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What About Insulin?

August 23rd, 2015 | by American Association
What About Insulin?
Living With Diabetes
42

Although it is a common practice to try pills before insulin, you may start on insulin based on several factors, including the following:

  • How long you have had diabetes
  • How high your blood glucose level is
  • What other medicines you take
  • Your overall health

Combination Therapy

Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this “combination” therapy is to try to help insulin work better.

Insulin Basics

  • There are different types of insulin depending on how quickly they work, when they peak, and how long they last.
  • Insulin is available in different strengths; the most common is U-100.
  • All insulin available in the United States is manufactured in a laboratory, but animal insulin can still be imported for personal use.

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food.

In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals.

People with type 2 diabetes make insulin, but their bodies don’t respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots to help their bodies use glucose for energy.

Insulin cannot be taken as a pill because it would be broken down during digestion just like the protein in food. It must be injected into the fat under your skin for it to get into your blood. In some rare cases insulin can lead to an allergic reaction at the injection site. Talk to your doctor if you believe you may be experiencing a reaction.

Types of Insulin

  • Rapid-acting insulin, begins to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog)
  • Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours. Types: Humulin R, Novolin R
  • Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH (Humulin N, Novolin N)
  • Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine (Lantus)

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination.

In 2015 an inhaled insulin product, Afrezza, became available in the U.S. Afrezza is a rapid-acting inhaled insulin that is administered at the beginning of each meal and can be used by adults with type 1 or type 2 diabetes. Afrezza is not a substitute for long-acting insulin. Afrezza must be used in combination with injectable long-acting insulin in patients with type 1 diabetes and in type 2 patients who use long-acting insulin.

  • Inhaled insulin begins working within 12 to 15 minutes, peaks by 30 minutes, and is out of your system in 180 minutes. Types: Technosphere insulin-inhalation system (Afrezza)
Read the Diabetes Forecast article Insulin Innovations – New forms of insulin at your pharmacy and on the horizon.

Characteristics of Insulin

Insulin has 3 characteristics:

  • Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
  • Peaktime is the time during which insulin is at maximum strength in terms of lowering blood glucose.
  • Duration is how long insulin continues to lower blood glucose.

Insulin Strength

All insulins come dissolved or suspended in liquids. The standard and most commonly used strength in the United States today is U-100, which means it has 100 units of insulin per milliliter of fluid, though U-500 insulin is available for patients who are extremely insulin resistant.

U-40, which has 40 units of insulin per milliliter of fluid, has generally been phased out around the world, but it is possible that it could still be found in some places (and U-40 insulin is still used in veterinary care).

If you’re traveling outside of the U.S., be certain to match your insulin strength with the correct size syringe.

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