Insulin

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• QWhat kind of insulin is used by people with diabetes?

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  A American Diabetes Association answered

  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.

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• QWhat are the elements of intensive diabetes management?

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  A American Diabetes Association answered

  The idea of embarking on an intensive diabetes management plan may seem overwhelming. There is a lot to remember, but keep in mind that it is an ongoing process. You can’t learn it overnight, and no one expects that of you. Your healthcare team is there to help you.

  You’ll have many questions as you begin. How many units of insulin should you take if your blood glucose is a little high? How should you change what you eat for your next meal? It will require trial and error and coordination and advice from your healthcare team as you learn to make adjustments. Over a short period of time, you will gain the confidence to make these adjustments on your own.

  The elements of intensive management are:

  • checking blood glucose level multiple times each day
  • insulin injections or use of an insulin pump
  • adjusting insulin doses according to food intake, exercise and blood levels
  • using a meal plan and exercising 
  • frequent contact with your healthcare team (once care routine is established)

  Although intensive therapy can slow down the development of complications, there is no evidence to date that it can reverse the process. And while intensive diabetes management has many health benefits, there are several drawbacks, including cost, much time and effort, an increase in hypoglycemia episodes, and you may gain weight.

  Intensive diabetes management can be risky for the elderly because of the increased risk for hypoglycemia. Hypoglycemia may also make it harder to live alone or be independent. Some older people may find the potential benefits not worth the risk, particularly if they have other health problems or impairments. However, if you are an older person who believes that you will live long enough to reap the benefits (about 10 years) and are willing to take on this responsibility, then let your healthcare team know.

  Individuals with coronary artery disease, irregular heartbeats, cerebrovascular disease, angina or other types of heart disease may not be suitable candidates for intensive therapy. Anyone taking medications, such as beta blockers, that may make it more difficult to detect hypoglycemia may be at higher risk when trying to achieve tight control.

• QWhat is the standard insulin routine for people with diabetes?

  1 Answer

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  A American Diabetes Association answered

  People diagnosed with type 1 diabetes usually start with two injections of insulin per day of two different types of insulin and generally progress to three or four injections per day of insulin of different types. The types of insulin used depend on their blood glucose levels. Studies have shown that three or four injections of insulin a day give the best blood glucose control and can prevent or delay the eye, kidney and nerve damage caused by diabetes.

  Most people with type 2 diabetes may need one injection per day without any diabetes pills. Some may need a single injection of insulin in the evening (at supper or bedtime) along with diabetes pills. Sometimes diabetes pills stop working, and people with type 2 diabetes will start with two injections per day of two different types of insulin. They may progress to three or four injections of insulin per day.

• QWhy is insulin used to treat type 1 diabetes?

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  A Dr. Daniel R. Spogen, MD , Family Medicine, answered on behalf of Univ. of Nev. School of Medicine, Family Medicine

  Insulin is the standard therapy for type 1 diabetes. Insulin is a hormone that helps the body regulate blood sugar levels. It is normally produced by the pancreas, but in type 1 diabetes the pancreas is unable to produce insulin to keep blood sugar controlled. Thus, patients with type 1 diabetes are given insulin medication by injection to help keep blood sugar levels at more normal levels.

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• QWhat is intensive diabetes management?

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  A American Diabetes Association answered

  Taking multiple daily injections is sometimes called intensive diabetes management or tight control. The goal is to mimic the natural secretion of insulin from the pancreas as much as possible. The more often you inject insulin, the more opportunities you have to fine-tune your control. You also have more freedom and flexibility with your schedule and food choices.

  Intensive management means more than simply taking extra insulin. In fact, you may not increase the total amount of insulin you take at all. What may change is how and when you deliver it. Work with your healthcare team to decide when to take it and how much to take to effectively cover your meals and your background (basal) glucose levels.

• QWhen is insulin needed to treat type 2 diabetes?

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  A American Diabetes Association answered

  In people with type 2 diabetes the body is not making enough insulin or not using the insulin it makes properly. Because their bodies still make and release insulin, people with type 2 diabetes may be able to manage blood glucose by changing their eating and exercise habits. If adjustments to diet and exercise aren’t enough to control their blood glucose, oral diabetes medications or insulin may be prescribed. Although it is a common practice to try oral medications before insulin, you may start on insulin based on several factors, including the following:

  • How long you have had diabetes
  • How high your blood glucose level is
  • What other medicines you take
  • Your overall health

  Because oral medications seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better.

• QWhat determines how much insulin my body needs if I have diabetes?

  1 Answer

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  A American Diabetes Association answered

  If you have diabetes, how much insulin your body needs can change. This depends on many things:

  • how much food you eat
  • what kind of food you eat
  • how much exercise you get
  • when you exercise versus when you take your medication
  • where you’re injecting insulin
  • the state of your health
  • how much stress you’re under

  Once you have established insulin doses for different meals, you can practice predicting what insulin doses will match your food intake. It usually takes practice to estimate your insulin need in terms of the amount of carbohydrate you eat and adjust for changes in food intake and exercise. The next step is to learn to calculate and take extra or a corrective dose of insulin when your blood glucose is higher than your target range. This is how you begin to fine-tune your insulin doses.

• QWhat is the goal of insulin therapy with type 1 diabetes?

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  A American Diabetes Association answered

  With type 1 diabetes, the pancreas no longer secretes insulin. The goal of insulin therapy is to mimic a normal pancreas as closely as possible. This often requires multiple daily injections of insulin or the use of an insulin pump and frequent blood glucose monitoring.

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• QWhat can increase insulin absorption after an injection?

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  A Intermountain Registered Dietitians , Nutrition & Dietetics, answered on behalf of Intermountain Healthcare

  How quickly insulin is absorbed (goes to work in your body) partly depends on what you do right after the injection. If you exercise the part of your body where you've just received an injection -- for example, you play tennis right after an injection in your serving arm -- you'll speed up the absorption rate. Similarly, if you go in a hot tub or take a warm bath or shower right after an injection, you'll also speed absorption. Be aware of this as you prepare to inject your insulin. Faster absorption may put you at risk for hypoglycemia. Most of the time, it's best to avoid both of these situations.
• QWhat is an insulin pump?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  An insulin pump is a small, computerized device about the size of a cellphone or deck of cards that delivers insulin continuously through a catheter to a person with diabetes. The pump can be worn on a belt loop or in a pocket. It replaces the need for insulin injections throughout the day.
  
  At mealtimes, the pump can give a quick dose of extra insulin, or a bolus. Using the pump allows closer control of blood sugar levels without as much risk of low blood sugar. It also requires more commitment to carbohydrate counting and to monitoring blood sugar at least four times a day. Pumps were first designed for people with type 1 diabetes, but more and more people with type 2 are using them.

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