Islets of Hope treatment options for persons with diabetes

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Article by Lahle Wolfe

Sources
E-MedicineHealth
Medline Plus
Hottub therapy in diabetes
RxList.com


More Insulin Information

Action of Commonly Prescribed Insulin (chart)

Content of Insulin

Description of Types of Injected Insulin Available


Diabetes Treatment & Management

Diabetes Type 1
Diabetes Type 2 
Pre-Diabetes
Gestational Diabetes
Diabetes Insipidus
Treating Hypoglycemia
Treating Hyperglycemia
Monitoring Your Blood Glucose
How to Give a Glucagon Shot
Diabetes Complications


real life parenting of kids with diabetes  
Virginia Nasmyth Loy
Real Life Parenting of Kids with Diab
etes:  When Loy's sons, Spike and Bo, were diagnosed with type 1 diabetes within a year of each other, Loy became an expert on managing the disease. Earlier this year, Spike and Bo (now in their teens) wrote Getting a Grip on Diabetes, and now Loy weighs in with her advice for parents.

sweet kids  Betty Page Brackenridge
Sweet Kids:
 In Sweet Kids, you get all of the practical, reassuring advice you need to care for children with diabetes. This new edition includes information on the latest medications and recommendations from the recently completed Diabetes Prevention Program.

type 1 diabetes in children, teens and young adults  Ragnar Hanas
Type 1 Diabetes in Children, Adolescents, and Young Adults:: It is an incredible book, which deals in depth with every detail of diabetes care in young people. Dr Charles Fox, Consultant Physician at Northampton General Hospital, UK

 Tim Wysocki
The Ten Keys to Helping Your Child With Diabetes
:  
This second edition explores the wide range of physical, emotional, and psychological issues that affect diabetic children and helps parents deal with them. New to this edition are topics such as children living with type 2 diabetes and the special needs of children using an insulin pump.  Wysocki, Ph.D. is the chief of the division of psychology and psychiatry at Nemours Children’s Clinic in Jacksonville, Florida, and has been in practice for more than 20 years.


Did you know?

... that excessive amounts of caffeine can mimic the symptoms of hypoglycemia?  You may feel like you are low even though your blood glucose is in a normal range.  In children, this may even cause a slight rebound effect by triggering the liver to release glycogen into the blood stream.

... that caffeine also increases the production of adrenaline which can also cause, or make hypoglycemia worse?

... that caffeine intensifies the action of insulin?

... that moderate amounts of caffeine may increase hypoglycemia sense of awareness?


Links about caffeine and hypoglycemia

Dissociation of augmented physiological, hormonal and cognitive responses to hypoglycaemia with sustained caffeine use.  The influence of caffeine on hypoglycemic sympto- matic awareness depended upon the duration of the hypoglycemic stimulus.  At onset, symptoms were more intense in caffeine- withdrawn state ( P <0.01); however, with increasing duration of hypoglycaemia, symptom intensity was greater in caffeine-replete condition ( P <0.05). Thus previous caffeine consumption influences the physiological and symptomatic responses to acute hypoglycaemia, but complete tolerance does not develop with sustained use.

HealthEd@msu

Vita Cost

AllergyCenter.com


Did you know?

...that taking a bath or shower or soaking in a hot tub soon after taking a shot of insulin can cause hypoglycemia?  Blood vessels in the skin dilate from the hot water and cause insulin to be rapidly absorbed.

 

islets of hope diabetes medical library                               main Treatment Options page
Diabetes  treatment options - medications

Insulin therapy

Insulin reactions:  allergies, drug interactions, insulin shock, and
                                 insulin sensitivity factors


Mini Site Index
Insulin Shock
Allergic reactions to insulin, buffering agents, and latex
Things that increase insulin sensitivity or increase rate of absorption
Bathing too soon after taking insulin can cause hypoglycemia
Things that decrease insulin sensitivity or rate of absorption (insulin resistance)
Drugs that may interact with, or affect insulin

Insulin shock

Insulin shock is a term used to describe severe hypoglycemia (low blood glucose) usually resulting from administering too much insulin, or, from not eating enough food to cover a food bolus of insulin.  Other things can also contribute to hypoglycemia (see Causes of Hypoglycemia).

Read about Insulin Shock in detail; it's symptoms, causes, treatment,  and prevention.  


Allergic Reactions to Insulin, Buffering Agents and Latex

Allergic reactions to animal insulins are not uncommon, however, a true allergy to the new synthetic human insulin is rare. What is more likely, however, still not common, is an allergic reaction to buffering agents in longer-acting insulin.

Call your doctor if any of the following symptoms develop:

  • Mild allergic reactions:   Swelling, itching or redness at the injection site (usually disappears within a few days or weeks)
     
  • More serious allergic reactions:   Fast pulse, low blood pressure, perspiration, rash over the entire body, shortness of breath, shallow breathing, or wheezing

My daughter Elizabeth was diagnosed with type 1 diabetes at age 4.  Only a few days into shot therapy she began to raise angry red welts all over her body almost immediately after shots.  There was no choice but to continue giving her insulin shots so her doctor added Bendryl to her diabetes care plan; it didn't work.  In addition to the welts, a few days later she began wheezing (she never had asthma prior to this occasion).

Since Elizabeth was taking two type of insulin, regular and long-acting, her doctor took her off the long-acting insulin as well as switched her to non-latex syringes in case it was an allergy to latex.  After a few days on only regular insulin, her reaction cleared up.  

When her reaction subsided, her doctor then added another brand of long-acting back into her routine her allergic reaction immediately returned.  In the end, it became apparent that Elizabeth was allergic to a buffering agent, not insulin, and was put on an insulin pump almost immediately in order to avoid 8 shots a day on only regular insulin.

When a person has a true allergy to insulin there are basically three things that can be tried:

  • Switch to another type of insulin (to animal, for example and hope for the best)
  • Take steroids to suppress the immune system
  • Attempt to desensitize the person to the allergen (this takes time and the patient must be hospitalized)

If you experience allergic reactions after taking insulin, it is important that you report it immediately to your doctor because reactions tend to get worse over time and can result in anaphylactic shock or death.  But take heart knowing it is more likely that the reaction was to an agent other than insulin or even perhaps to latex (found in bandages, syringes, and the rubber stopper on most vials of insulin).  Some people are even allergic to the adhesives and adhesive removers applied to the skin to hold insulin pump canulas in place.

If you are allergic to latex, you can switch to latex-free syringes, and one company (at least in 2004) manufactures latex-free insulin stoppers.  If the culprit is a buffering agent found in longer-acting insulin, talk to your doctor about going on an insulin pump so that you can take rapid insulin via the pump and avoid having to take shots every couple of hours.


Things that increase insulin sensitivity or increase insulin absorption rate

Many things can increase insulin sensitivity, or increase the absorption rate of insulin:

  • Anti-diabetes medications (i.e., Actos, Avandia, Glucophage)
  • Losing weight (even 15 lbs can make a difference in insulin sensitivity
  • Excessive amounts of caffeine
  • Getting adequate rest (studies show persons with insomnia tend to have a higher incidence of insulin resistance)
  • Consuming alcohol, especially without eating can lead to hypoglycemia
  • Exercise, especially in you inject into a muscle (i.e., thigh) that will be used a lot
  • Bathing too soon after injecting insulin
  • Hot weather
  • New injection or canula sites not previously used
  • Injecting insulin in muscular areas (fattier tissue areas may require more insulin)

Exercise can increase insulin sensitivity by as much as 15%, especially in those who are insulin resistant from metabolic disorders including PCOS, thyroid disease, and type 2 diabetes.


Bathing too soon after taking insulin can cause hypoglycemia

Bathing and hot tubs can increase the rate of insulin absorption because hot water increases circulation in the body and can cause temporary increase in insulin absorption.  For this reason, it is important to time shots and insulin boluses (via a pump) so that you don't give insulin and hop right into the tub.  Taking hot baths immediately following injections can cause insulin to be absorbed more rapidly and may result in hypoglycemia (low blood glucose).  

Try to wait 1-2 hours after injecting (or bolusing with a pump) insulin before bathing.  This is especially important for small children who are more likely to experience an increase in body temperature from bathing which can result in severe hypoglycemia.


Things that decrease insulin sensitivity or rate of absorption

Metabolic Insulin Resistance

When a person is insulin resistant, as in the case of most persons with type 2 diabetes, they create insulin, but do not respond to insulin normally.  A person who is insulin resistant may have perfectly normal blood glucose levels but also be overproducing insulin in order to maintain normal levels.  Excessive production on insulin is called "hyperinsulinemia."  If you are being checked for type 2 diabetes, polycystic ovarian syndrome, or any other disorder where an oral glucose tolerance test is being administered ask your doctor to check your insulin levels at the same time blood glucose is checked.

Other Factors That Can Decrease Insulin Action

There are many things that can make a person resistant (less sensitive) to insulin:

  • Being overweight
  • Being inactive
  • Sudden reduction in caffeine intake
  • Improperly stored insulin can lose its potency
  • Certain medications
  • Insomnia; sleep deprivation
  • Aging
  • Yo-yo dieting and eating disorders
  • Diet high in processed carbohydrates and fat
  • Certain medical disorders (thyroid, polycystic ovarian syndrome, metabolic syndrome, etc.)

For persons on insulin, factors that can make you less sensitive to the effects of insulin include:

  • Not rotating injection sites often enough.  Repeated insulin injections in the same part of the body can cause lipodystrophy, an alteration to the subcutaneous (i.e., under the skin) fat layer that can slow absorption of the medication. 
  • Hyperglycemia (it make take more insulin for a body to respond to a correction bolus when over 300 mg/dL), especially when hyperglycemia is chronic.

While uncommon, persons with type 1 diabetes can also have a combination that includes type 2 diabetes.  This form of combination diabetes calls for the person to take insulin (type 1) but they are resistant to it (type 2) even when taken by injection.


Drugs that Can Interact with, or, Affect Insulin

  • Some beta-blockers (e.g. propranolol) may make the symptoms of hypoglycaemia less obvious.
  • Alcohol may enhance the effect of insulin, and may make it work longer (increasing the risk of a hypo); it is important not to have alcohol without eating some food
  • ACE inhibitors may reduce the amount of insulin needed
  • Aspirin
  • Oral contraceptives can have a small effect
  • Thiazide diuretics, e.g. bendrofluazide
  • Corticosteroids e.g. prednisone or prednisolone
  • Thyroid hormones
  • Diltiazem and other calcium channel blockers
  • Cold remedies containing a decongestant
  • Liquid medicines often contain sugar and/or alcohol
  • Certain herbs, supplements, and vitamins (including cinnamon, vinegar, chromium)

Check with your doctor or pharmacist about a possible interaction if other medicines are prescribed for you.

 

   

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Page Updated 03/12/2006