Insulin basicsBy Rima T. Tan MD
Philippine Daily Inquirer
Insulin is a hormone that maybe relatively or absolutely deficient in persons with diabetes. It is actually the most effective therapy for lowering one’s blood sugar. Some persons with diabetes are wary of starting insulin therapy for a variety of reasons, which include the fear of needles and the misconception that initiating insulin therapy represents a personal failure or a more severe type of diabetes.
Starting insulin therapy does not necessarily mean failure. Type 2 diabetes is a progressive disease that over time causes the deterioration of the insulin-producing beta cells of the pancreas. That is why many people with diabetes will eventually need insulin therapy. When non-insulin options, such as lifestyle modification and oral medications, are no longer adequate to control blood glucose levels, insulin is the next step in the continuum of therapy for type 2 diabetes.
There are also situations when insulin treatment is needed only temporarily, such as during pregnancy, surgery and other acute medical conditions. As for persons with type 1 diabetes, insulin therapy is a must because it is required for their survival.
Insulin must be injected and cannot be taken as a pill because enzymes during digestion break insulin down and render it ineffective. The good news is that today, insulin needles are smaller and thinner than ever before, so that the injections are almost painless once the fear of needles are subdued.
For persons with type 2 diabetes, a physician’s decision to prescribe insulin therapy is based on several factors, which include: how long the person has had diabetes; how high the blood glucose is; other complications present; other medications the person is taking, and his/her overall health.
There are different types of insulin depending on how quickly they work, when they peak and how long they last. Rapid-acting insulin analogs such as insulin lispro, insulin as part or insulin glulisine begin to work about 5 minutes after injection, peaks in about an hour, and continues to work for two to four hours. Regular human insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from two to three hours after injection, and is effective for approximately three to six hours.
Intermediate-acting human insulin generally reaches the bloodstream about two to four hours after injection, peaks 4 to 12 hours later and is effective for about 12 to 18 hours. There are also two long-acting insulin analogs: glargine and detemir. They both tend to lower glucose levels fairly evenly over a 24-hour period with less of a peak of action than the other types of insulin. There are also premixes of the different types of insulin available.
Some people with type 2 diabetes will need one or more injections per day along with diabetes pills. The decision as to the type of insulin and the frequency of injections will depend on a combination of factors, ideally decided upon by the physician, depending on the needs and also in agreement with the person with diabetes.
Insulin, when properly used in conjunction with lifestyle adjustments and other medications, can restore blood sugars to normal- or near-normal levels. Keeping blood sugar levels under control can definitely prevent or minimize complications, allowing persons with diabetes to lead fuller lives.
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Dr. Rima T. Tan is a diabetes specialist. The “Changing Diabetes” column commemorates the 92nd anniversary of insulin’s discovery. It aims to increase awareness on diabetes prevention, diagnosis and management. Novo Nordisk supports “Changing Diabetes.” Headquartered in Denmark, Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. For questions or comments, e-mail email@example.com or follow us at www.facebook.com/ChangingDiabetesPH.