Islets of Hope treatment options for persons with diabetes
Article by Lahle Wolfe. For permission to use this article please contact: Editor@isletsofhope.com.
Description of Types of Injected Insulin Available
Did You Know?
.... that Animas Corporation offers free, loaner, backup pumps to take along with you when you are on vacation? Read about what happened when we went on vacation and Elizabeth's insulin pump (named "Emily") died. Animas came to the rescue! Next time, we will take advantage of their backup pump program.
"In people with insulin- dependent type 1 diabetes, exercise does not appear to increase the rate of absorption of insulin glargine (Lantus), a long-acting insulin analog, according to study findings."
"As a young Internist, this book proved to be essential in my understanding of diabetes. Searching through my more commonly used references to include Internal Medicine and Endocrinology Textbooks I was unable to find a concise summary of the information and recommendations necessary to manage my patients with pumps. The 500 rule and the 1800 rule were just vague concepts found in obscure
management articles and discussions with other providers. I did not have the benefit of a certified pump trainer or diabetic nurse educator. But with this reference as a guide I was able to develop a management plan. In 3 short months I dropped my patient from a HgBA1C of 9.4 to 6.3. Where there were previous highs in the 400's there are just now slight deviations from desired values. This reference and the bolus wizard on the Medtronic pump is all that one needs
to demystify the management. And of course you and your patient needs to be motivated and dedicated. Dr. Daniel Carlson, Germany"
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Insulin therapy in diabetes
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What is insulin?
Insulin is polypeptide hormone produced in the Islets of Langerhans in the pancreas that regulates carbohydrate metabolism (specifically, beta cells in the pancreas create insulin).
Without insulin, the body cannot move glucose (sugar) from the blood stream into body and tissue cells. Insulin also has a substantial effect on small vessel muscle tone, controls storage and release of fat (triglycerides), and cellular uptake of both amino acids and some electrolytes.
When no insulin is present in the body hyperglycemia (high blood glucose) will result. When too much insulin is present, hypoglycemia (low blood glucose) will result. Everyone needs insulin to live so people with diabetes that do not make enough insulin on their own (or, make no insulin at all) take daily injections of insulin to live.
What is insulin used for?
Insulin is used as a treatment in some forms of diabetes mellitus. Patients with type 1 diabetes mellitus depend on exogenous insulin (injected subcutaneously via syringe, pen, injector, or insulin pump) for their survival because of an absolute deficiency of the hormone. Patients with type 2 diabetes mellitus have either relatively low insulin production or insulin resistance or both. A small, but growing population of persons with type 2 diabetics eventually require insulin administration when other medications become inadequate in controlling blood glucose levels.
How quickly insulin is absorbed is affected by many things including bathing, hot weather, exercise, and excitement. Read our section on "Common Causes of Hypoglycemia" for more information.
Side effects of insulin
The right insulin therapy can reduce risk of long-term complications
Elevated blood glucose, even when there are no hyperglycemic problems like diabetic ketoacidosis (DKA), increases your risk for long-term diabetes complications. Several large, well designed, long-term studies have conclusively shown that diabetic complications decrease significantly. If glucose levels are closely controlled, the rate and risk of complications can even approach that of the nondiabetic.
Chronic diabetic complications include cerebrovascular accidents (CVA or stroke), heart attack, blindness (from proliferative diabetic retinopathy), other vascular damage, nerve damage from diabetic neuropathy, or kidney failure from diabetic nephropathy. Studies have demonstrated over and over again that, if it is possible for a patient, intensive insulin therapy (also called flexible therapy) is superior to conventional insulin therapy. However, close control of blood glucose levels (as in intensive insulin therapy) does require care and considerable effort to avoid the risk and danger of hypoglycemia. For this reason, not all persons with diabetes are suitable candidates for insulin pump therapy, or other means of applying intensive insulin therapy.
A good measure of long term diabetic control (over approximately 90 days in most people) is the serum level of glycosylated hemoglobin (HbA1c. A shorter measure of glucose averaging (over two weeks or so) is the fructosamine level. This test measures similarly glycosylated proteins (mainly albumin) with a shorter half life in the blood.
How is insulin manufactured?
Insulin structure varies slightly between species of animal but certain types of animal insulin can be used to treat diabetes in humans. Animal insulin carbohydrate metabolism regulatory function strength varies when used for humans (people are more or less sensitive to animal insulin).
Pig insulin is particularly close to human insulin and both pig and bovine (beef) insulin were originally used to treat persons with diabetes. Both can produce allergic reactions in some people and today synthetic human insulin is most widely prescribed (but there still can be allergic reaction to synthetic insulin or buffering agents added to longer-acting insulin). (See Reactions to Insulin)
Through genetic engineering of the underlying DNA, the primary amino acid sequence of insulin can be changed to alter certain important characteristics. These characteristics are its Absorption, Distribution, Metabolism, and Excretion (ADME).
The ADME modifications are used to created two types of insulin:
Note: Persons on insulin pumps receive small, frequent boluses automatically via the pump set. Insulin pumps almost always use only rapid acting insulin that is continually administered in small doses to create "background" insulin. This is what shutting down the pump can quickly lead to hyperglycemia (because there is no long-acting insulin present in the body).
Medical preparations of insulin are never just insulin and water alone. Clinical insulins are specially prepared mixtures of insulin plus other substances. These delay absorption of the insulin, adjust the pH of the solution to reduce reactions at the injection site, and so on. Some recent insulins are not even precisely insulin, but so called insulin analogs.
The insulin molecule in an insulin analog is slightly modified so that they are:
Page Updated 09/02/2006