Insulin Therapy 101 – Insulin Injection Basics

Insulin is a hormone produced by your pancreas whose primary function is to lower blood sugar. It does this by binding to insulin receptors on the cell wall which open glucose transporters. Once the glucose transporters are opened by the action of insulin, glucose can flow freely from the blood into the cell.

If you are insulin dependent your body relies on insulin injections in order to function correctly. This is either because your pancreas is not secreting any insulin, as in type 1 diabetes), or else the insulin that your pancreas is making is not doing its job properly, as in type 2 diabetes.

Insulin Basics

Before we jump into discussing the various insulin regimens, I need to first explain two terms which you will come across frequently:

Basal insulin – This is the injection of a long-acting insulin which mimics the insulin secretion of the pancreas. A single basal shot of insulin continues to act slowly throughout the day, therefore you only need to inject it once or twice daily. These long-acting insulins are “peakless” which means that they try and maintain the same glucose level throughout the day, unlike the fast acting insulins which result in a rapid decrease in blood sugar.

Bolus insulin – A bolus is a medical term for a single dose. Bolus insulin is given when you eat food in order to counteract the rapid increase in blood glucose after a meal. Bolus insulins are typically fast-acting, some of which start bringing down blood glucose in a matter of minutes. They do not remain in your system for long, being metabolized and excreted out of the body usually within a few hours.

So, to summarise… basal insulin keeps your blood sugar stable in the absence of food, but when you eat you need to take a bolus of fast acting insulin in order to counteract the sudden increase in blood sugar which comes from the breakdown of carbohydrate into glucose.

When Is Insulin Needed?

Insulin is always necessary for the treatment of type 1 diabetes, because there is a complete lack of the hormone in these patients. Type 2 diabetics do not usually require insulin until the disease has progressed to a point where the patient has become highly resistant to insulin, or when oral antidiabetic medications are no longer enough to keep blood glucose levels down.

A patient with insulin dependent type 2 diabetes has to use insulin in the same way as type 1 diabetics. However, there is a difference in that type 2 diabetics usually have to take much larger doses of insulin than type 1 patients because they have become so resistant to the effects of insulin.

For many type 2 diabetics, the addition of a long acting (basal) insulin such as Lantus or Levemir is usually enough to provide enough help to assist the body’s own insulin in doing its job. If this is still not effective enough, a basal dose can be taken in addition to fast acting boluses of insulin at mealtimes.

Insulin Mixtures

These come premixed under certain brand names, a popular one is a 70/30 mix (70% long acting, 30% fast acting) called humulin or mixtard. These are usually taken before breakfast and supper.

However, the combination of basal and bolus injections provides much tighter glucose control and is a more flexible system than taking premixed insulin. This is because you can vary the amount and timing of the bolus to match what type of food you eat and when you eat it.

With mixtures of insulin such as the 70/30 mix, you have to take it on a rigid schedule, and you can only eat a certain number of carbohydrates each day and at a scheduled time. You are not able to vary the timing of the injections because they contain both slow acting and fast acting insulin, and you are not able to eat more or less food depending on how hungry you are that day.

How to Inject Insulin

Depending on the insulin regime prescribed by your doctor, you may have to inject insulin via a traditional syringe. However, the majority of patients now are using injection pens which come pre-filled with insulin as they are much easier to use. In either case, the following basics apply:

Step 1: If using a syringe, roll the insulin vial (or the syringe itself if it has been pre-filled) between the palms of your hands a number of times before filling the syringe to redistribute any particles that may have settled to the bottom. This ensures an even concentration of insulin in each dose. The same applies to insulin pens, but they should also be shaken as most pens have a small glass ball inside which can move around and mix the insulin thoroughly.

Step 2: Choose an injection site and pinch the skin slightly. Position the syringe or pen so that the insulin is injected under the fatty layer of the skin. Note that a 45 degree angle is best for children and adults who are very thin, otherwise a 90 degree angle may be more appropriate.

Step 3: You should rotate your injection site regularly. Insulin is best absorbed through the abdominal area so rotating injection sites in this area is ideal. You could visualize your abdomen as a grid of 8 squares. Assign to each square a particular day and change to a new one each day of the week.

Insulin Injection Tips

1. Subsequent injections should be delivered at least 1 inch away from the previous injection site.

2. It is not necessary to disinfect the injection site with an alcohol swab as long as your skin is clean.

3. If necessary, insulin may be injected through clothing, but this is not recommended.

4. Never shake a vial of insulin as this creates air bubbles which can clog the syringe.

5. Never mix one type of insulin with another in a single syringe. This can make it’s effects erratic.

6. Try not to inject insulin into muscle tissue. It is painful and the insulin is absorbed too quickly and cause hypoglycemia.

Insulin Pumps

Insulin pumps are normally used in type 1 diabetes [] however they can work as effectively for insulin dependent type 2 diabetics also.

Some advantages of using an insulin pump include:

You change your infusion site once every 3 days, so if you have a dislike of needles, insulin pumping is better than having to inject yourself times a day.

You will use less insulin with a pump than on injections. Insulin pumps only use fast acting insulin which is more efficient than the slow acting types. Typically you use 20% less insulin when using a pump.

Because you have more control of the amount of insulin you take, if you are motivated, you can achieve much lower HbA1c (glucose average) than with injections. This improved control is due to the fact you can take doses that are not whole units, but fractions of a unit.

A new development in the area of insulin pumps is the advent of the artificial pancreas. This device combines an insulin pump with a continuous blood glucose meter, and automatically calculates how much insulin you need, minute by minute. This device is not currently on the market, but foundations such as the JDRF have invested a lot of money into it’s R&D. Human trials are currently underway.

Is an Insulin Pump Right For Me?

Not everyone is suited to pump therapy, and it usually reserved for cases of type 1 diabetes or insulin dependent type 2 diabetes. In order to be successful at using an insulin pump:

  • You need to be good at counting carbohydrates. You have to manually program the pump with the number of carbohydrates you are going to eat. It then calculates the dose of insulin to give you.
  • You need to be comfortable working with technology. If you are unable to basic devices such as a cell phone, then the insulin pump is not for you. However, as you are reading this information on your computer, this is likely not the case.
  • You need to be patient in order to give the pump a chance to impress you. It usually takes at least a week or two before your glucose levels reach a healthy level. It will also be at least several more weeks after that before you become confidant with adjusting the device.
  • You need to have a cool head rather than anxiety prone. When your glucose level starts to seem a little scary you have to quickly figure out what changes you need to make. Your doctor will be able to assist you with the learning curve at first, but you will eventually have to cope with the device on your own as the lag time between seeing a problem and getting help is too long for another person to control your pump for you.
  • Finally, you must be willing to test your blood glucose level with a glucometer about 8 times per day and more often when you are making adjustments to your routine.

Insulin Infusion Therapy For Type I Diabetes – What is an Insulin Pump?

Decades ago, people with Type I (juvenile) diabetes had to rely on regular injections to control blood glucose levels. Today, insulin infusion (also known as insulin pump therapy) has eliminated the need for painful, frequent and invasive injections for tens of thousands of diabetics. 

Type I diabetes is an autoimmune disease. It causes the body to destroy the cells that produce insulin, a hormone which is critical to regulating the body’s level of blood glucose.  The disease typically manifests itself in childhood or the teen years (though it has been found babies and in young adults.) 

Those with Type I diabetes must use manufactured insulin delivered through the skin directly into the body. Before the development of the insulin pump, the only way to deliver the hormone was by injecting it into the blood via a needle. Sufferers had to test their blood throughout the day, usually by pricking a finger and applying a droplet of blood to a test strip. The strip indicates blood glucose levels in the body, and determines whether or not an insulin injection is needed. 

The development of insulin infusion makes delivery of this critical hormone easier and less prone to human error and the pitfalls of guesswork. Insulin infusion takes place through the use of an insulin pump. 

An insulin pump consists of a small, digitalized computer, a cannula (or tube) and a needle. The needle is inserted just under the skin of the patient, usually in the abdominal region. It is typically held in place by an adhesive pad or strip. The needle is connected to the digital pump device by the cannula. The needle remains under the skin twenty-four hours per day, and the small pump can be clipped to clothing, usually a belt or pants waistband. The entire device is relatively discreet and is difficult to detect underneath a person’s clothing. 

The insulin pump contains an internal reservoir which holds the hormone. Instructions for correct dosage amounts and injection timings are entered into the computerized device. Once programmed, the device will deliver the hormone through the tube and needle and into the body as required. The pump can also be manually activated if extra doses of insulin are needed which have not been pre-programmed into the device. 

Blood glucose levels must still be checked regularly. However, the need for manual needle injections of insulin is eliminated with the use of a pump. It may also reduce the total number of daily glucose tests that are needed. 

Insulin infusion for Type I diabetes is a relatively new technology, but is rapidly gaining acceptance in the medical community for its numerous advantages, which include:  

*Ease of administration: Insulin infusion has been a lifesaver for many Type I diabetes sufferers, particularly children. Children with Type I diabetes are able to attend school and participate in regular daily activity, and parents need not worry about finding someone to administer insulin to their child in their absence. Nor do they need to worry about a child going into insulin shock while at school. Parents can simply fill and program the pump and know that their child will receive the correct amount of insulin throughout the day. 

*Convenience: Insulin infusion is not disruptive to normal daily activity. Diabetics need not take time out of regular activities to administer insulin. 

*Dosage level control: Sometimes the amount of insulin a person requires is so small (particularly in the case of babies and very small children) that manual administration poses significant risk of overdosing. The insulin pump, on the other hand, can accurately deliver even very small amounts of insulin to the body. 

Unfortunately, insulin infusion is considered to be too new a technology by many insurance companies. Therefore, many of them do not cover insulin pumps for diabetic patients. However, insulin pumps have frequently proved themselves to be life-saving devices, especially in children, and they are slowly becoming recognized as a legitimate and necessary form of Type I diabetes treatment rather than merely devices of convenience. Pressure from consumers and the producers of insulin pumps have caused some insurance companies to change their policies regarding the coverage of insulin pumps. It’s likely that more companies will follow suit in the years and decades to come.

Some Enlightening Information About Insulin Resistance and Insulin Resistance Syndrome

Believe it or not – I was astounded! Well over 60,000 searches are done online each and every month for the term insulin resistance. That means a lot of people are curious, and possibly concerned about this. As they should be. It also means that a lot of people are confused about it… and they shouldn’t be.

Here is some information that hopefully will clarify some of the “mysteries” surrounding insulin resistance and insulin resistance syndrome.

Most cases of reactive hypoglycemia (1) are labeled idiopathic, which means “unknown cause”. I believe insulin resistance causes most cases of idiopathic reactive hypoglycemia, and that insulin resistance is caused, in turn, by diet and heredity. Insulin resistance can be an early warning sign of Type II diabetes and studies have shown that Type II diabetics may have been insulin resistant for up to 12 years before diagnosis.

(1. By far the most common cases of chronic hypoglycemia are types of reactive hypoglycemia. Reactive hypoglycemia is also called postprandial hypoglycemia, postprandial syndrome or functional hypoglycemia and symptoms appear two to five hours after you eat. Postprandial, by the way, simply means, “after eating”.)

Insulin is supposed to trigger the acceptance of circulating blood sugar (glucose) into the body’s cells, but over time and with an over refined diet, your cells can become insulin resistant. When cells are insulin resistant, it takes increasing amounts of insulin to trigger the acceptance of additional sugar into cells in your body.

Unchecked, this often progresses to Type II diabetes when your pancreas just gives up after years of producing more insulin than it was meant to. Your blood pressure, cholesterol and tryglycerides readings go up, and you are now at risk of heart attack.

Syndrome X (aka Insulin Resistance Syndrome) is defined as insulin resistance with high blood pressure and high tryglycerides. If you have Syndrome X, you are also at increased risk of developing cancer.

As with almost everything, some people are more quickly affected by adverse conditions than others are. We already know that some people are more likely to get diabetes or cancer or heart disease. And this is at least partly because some people are more likely to have trouble with our over processed and over refined diet. This is the heredity component of insulin resistance. The more refined foods, especially sugar, that we eat, the more insulin the pancreas produces. No one should be eating the amounts of sugar that most of us do, but some people’s bodies can resist the effects longer.

Insulin resistance happens when your body has been overwhelmed with too much insulin for so long that your cells stop listening. For the cells of your body, a constantly high level of insulin is just like constant noise in your ears.

Over time, you learn to ignore the noise, and it takes a louder sound to get your attention. Your cells view insulin in the same way. It takes more and more insulin to get your cells to pay attention. When your cells ignore insulin and refuse to “open” to take in sugar from your blood, your pancreas simply sends more insulin until your cells begin to respond. The excess insulin has several effects. First, by the time the cells finally begin to accept sugar, there is so much insulin available that your blood sugar drops too much-hypoglycemia. Second, insulin resistance causes more insulin resistance, so eventually there is a lot of insulin floating around your system all the time.

All that insulin makes it difficult to keep your blood sugar steady. When the insulin resistance train has been accelerating on its track for a while, your body really isn’t handling sugar properly anymore, and you will have an “abnormal sugar metabolism”. One way an abnormal sugar metabolism will show up is in chronic hypoglycemia.

Processing sugar is hard work. Eating a donut or a cookie or a granola bar causes a blood sugar spike that the pancreas must deal with. Every spike requires the release of insulin to get it back under control. If we eat a lot of refined foods containing a lot of sugar, we find ourselves living on the blood sugar roller coaster. Abnormal sugar handling, over time, causes increased insulin resistance.

We know that a high level of sugar in the blood is bad. That’s why diabetics stop eating sweets and take medication. A high level of insulin is also bad, but more insidious. Insulin is not meant to sit around in the body all the time, and excess insulin causes a host of problems. For one thing, insulin is a storage hormone, so if you have too much insulin, you will gain weight because excess sugar is stored as fat.

Excess weight is a major risk factor for diabetes, and so is overworking the pancreas by producing too much insulin. In early Type II diabetes, the pancreas is working very hard to keep up with the demand. Insulin levels in the body are abnormally high, and your blood sugar may be alternating between high and low. This leads to full-blown diabetes when the over-worked pancreas simply can’t produce the amounts of insulin needed to overcome the insulin resistance of the body’s cells. This slide into Type II diabetes is much more likely in people who are significantly overweight. Sixty-five percent of people living with diabetes will die of a heart attack or stroke.

In addition to Type II diabetes, insulin resistance can cause an increase in blood pressure, “bad” cholesterol and tryglycerides. Dr. Gerald Reaven first recognized that these problems are linked in the late 1980s. He coined the term Syndrome X because no one knew at the time how these problems were linked or what caused them. But it is as clear now as it was then-this combination is a heart attack waiting to happen!

In his book, Syndrome X, Dr. Reaven states that Syndrome X “…may be the cause of 50 percent of all heart attacks”. Dr. Reaven also suggests that Insulin Resistance Syndrome “…affects between 60-75 million Americans”. More recently, experts have also come to believe that Syndrome X (aka insulin resistance syndrome) also increases the risk of cancer.

The more of the following risk factors you have, the greater the chance you have Syndrome X:

Overweight, a sedentary lifestyle, over age 40, non-Caucasian ethnicity, a family history of Type II diabetes, high blood pressure or cardiovascular disease, a history of glucose intolerance, a diagnosis of high blood pressure, elevated triglycerides/low HDL cholesterol, or cardiovascular disease.

This makes it very clear that whether or not you are hypoglycemic or have high blood sugar, you may be at risk if you have any of these risk factors. Consult your physician, and be prepared to change your diet and your lifestyle ASAP to turn back the advance of abnormal blood sugar, insulin resistance and Syndrome X!