Understanding Insulin

 


Outline for the videotape "Understanding Insulin", from The American Association of Diabetes Educators Patient Education Video Series, produced by Milner-Fenwick, Inc., copyright 2003.

 

**Funded through a grant from the Friends of the University of Michigan Hospitals. **

 


  1. How Insulin Works

A.     Food is changed to glucose, a form of blood sugar

B.     As blood sugar rises, pancreas gland releases insulin

C.     Insulin helps cells to use blood sugar for energy

D.     Normal blood sugar range = 70-120

E.      Diabetes occurs when blood sugar is too high (hyperglycemia).  Causes for diabetes:

1.      pancreas may not make enough insulin

2.      pancreas doesn’t supply enough insulin soon enough after you eat

3.      insulin resistance – cells have trouble using insulin

 

  1. Types of Insulin

 

Type

Onset After Injection

Peak Effect

Duration

Other Info

Rapid Acting

Lispro (Humalog)

Aspart (Novolog)

15 min.

30 min. – 1.5 hrs

3-4 hrs.

Drops blood sugar quickly so only take when ready to eat

Short Acting

Regular

30 min. – 1 hr.

2-3 hrs.

3-6 hrs.

 

Intermediate Acting

Lente

NPH

2-4 hrs

10-16 hrs.

10-18 hrs.

 

Long Acting

Ultralente

6-10 hrs.

10-16 hrs.

 

18-20 hrs.

 

 

Long Acting

Glargine (Lantus)

1 hr.

no peak – steady level for 24 hrs.

 

Take at same time every day usually taken at bedtime

Mixed Doses

-Combining short & longer acting insulins in same syringe by hand (e.g. Regular + NPH Insulins)

or,

-Premixed bottles, e.g. 70/30

NOTE:  Glargine (Lantus) cannot be mixed with another insulin in the same syringe.

 

  1. How to Use Insulin Safely

A.     Record blood glucose at specific times

B.     U-100 is standard concentration, use with U-100 syringe

C.     Check your insulin before using it – right type and brand, know your proper dose

D.     Store properly

1.      Extra insulin – store in cool, dark place, e.g refrigerator door

2.      Do not store where will be too hot or will freeze

3.      Bottle you are currently using – can store at room temperature for 28 days

4.      Check expiration date on bottle – do not use if expired

E.      Cloudy Insulins (NPH, Lente, Ultralente) – must be mixed before using.  Do not use if clumped or glass looks frosted.

F.      Clear Insulins (Aspart, Lispro, Regular, Glargine) – Do not use if cloudy or discolored

G.     Other medications may effect how Insulin works – Review all medications you take with your health care provider.

 

  1. Hypoglycemia (low blood sugar) = less than 70 mg/dl

A.     To avoid - must keep food intake and exercise in balance with your insulin

B.     Caused by: skipping a meal, exercise more than usual, taking too much insulin

C.     Symptoms: headache, weakness, cold sweat or clammy feeling, shakiness, hunger, irritability, dizziness

 

  1. Guidelines for treating hypoglycemia

A.     Test blood sugar.  If below 70 or too shaky, confused or too weak to check, treat with one of the following:

1.      4-6 ounces fruit juice or regular soda

2.      3 glucose tablets

3.      1 tube glucose gel

4.      5-7 Lifesavers

5.      8 ounces milk

6.      Some diabetes pills (Precose, Glyset) taken with insulin may slow the effect of some foods.  To treat hypoglycemia use glucose tablets, gel, or milk.

B.     Rest for 10-15 min. and test blood sugar again.

C.     If still below 80 or still feel some hypoglycemia symptoms, treat yourself again.

D.     To prevent blood sugar from dropping again within a few hours:  If next meal is within 30 min., eat it right away.  If more than 30 min. before next meal, eat a snack.

E.      If don’t treat hypoglycemia, will get worse and lead to unconsciousness.

F.      Glucagon – Injected by a family member if you are unconscious.  Requires a prescription.

G.     Tell your health team if having frequent hypoglycemia or have passed out.

H.     Alcohol may increase risk for hypoglycemia.  Discuss how to use safely with your health team.

 

  1. Sick Days

A.     Sickness raises blood sugar level

B.     Make a sick day plan with your health team before you get sick.  The plan includes:

1.      taking your insulin

2.      blood glucose monitoring

3.      drinking fluids

4.      eating

5.      over the counter medications that won’t interfere with your diabetes medication

C.     Continue to take your insulin.  Consult with your health team re: changing your insulin dose or if you are having difficulty taking your insulin as directed.

 

  1. Pattern Management

A.     Helps in determining whether adjustments to treatment plan are needed

B.     Check blood glucose at certain times of the day based on the type of insulin you take

C.     Keep good records including:

1.      date, time and blood sugar result, whether taken before or after a meal

2.      amount and type of medication

3.      type and amount of food eaten

4.      exercise – when and how long

D.     Review your records with your health care team