My Diabetes Project – Insulin treatment

Diabetes information and services in Europehttp://mydiabetes.eurohealth.ie

Insulin is often used when any other medications aren’t helping to control your blood glucose levels, but can also be used alongside those medicines. You have many options when it comes to insulin treatments, so you can pick the option (or options) that work best for your individual situation.

1. There are three main kinds of insulin: animal, human (which has been produce   d synthetically to match human insulin), and insulin analogues (which has the same chemical structure of human insulin but has been changed to make it work more quickly or last longer). Most people today use human insulin or analogues, but some find that animal insulin works better for them.
   1. Some insulin analogues last a whole day (long-acting), some last for about 8 hours (short-acting), and some work quickly but don’t last very long (rapid-acting).
      1. Rapid acting analogues—these should be injected right before eating and have a peak action between 0-3 hours, but can last for a total of 2-5 hours. These only last long enough for the meal before which they are taken.
      2. Long-acting analogues—these are injected once or twice a day and provide background insulin that last about 24 hours. These don’t have a peak action so they don’t need to be taken with food.

• Very long-acting analogues—these are best for people who can’t inject themselves as they provide insulin for up to 42 hours, but are still injected about once a day. These also do not need to be taken with food.

1. Short-acting insulins—these should be taken 15-30 minutes before eating to help with the rise in blood glucose levels that occur after a meal. They have a peak action of 2-6 hours and last for about 8 hours.
2. Medium- and long-lasting insulins—these are taken once or twice a day to provide background insulin, or in combination with short-acting insulins/rapid-acting analogues. Their peak is from 4-12 hours and can last up to 30 hours. These are the only insulins that appear cloudy and not clear.
3. You can also take mixed insulin or mixed analogues, which are combinations of medium- and short-acting insulins/analogues.

2. Insulin has to be injected so that it can enter your bloodstream. If you took it in tablet form, it would be broken down in your stomach and never make it to your bloodstream. If you need to inject insulin, you will be advised when to do it, how to do it, and where to do it on your body. They will also give you advice on how to store the insulin and how to dispose needles properly. You can either inject insulin with a syringe or an injection pen (also called an auto-injector), and will likely need to 2-4 injections each day.
   1. The needle you use to inject insulin is very small, and the insulin only needs to be injected right underneath the skin (as opposed to in a muscle or vein). After you inject it, it is absorbed by small blood vessels and then taken to the bloodstream where it can help control blood glucose levels.
   2. There are 3 main areas where you can inject insulin—the stomach, buttocks, and thighs—although your healthcare team may suggest another site like your arm. What’s important is that you rotate injection sites so that there is no build-up of lumps underneath the skin (called lipohypertrophy), which could also cause uneven absorption of the insulin, meaning it won’t be as effective in controlling blood glucose levels.
   3. Before you inject, make sure that your hands and the area you’re injecting are clean. Also make sure that you are using a new needle, as reusing needles will blunt the tip and make injection painful. Because the needles are so small the injection shouldn’t hurt, although they might be slightly painful or uncomfortable at first, especially if you’re tense or nervous. But once you get used to the injections, they will get easier and many people say they become second nature.
   4. How to inject insulin:
3. Eject two units of insulin into the air to make sure the tip of the needle is filled with insulin (this is called an ‘air shot’).
4. Choose an area where there is plenty of fatty tissue, such as the tops of thighs or the bottom.
5. If you have been advised to, lift a fold of skin (the lifted skin fold should not be squeezed so tightly that it causes skin blanching or pain) and insert the needle at a 90° angle. With short needles you don’t need to pinch up, unless you are very thin. Check with your diabetes healthcare team.
6. Put the needle in quickly. If you continue to find injections painful, try numbing an area of skin by rubbing a piece of ice on the site for 15–20 seconds before injecting.
7. Inject the insulin, ensuring the plunger (syringe) or thumb button (pen) is fully pressed down and count to 10 before removing the needle.
8. Release the skin fold and dispose of the used needle safely.
   1. How to store insulin:
      1. Insulin must be kept at temperatures lower than 25C, ideally between 2 and 6C. This shouldn’t be a problem, as most room temperatures are below 25C, but can get warmer during the summer months. Any insulin you are not currently using should be stored in the fridge throughout the entire year—just don’t put it too close to the freezer compartment, as this could damage the insulin. If the insulin has been left out of the fridge for 28 days or more, you should throw it away.
      2. These are general guidelines that work for most kinds of insulin. But sometimes different types of insulin have different storage needs, so make sure you read the patient information leaflet that comes with yours!
   2. How to dispose of needles and lancets:
      1. It is very important to dispose of your needles safely to avoid injuring or infecting anyone. All needles, syringes, and lancets should be put in a sharps disposal box and NOT a regular trash bin. You can also get a clipper, which safely snaps off the sharps from syringes and pens and can also be used to store them, by prescription. The clipper should also be put into a sharps disposal box when it is full.
      2. Different countries have different arrangements in place for how to dispose of your sharps disposal box when it is full, so make sure to contact your local healthcare provider to find out your city’s plan.
   3. Syringes vs. insulin pens (Diabetes self-management.com)
      1. Syringes are disposable, with plastic barrels and thin needles coated with lubricant to make sure they enter the skin smoothly. Most syringes come with the needle already attached.  If you use a syringe to inject your insulin, you would likely purchase the insulin in a vial, which are small glass bottles that usually hold 1,000 units of insulin.
      2. Pens were first introduced in the mid-1980s, and many people around the world have moved from using syringes to using insulin pens. There are two main types: disposable pens that come with the insulin already inside, or reusable pens that take a prefilled cartridge of insulin. Both types have a dial on the base that allows you to select the size of the dose you want to inject.
         1. Disposable pens: They are thinner, lighter, and made of plastic. They come prefilled with 300 units of insulin, and when they’re empty you simply throw it away and get another pen. You can buy them filled with almost every time of modern insulin/analogue, but they can only deliver in full units.
         2. Reusable pens: made of metal, relatively heavy, and hold prefilled cartridges that also contain 300 units of insulin. Some only deliver insulin in full units, while others can deliver half-units.
         3. Both types of pens are used with a disposable pen needle which attaches to a base that screws or snaps on to the pen. Make sure that you have a prescription for the pen needles along with the pens themselves.

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