Insulin Therapy for Newbies
In extremely oversimplified terms, diabetes results when your body has an insufficient amount of insulin available to make glucose available to muscles and organs that need it. Often this condition can be treated using oral hypoglycemic agents, or diabetes medications, and lifestyle changes involving diet and exercise. Unfortunately, diabetes is a progressive disease that gets worse over time. Eventually, most diabetics will have to supplement their body’s insulin with injected, inhaled, or transdermal (patch) insulin.
Insulin is available in several different forms and can be supplied using several different delivery methods. This makes insulin therapy a confusing and intimidating, often frightening, topic for diabetics new to this treatment. Here is a quick breakdown of the various types of insulin available:
Humulin is a synthetic insulin produced using recombinant DNA, or rDNA, technology by the Eli Lilly Company. Humulin is produced in several different forms. Each has its own time to take effect and its own length of effectiveness..
Humulin R, or regular insulin, takes effect in about 30 minutes after injection and reaches its peak effectiveness in between 2.5 hours and 5 hours. Regular insulin is used to regulate the spikes in blood sugar that occur shortly after meals or snacks.
Humulin N, or NPH insulin, takes effect in about 1.5 hours and reaches its peak between 4 and 12 hours after injection.
Humulin L, or lente insulin, starts working in about 2.5 hours and reaches its peak between 7 and 15 hours after injection.
Humulin U, or ultralente insulin, starts working in about 4 hours and reaches its peak between 8 and 24 hours after injection.
Humulin 50/50 is a mixture of regular and NPH insulins in equal amounts. The effect of this mixture is to provide both a fast action, around 30 minutes, and a longer period of effectiveness, up to 8 hours.
Humulin 70/30 is a mixture of 70% NPH insulin and 30% regular insulin. This mixture gives some fast-acting insulin with a greater amount of effectiveness for a longer period.
Humalog (insulin lispro manufactured by Eli Lilly) and NovaLog (insulin aspart manufactured by Novo-Nordisk) are fast-acting insulin analogues that take effect in as little as 10 minutes and last only about 2 hours.
Lantus (insulin glargine manufactured by Eli Lilly) is a slow-acting, long-lasting insulin that takes effect in about 2 hours after injection and lasts around 24 hours. Lantus is frequently used to establish a baseline insulin level that can then be supplemented as necessary with one of the other insulins.
If the 50/50 or 70/30 pre-mixed insulins do not fit your needs, most insulins can be mixed in the same syringe. This means that your insulin therapy program can be tailored to fit your specific and unique needs. Lantus insulin cannot be mixed and must always be taken separately.
Insulin therapy requires a method of getting the insulin into your body in a usable form. The traditional way is through hypodermic syringes. Injection using a syringe is still the most widely used method of insulin delivery, but there are other options.
Insulin pens are popular, particularly among younger diabetics and those with limited vision. Pens are convenient and easy to use. They come pre-loaded with insulin; all the user has to do is dial up the correct dose and inject it. Many pens come in a one-use disposable form with a pre-measured dose of insulin. The real disadvantage of insulin pens is that insulins cannot be mixed. Taking a combination of different insulins requires multiple injections.
Pumps are another popular alternative to syringes. Insulin pumps can provide much tighter blood sugar control than traditional injection techniques. They do this by using infusers to deliver insulin as scheduled and on demand. Pumps usually need to be supplemented by injections on an as-needed basis to achieve fine control. Using an insulin pump requires detailed attention to your blood sugar levels and insulin needs but can give you a stable blood sugar level that closely mimics the normal function of the pancreas and liver.
New technologies are being developed that promise to finally deliver diabetics from the tyranny of the needle. The two most promising right now are the patch and the inhaler. A patch can deliver a basal insulin dose continuously through the day, eliminating the need for a daily injection. Inhaled insulin promises to provide fast-acting insulin when needed without needles. Both patches and pumps are undergoing development and will be available sometime within the next ten years.
Injecting insulin is not fun. I have never liked needles, and I like them even less now that I have to use them multiple times daily. Even in the face of that, though, I realize that insulin therapy has long-term benefits in reducing, or even preventing, complications from my diabetes and will contribute to a longer, happier life. I wish the same for you.
