Insulin

This year we celebrate 100 years since the discovery of insulin and the fact that people diagnosed with Type 1 diabetes can live a long life.

Dr Angela Murphy continues.

Insulin Fast Facts

  • Basal insulin gives the necessary background insulin and specifically controls glucose released by the liver when a person has not eaten. It is longer acting and is usually given as a daily dose; in some patients the dose can be split and given twice daily.
  • Short-acting insulin is needed to absorb glucose derived from food eaten at mealtimes. The timing of bolus insulin is one of the biggest challenges for people living with Type 1 diabetes. It is essential that glucose and insulin ‘meet’ and do not miss each other. This means that the bolus injection must be given BEFORE MEALS and often up to 30 minutes before the meal. This holds true even for the new analogue insulins. No insulin is fast enough that it can be injected at the time of eating or even after a meal.
  • Pre-mix insulin has a fixed ratio of short-acting insulin and intermediate or long-acting insulin (ones that are usually used as basal insulins) and must again be given BEFORE MEALS. They are usually given twice daily before breakfast and before supper. In some instances, they may be used for the breakfast dose and other insulins used for the rest of the day – this is particularly the case with children when trying to cover food eaten at school.
  • Concentrated insulin – insulin is usually packaged as 100u insulin per ml liquid; a concentrated insulin may deliver more insulin per ml. In South Africa we have a U300 glargine (long-acting) and a U200 lispro (short-acting). The advantage is for people injecting big doses of insulin they can do with less liquid volume which is much more comfortable. There seems to be less hypoglycaemia overnight with U300 as well.

Insulin being used can be kept at room temperature but spare insulin in the fridge. It is more cost effective and envirometally friendly to use cartridges instead of disposable pens. Good insulin injection techniques are essential to achieve good glucose levels. This means changing the needle on the insulin pen after every 3rd injection and rotating sites constantly.

We live in a time of innovation. Newer insulins are always been researched and we now have ULTRA-FASTING ACTING insulin which may be even easier to use for meal-time insulin. Insulin has also been combined with Glucagon-like Peptide-1 analogues to give the benefit of both glucose and weight control. However, even the most basic insulin is life-saving and if used correctly can still contribute to good diabetes control.

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