Eric Timmy asked:


There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain.

When choosing a syringe, there are four things to consider:

Which insulin concentration it’s designed for

Its capacity

The needle gauge (or thickness)

The needle length

Your doctor can help you choose a syringe that’s designed for the insulin strength that you use as well as the needle gauge (children often need smaller gauge needles for comfort). For example, if you use U-100 insulin, use U-100 syringes; otherwise, you will inject the wrong amount of insulin.

Common syringe capacities in cubic centimeters (cc) are:

3/10 cc – designed for people who take less than 30 units of insulin per dose.

1/2 cc – works best for doses of 25 to 50 units

1 cc – holds doses up to 100 units of insulin

Choose the smallest syringe barrel that can hold the total insulin dose you need to take. This will make reading the unit increments on the syringe barrel easier.

Bad insulin can head to higher blood glucose levels. Insulin does not get to be kept refrigerated but it lasts longer when it is. All insulin should be discarded after the expiry appointment or 30 days after it was opened and pierced with a syringe, whichever is earlier. Insulin that has been frozen or exposed to any warmth origin should too be thrown away.

Note: If you are using an insulin pen, talk with your doctor or pharmacist about how to use the pen correctly. Giving insulin with these pens is not covered in this information.



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The choice of an insulin depends upon the condition of the patient. In emergencies such as diabetic coma, crystalline insulin (only soluble insulin) is preferred because of its quick onset of action. It is repeated at 6-hour intervals given intravenously usually, until the situation is under control. Crystalline insulin is also employed in combination with intermediate-acting insulin preparations for quick action. However, a dose of intermediate-acting insulins taken before breakfast is effective in controlling most cases of diabetes, other than some cases of juvenile diabetes, in which there is a marked rise in blood sugar during the night and in which, an additional evening dose may be needed. The use of long-acting preparations, with the hope of a single injection for controlling diabetes, has been disappointing and is not advocated. Premixed mixture of crystalline and lente insulin (Biphasic insulin) are convenient for tighter control of fasting and post meal blood glucose elevation. A large number of such preparations are available in the market. A convenient device is insulin pen (Nayolet) which has premixed insulin mixture and can be put into packet by executives or others who are on the move.

The dose varies with the severity of the condition and the response of the patient. Repeated estimation of blood sugar during the treatment is helpful in adjusting the doses. In general, the treatment is started with an intermediate-acting preparation and a dose of 10 to 15 units is given; 2/3 dose is given before breakfast and 1/3 dose before dinner. This is increased by 5 units per day with a constant monitoring of glucose levels of blood and urine till satisfactory control is achieved.

All the preparations of insulin are ineffective orally and have to be injected under the skin. Recently, computer-assisted, battery-driven implantable devices have become available, which inject insulin appropriate to the requirements (insulin pumps). Usually highly purified insulins are used in these devices. It will be a major breakthrough in this field if someone discovers a drug as effective as insulin that can be given orally.

Newer insulins are now available. They are 3 to 5 times more expensive. They have the advantage that insulin allergy, fat loss at the site of injection, and sometimes, fat accumulation, occur less frequently. The possibility of the formation of anti-insulin antibodies is also less.

The most common adverse effect is hypoglycaemia. Hypoglycaemia may be caused by the delay or omission of meals or by unexpected exertion. The symptoms of hypoglycaemia include intense hunger, sweating, palpitation of the heart, tremors, weakness, and irritability. These symptoms can be recognized early and can be relieved by sugar, glucose or sweets in 10 to 20 minutes. If you are taking acarbose with insulin injection then use only glucose and not household sugar. It is to be noted that long standing diabetics may not notice all of these symptoms of low blood sugar.

Insulin may cause allergic reaction at the site of the injection, characterized by stinging and itching sensations associated with reddening and swelling of the skin. Generalized allergic reactions are rare. Human insulin does not cause allergic reactions. Repeated injections of insulin at the same site may cause depression or elevation at the injection site (Lipodystrophy). In rare cases patients may not respond to insulin (due to insulin resistance). These problems are uncommon with human insulins.

Use disposable insulin syringes only for insulin by self-infection.

Reduce the dose of insulin if a meal is likely to be missed or physical exertion is likely.

Take suger or glucose if any symptoms of hypoglycaemia appear.

Consult the doctor immediately if any allergic reaction occurs.

Rotate the site of insulin injection i.e start from one thigh, then rotate to abdominal wall then forearm then upper arm after one side rotate to the next side.

Safron Jeen asked:


1. Daily estimation of blood sugar levels

Daily estimation of blood sugar levels is necessary in all cases of diabetes – three times a day i.e. fasting, before lunch and dinner. However, at least twice daily measurement of blood sugar levels must be taken – fasting and before dinner. All diabetics are advised to use a blood glucose meter at home for a regular check-up of their blood sugar levels.

If a diabetic finds more/elevated sugar in his blood, he should analyse as follows:

(i) What has he been doing for the last 2 hours? He may be under stress.

(ii) Did he eat more?

(iii) Did he get less insulin/oral drug?

He should act as follows:

(i) If the result is mild sugar, do exercise, jump, walk; the sugar will thus get consumed or dissipated.

(ii) Avoid stress.

(iii) If the quantity of sugar is high, he should regulate his subsequent diet, exercise and drugs.

(iv) If the sugar is alarmingly high, he should consult his physician immediately.

2. Self-insulin injection

If the patient is on insulin injections, he should preferably learn the technique of self-injecting insulin into the various sites of his/her body. In such cases one should know about the proper sterilisation of syringes, needles, or preferably use disposabl~ syringes as well as needles which are available particularly for injecting insulin. A device such as NovoPen 3, like a pen loaded with penfill (refill containing enough insulin which can be used for many days depending on the need of the patient) can also be used for administering the daily dosages of insulin, under the direction of the physician. The penfill can be replaced when exhausted.

3. Prevent diabetic coma

A diabetic should avoid fasting. Even if a diabetic is get ting diarrhoea/vomiting/both, he should take the insulin/oral drug along with glucose/sugar dissolved in water as soon as the situation permits. In advanced cases, referral to a hospital is important for glucose therapy along with parenteral insulin. If the above is not strictly followed, it will lead to diabetic coma which is a medical emergency.

4. More about diabetic coma

It occurs when the blood sugar level becomes below normal (hypoglycaemic coma) or very high (hyperglycaemic coma). In the former case the patient say have taken more than the prescribed dosages of antidiabetic drugs in over-enthusiasm to make the blood sugar levels normal, or he may have taken meagre food with the same dosages of antidiabetic drugs. In the latter case, the patient either misses the drug, or takes heavy food as well; the chances are much more when there is some infection in the body.

The symptoms / signs of both the above types of coma are different. In hypoglycaemic coma, the skin is moist with profuse perspiration which can be noticed even by a person standing nearby. All diabetics should be aware of these symptoms and as soon as they start perspiring, they should start taking sugar cubes which every diabetic is required to keep in his pocket. In hyperglycaemic coma, the skin is dry. To meet this emergency efficiently, diabetics are required to keep a card in their pockets indicating that they are diabetic, so that on reaching the hospital, the doctor on duty can immediately ascertain the cause of coma and start treatment.



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Molly Lyons asked:


Managing type 1 is a tall order for many kids. “The whole system hinges on adherence at every step: testing blood sugar, giving shots, recording every little thing they eat,” explains Naomi Neufeld, M.D., clinical professor of pediatrics at the University of California, Los Angeles. “But it doesn’t always happen, especially when your kids aren’t in your sight.”

The good news is that several innovations are making it easier for kids-and their parents or guardians-to keep careful control.

Monitors

Wireless blood-glucose meters using cell-phone or Bluetooth® technology store readings and can transmit them to a computer at home or at the doctor’s. The physician can view your child’s blood sugar history on a single screen, which makes it easier to spot trends and problems.

Talk to your doctor about the right device for your child. Some wireless monitors are not FDA-approved for kids, and your insurance may not cover them all. Some doctors also use the continuous glucose monitor with kids, even though it’s not FDA-approved for use with children. This device, which measures glucose levels in the tissue fluid under the skin, isn’t a substitute for the blood glucose monitor.

Insulin pumps

These wearable pumps for continuous administration of insulin can be a boon to kids. In one study from the Joslin Diabetes Center in Boston, school-age children on pumps monitored themselves more frequently, needed less insulin daily and had better blood sugar control than those using standard injection therapy. Studies have found that children as young as 18 months can use the portable pumps effectively. The pumps provide a baseline level of insulin throughout the day and can be programmed to give rapid-acting insulin analogues before or immediately after meals. Someone still has to enter the amount of insulin to administer, and that depends on what the child is eating.

Combination monitor-pumps

“These devices are the most promising to pediatric endocrinologists,” says Dr. Neufeld. The pumps sense glucose and automatically adjust insulin. The first model may be available this year.

New ways to deliver insulin

For toddlers, rapid-acting insulins are ideal. “At this age, you can’t always predict what they’re going to eat,” says Dr. Neufeld. (Inhaled insulin, which acts rapidly but lasts as long as regular insulin, is pending approval for use in children; its effect on developing lung tissue still needs to be determined.)

Endocrinologists are also investigating the treatment of other diseases in the hopes of finding applicable technologies. A new pen for injecting growth hormones, for example, records time and dose with an iPod-like device, says Dr. Neufeld, “and there’s no reason it couldn’t be used for diabetes.”

Be receptive to changes in technology, say experts, and ask your doctor to keep you up-to-date. The latest-and future-devices won’t take patient responsibility out of the equation, but they will make your life and your child’s life easier.

Source: Diabetes Care, November 2006.

Ask the Right Questions

Thinking of trying a new device? The American Diabetes Association advises asking your doctor:

* What experiences have other patients had with it?

* Have insurance companies covered the costs?

* Are there benefits to a pump over injections?

* What’s involved in going from injections to a pump?

* Is it clear how much insulin to use with a pump?

* If my child gets continuous insulin, how will it affect what she eats and how she exercises?

* What kind of training will my child and I receive?

* How often will blood sugars need to be checked?

* Does it hurt?

The latest crop of diabetic devices offer exciting possibilities for glucose control for children with type 1 diabetes-and adults, too. Find out which one is right your family.

Molly Lyons

©MDminute: Diabetes Issue 1, 2007



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