What Are The Drawbacks To Insulin Treatment For Diabetes
The biggest issue with insulin right now is unaffordability. A box of rapid-acting insulin can cost $400 without insurance. As so many people continue to lose their health coverage, its becoming an enormous problem, Dr. Zilbermint says.
Consistently rising costs have led some patients to ration their insulin, which can be dangerous and even deadly. The cost of testing strips is also an issue, and both have led to a black market in testing strips and insulin. Its illegal, says Dr. Zilbermint, but its happening.
What Are The Different Types Of Insulin
The American Diabetes Association characterizes insulin by how fast it works. But everyones body is different. If you have diabetes, you should expect deviations in the amount of time any medication takes to reach your bloodstream.;
Here are 8 different types of Insulin and how they work.
- Onset;is defined as the length of time before insulin hits your bloodstream and begins to lower blood glucose.
- Peak;is the time during which insulin is at its maximum effectiveness at lowering your blood glucose levels.
- Duration;is the length of time insulin continues to lower your blood glucose levels.
- Rapid-acting insulin begins to affect blood glucose approximately 15 minutes after injection. It peaks in about an hour, and then continues to work for a few more.
- Short-acting insulin reaches your bloodstream within 30 minutes of injection. It peaks in the 2-3-hour range and stays effective for 3-6 hours.
- Intermediate-acting insulin includes NPH insulin which helps control glucose for 10-12 hours.;A;protamine;is a type of protein that slows the action of this insulin.
- Long-acting insulin enters the bloodstream 1-2 hours after injection and may be effective for as long as 24 hours. An advantage to long-acting insulin is there is no pronounced peak, and it works more like typical pancreatic insulin.
- Premixed/combination insulin contains a mix of rapid- or short-acting insulin combined with an intermediate-acting insulin. This eliminates the need to draw insulin from more than one bottle.
When Should You Take Insulin
The answer to this question depends on a few things. Most importantly, though, is the type of insulin that you take. For example, fast- or rapid-acting insulins, such as lispro , glulisine , and aspart , are meant to be taken 10 to 15 minutes before eating. The new fast-acting insulin Fiasp is taken right at the start of a meal or within 20 minutes of starting a meal. Fiasp starts to work a couple of minutes after you inject it.
What about other insulins? Heres the rundown:
Regular insulin, which is a short-acting insulin, is generally taken 15 to 30 minutes before your meal.
NPH, an intermediate-acting insulin, is typically given 30 to 60 minutes before a meal or at bedtime.
Long-acting insulins, such as glargine and detemir , are often taken at bedtime, but also in the morning. Because these insulins are considered to be peakless and are types of basal insulin, taking them is not dependent on your meal times. However, its usually recommended that you take long-acting insulins at about the same time each day, give or take an hour.
Your doctor or diabetes educator may suggest that you take your insulin differently in some situations. For example, if you have gastroparesis , you might have better blood glucose results by delaying your injection instead of taking it before you eat.
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Your Blood Sugar Levels
Everything starts with monitoring your blood sugar levels.
If a patient is taking insulin, they really do need to be checking their blood sugar much more often than when they werent taking insulin, says Joanne Rinker, director of training and technical assistance at The Center for Healthy North Carolina. When theyre prescribed insulin, especially if its short-acting insulin, they should be checking their blood sugar 2 hours after every meal. Because that is the only way for us to know if that was the correct dose.
You dont want your blood sugar going too low or too high . You should stay between 80-130 mg/dL before meals and less than 180 after a meal.
Testing is the only way to know, for sure, where your levels are. Once you know your number at different times of the day — when you get up, before and after meals, or at bedtime, for example — you can start to figure out what to do about it.
Why Is Metformin Taken After Food
Metformin may show some side effects in the first few weeks of medication. Doctors recommend taking it after a meal as it proves to be beneficial in reducing the symptoms of bowel’s side effects.
Dr. SM Kamal Hasan, MBBS, Rangpur Medical College and HospitalRangpur- Dinajpur Highway, Cantt, Near Central Jail, Rangpur 5400, Bangladesh
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Effect Of Other Factors On Postprandial Glucose Control
When interpreting data from the described studies, it is important to consider other factors that can adversely affect postprandial glycaemia and potentially skew results.
Gastric emptying rate is also an important variable that can influence postprandial glycaemia in both people with and without diabetes, with significant interindividual variability. Premeal glucose affects gastric emptying, with hyperglycaemia causing a physiological slowing, as may meal composition and other concomitant medication such as glucagonlike peptide1 receptor agonists , , . People with gastroparesis may also need a different bolus profile, such as a dualwave or a squarewave, to mimic the delayed gastric absorption of carbohydrate . One study examined the intraindividual variability in postprandial glucose excursions in a small cohort of people with Type;1 diabetes on MDI, using standardized test meals with either insulin lispro or regular human insulin . The intraindividual coefficients of variance of the mean glucose excursions after the meals were significant, and also lower with insulin lispro, at most time points: 1;h, 66% vs 71%; 2;h, 49% vs 69%; 4;h, 66% vs 75% and 5;h, 49% vs 72% .
The site at which s.c. insulin is injected can also affect the PK characteristics of insulin. Abdominal injecting of rapidacting insulin analogues results in the highest concentration of insulin at the earliest time when compared with insulin administration in the arm, thigh or buttocks .
Evidence From Pharmacokinetic And Pharmacodynamic Studies
Pharmacokinetic studies carried out in people with Type;1 diabetes show that all three rapidacting insulin analogues have similar PK and pharmacodynamic profiles , . They demonstrate peak plasma insulin concentrations approximately double those of RHI, and a time to maximum concentration less than half that of RHI, with concentrations of the analogues falling more rapidly, returning to levels <20% of peak concentrations at about 4;h , , .
Pharmacokinetics of bolus insulins. Panels , and are reproduced from Home et;al. Diabetes Obes Metab 2012; 14: 780788. Panel; is reproduced with permission from Andersen et;al. EASD 2016; ePoster #931. Panels and are reproduced from Heise et;al. Diabetes Obes Metab 2015; 17: 682688 , under a Creative Commons licence. s.c., subcutaneous.
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How Do I Use An Insulin Pen
Select a clean, dry work area. The supplies you will need include:
- The prescribed insulin pen
- Pen needles and alcohol wipes
- A container for used equipment. You can use a hard plastic container with a screw-on or tight lid, or a commercial sharps container.
Here are the steps you will take:
What Causes Someone To Be Prescribed Insulin
If your body doesnt make insulin or doesnt make enough, you are eventually diagnosed with type 1 diabetes. It used to be called juvenile diabetes, but new estimates show that as many as half of people with type 1 diabetes are not diagnosed until adulthood. On the other hand, if your body doesnt use insulin properly, you have type 2 diabetes.
While people with type 1 diabetes need to take insulin to survive, many people with type 2 are able to stave off insulin use or even avoid it altogether by exercising, losing weight, adapting healthier eating habits, or using other prescription medications.
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Letting Stress Get To You
Your mental health plays a big role in your blood sugar level. How? Emotional;stress can cause swings in your blood sugar. This is in part because stress triggers the release of a hormone called cortisol, which can impair insulin sensitivity, according to a March 2017 article in the;Annals of the New York Academy of Sciences.;Port says this means the same dose of basal or bolus insulin can actually be less effective if youre stressed out.
Try to identify the stressors and sources of chronic anxiety in your life. Then look for a relaxation technique that works for you. Talk to your doctor for ideas. Get consistent sleep. Listen to music. Turn off all devices at night, Port recommends. If possible, make time each day to de-stress take a yoga class, do deep breathing exercises, set aside time to read a book or relax with friends, or establish a soothing bedtime routine to help you wind down.
Forgetting Blood Sugar Checks
Checking your blood sugar levels regularly helps you stay tuned in to how your body responds to your medications, food, and lifestyle habits, Dr. Port says. It can help you and your doctor determine the right amount of basal and bolus;insulin to take.;Fasting blood sugar levels reflect how basal insulin is working in the background, whereas pre-meal and evening blood sugar levels are a better barometer of how the bolus insulin dosing is matching up with your food and carbohydrate intake. “Many people stop checking their blood sugar because they dont feel badly,” Port says. Or, despite having symptoms of high or low blood sugar, they simply ignore the fact that their diabetes may be out of control, she adds.
Smart strategies to stay on top of your blood sugar testing routine include choosing a glucose meter that works for your lifestyle, keeping the meter where its easy to get to and use, and finding ways to remind yourself to do the checks. It can be a note on your refrigerator, an alarm on your phone, or some other device that prompts you to use it whatever works for you. You might also be eligible to use a continuous glucose monitor, a special device placed just under the skin that tracks blood sugar readings continuously and sends this information to a reader or to a phone app.;Most devices require minimal or no calibration with finger stick blood glucose readings and can typically be worn for up to 7 to 14 days, depending on the brand.
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Best Times To Take Mealtime Insulin
When you begin taking insulin, your doctor might check in with you often. They may have you tweak the amount you take or the time you take it based on the results of blood sugar tests. Youll need to fine-tune your dose and schedule until you find one that works best.
Research shows that the best time to take a mealtime insulin is 15 to 20 minutes before you eat a meal. You can also take it after your meal, but this may put you at a higher risk of a hypoglycemic episode.
Dont panic if you forget to take your insulin before your meal. Instead, take it at the end of the meal and keep an eye on your blood glucose.
If you forget to take your insulin and its already time for another meal, your blood glucose level will probably be higher than it normally is before a meal. If this happens, measure your blood glucose and then dose for the meal, plus a correction dose to cover the higher glucose level.
If you forget to take your mealtime insulin often, talk with your doctor and they may prescribe a different type of insulin for you.
Its All In The Timing
If you have trouble affording your medicines, or you arent taking them because of side effects, let your doctor know right away. But what if youre taking your medicines but arent really sure WHEN to take them? Or youre taking them when when its convenient for you, rather than as prescribed? Does it even really matter? The answer to that question is yes. Some medicines can be affected by what and when you eat. Having food in your stomach at the time you take your medicine can end up delaying or decreasing the absorption of that medicine. And certain medicines can interact with the type of food you eat. On the other hand, there are certain medicines that are better tolerated by taken them with food aspirin and other anti-inflammatory drugs are a good example.
Understandably, it can be somewhat confusing figuring out exactly when to take your diabetes medicine. Terms such as take before a meal or take with food or take on an empty stomach are not always clear and are definitely open to interpretation. How soon before a meal? With the first bite of food or halfway through a meal? How are you to know? To help you make sense of vague phrasing, heres some clarification:
Take on an empty stomach: Take your medicine 2 hours before you eat or at least 2 hours after you eat.
Take before a meal: This typically means that you should take your medicine at least an hour before you eat your meal.
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Do I Need To Monitor My Blood Sugar Level
Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you dont already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You can read the results yourself or insert the strip into a machine called an electronic glucose meter. The results will tell you whether your blood sugar is in a healthy range. Your doctor will give you additional information about monitoring your blood sugar.
Injecting Insulin With An Insulin Pen:
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Faq: Frequently Asked Questions
1. Why is insulin so expensive?
Though reforms are underway in many parts of the US, insulin costs are still prohibitively expensive for many people with diabetes. Reasons include the complexity of the pharmaceutical supply chain and lack of generic substitutes.;;
2. What is sliding scale insulin?
Sliding scale therapy is a regimen that prescribes a progressive increase in insulin doses before meals and at bedtime, based on your blood sugar levels.
3. What is an insulin index?
The insulin index gives foods a rating based on how much your blood insulin concentration rises in the two hours after consumption.
4. What is an insulin resistance diet?;
An insulin resistance diet incorporates foods that will help maintain your bodys balance of insulin and blood sugar. Think nourishing calories from veggies, fruit, lean proteins, and healthy fats.
What Is An Insulin Reaction
If youre going to use rapid-acting insulin, you need to be aware of insulin reactions and how to treat them. Rapid-acting insulin begins to work very quickly. So while you and your doctor are working to find the right dosage of this insulin, you may have some insulin reactions.
Hypoglycemia is the name for a condition in which the level of sugar in your blood is too low. If you use insulin, your blood sugar level can get too low if you exercise more than usual or if you dont eat enough. It also can get too low if you dont eat on time or if you take too much insulin. Most people who take insulin have insulin reactions at some time. Signs of an insulin reaction and hypoglycemia include the following:
- Feeling very tired.
- Being unable to speak or think clearly.
- Losing muscle coordination.
- Suddenly feeling like youre going to pass out.
- Becoming very pale.
- Candy: 5 Lifesavers.
- Glucose tablets: 3 tablets .
If you dont feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.
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