are unable to basic devices such as a cell phone, then the insulin pump is not for you. However, as you are reading this information on your computer, this is likely not the case.
You need to be patient in order to give the pump a chance to impress you. It usually takes at least a week or two before your glucose levels reach a healthy level. It will also be at least several more weeks after that before you become confidant with adjusting the device.
You need to have a cool head rather than anxiety prone. When your glucose level starts to seem a little scary you have to quickly figure out what changes you need to make. Your doctor will be able to assist you with the learning curve at first, but you will eventually have to cope with the device on your own as the lag time between seeing a problem and getting help is too long for another person to control your pump for you.
Finally, you must be willing to test your blood glucose level with a glucometer about 8 times per day and more often when you are making adjustments to your routine.

Article Author: Michael JC Murphy

Tell me, did you jump out of bed this morning feeling energetic, revitalized and ready to take on the world? Or did you feel really tired as though you needed more sleep?

How often do you wake up feeling fatigued or really tired? This is the most common and strongest sign of type 2 diabetes. Unexplained fatigue … you know you haven’t been out partying all night, or working harder than usual. Actually you have been going to bed earlier than you used to, hoping you would not feel so worn out when you first woke up or that you would make if through the day without feeling weary. There are many other signs, but this is one of the earliest signs that you have high blood sugar levels. It can go on for years; you start to accept that this is the way your life is going to be. You wish it would go away but it just stays and affects so many areas of your life.

You feel fatigued or really tired because glucose cannot enter the cells that depend on insulin to act as the transporter of sugar, therefore sugar stays in your bloodstream. Once you blood sugars rise above 180 mg/dl (10 mmol/l), sugar begins to spill over into your urine and that leads to several of the short-term complications of diabetes.

One or more of the following diabetic symptoms may be present along with high blood sugar levels, when you are first diagnosed with type 2 diabetes:

frequency of passing urine and thirst
unusual tiredness at times when you shouldn’t be drowsy or tired
blurred vision or any change in your eyesight
frequent infections that are slow to heal. Women often have recurring vaginal yeast infections or thrush
tingling or numbness in hands and feet
inflamed gums which are caused by high blood sugars affecting the blood vessels in your mouth. The sugar can also be causing teeth cavities

You may also have type 2 diabetes if your health care provider has diagnosed you with:

high cholesterol levels
high blood pressure
anemia
cataracts

Another classic sign is weight gain. This occurs because insulin in your body is not being used properly. High blood insulin levels increases your appetite.

Type 2 diabetes is a progressive condition that starts small and becomes worse over time. In the early stages it can be controlled through a healthy eating plan and exercise. The best way to prevent your pancreas from overworking and breaking down completely, is to check with your health care provider when you have any of the above symptoms. He can order fasting blood sugar levels, and/or an oral glucose tolerance test (OGTT), which will confirm or rule out type 2 diabetes.

a blood sugar level after fasting for eight hours, if over 140 mg/dl (7.8 mmol/l) on at least two occasions, usually means you have diabetes
you have diabetes when the OGTT result shows a level equal to or more than 200 mg/dl (11.1 mmol/l)

Your health care provider is the one who is responsible for diagnosing and treating your type 2 diabetes. If you have diabetes you must become your own expert, learning to cope with whatever life may throw at you in a satisfactory way. You need to be able to rely on your own knowledge.

Article author: Beverleigh H Piepers

Researchers believe that a variety of selected foods and spices could help treat diabetes. Spices such as cinnamon, cloves, bay leaves and turmeric shows a positive reaction that would help the body to handle insulin efficiently. Among those spices, cinnamon seems to have the right qualities to improve the body’s glucose levels and lower the cholesterol levels, for those affected with Type 2 diabetes.

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A vicious circle is in operation and we have no idea of how devastating the outcome will be. In the past it was easy to diagnose a child with juvenile onset or type 1 diabetes. This child typically presented with weight loss, dehydration and thirst. Now there is a new picture; obesity has spread to younger children and there is a much higher prevalence of type 2 diabetes than ever before.

A recent report stated:

one child in four, born in the year 2000 will end up being diagnosed with this condition
nearly one child in ten with diabetes now has type 2
twenty years ago this condition was unheard of in young children or adolescents
we do not yet realize the damaging effects of childhood obesity
this could mean the complications now seen in mature people, will be seen in young adults and lead to a lower-life expectancy

Add to that the difficulty these children will experience with their peers:

obesity is a burden for a child, even without diabetes
maintaining high self esteem can be very difficult for overweight children
in adolescent years attractiveness equates with body shape and intelligence

The younger a person is at the time of diagnosis, the more likely they are to develop devastating complications during their lifetime. They could develop:

blindness
kidney failure
a higher rate of heart disease than older adults with type 2

The cycle continues as babies born to young women with type 2 diabetes are at a higher risk of inheriting the same.

Just as in adults, this condition in young people takes several years to develop. Children:

are usually overweight or obese
have a strong family history of diabetes
are likely to have acanthosis nigricans, a velvety darkening of the skin especially around the neck and under the arms. This is a due to insulin resistance
girls are more likely to have polycystic ovarian syndrome (PCOS)
if still studying, often lack the ability to concentrate so have poor grades
suffer from fatigue
often only have a mild increase in thirst and urination

How is this treated?

Once diagnosed by your health care provider, managing young people with type 2 diabetes is a family affair. A healthy eating plan and lifestyle changes the whole family can join in, is often suggested. The best news is these changes are great for everyone’s health.

The aim is to:

normalize blood sugar levels
reduce blood fats
prevent the development of complications

Type 2 diabetes can be managed successfully through a combination of regular physical activity, a healthy eating plan and sometimes medication.