Diabetes Insulin

Insulin is used to control blood sugars in people with type 1 diabetes and sometimes for people with type 2 diabetes. For type 2 diabetes insulin may be the initial medication if blood sugars are very high, above 450. It may also be necessary in situations where lifestyle changes and oral medication fail to give adequate control of blood sugar. Insulin is given as an injection under the skin, the patient is trained to inject themselves with the insulin.

There are many brands and names of insulin but there are two basic types. Insulin comes as either a long acting or a short acting type. Long acting insulin (sometimes called intermediate acting) has a gradual onset of action and works over a long period of time. It is often used in the morning and at bed time. Short acting insulin works soon after being administered but its effect goes away shortly after it is used. Short acting insulin is usually used at meal times. Short acting insulin can also be used in a “sliding scale” where the dose of the insulin is adjusted depending on the blood sugar. Some insulin are packaged as a mixture of long and short acting insulin for example 70/30 is a mixture of 70% long acting insulin and 30% short acting insulin.

When on insulin patients are usually asked to check their blood sugar. This is done with a machine called a glucometer. There are different ways that a patient may be asked to check the blood sugar. A fasting value is usually checked, this is the blood sugar first thing in the morning before eating. The blood sugar may also be checked before meals, after meals, or both. After meal blood sugars are timed with the meal and will either be one hour or two hours after eating depending on how your doctor instructs you. These values give different information and the instructions will vary depending on the information your doctor is needing.

One risk of using insulin is hypoglycemia. Hypoglycemia is when the insulin drops the blood sugar too low. This can be dangerous and needs to be treated immediately. If the blood sugar drops below 70, patients may start to feel symptoms. If the blood sugar drops below 50 the patient may become unconscious and go into a coma. The symptoms of hypoglycemia include nausea, sweating, headache, and a generalized feeling poorly. If these symptoms develop it is important that the patient check the blood sugar and treat the low blood sugar by ingesting carbohydrate. Drinking orange juice, soda, or other high carbohydrate containing drink will usually reverse the low blood sugar. Glucagon is a medication that can be given as an injection to raise the blood sugar in a case where the patient is unconscious or unable to ingest carbohydrate. If hypoglycemia occurs, the patient should call their doctor right away. If the blood sugar does not respond or the patient is losing or has lost consciousness, emergency personnel should be called (911 in the US). In general, this type of severe hypoglycemia is rare with proper usage of insulin.