Insulin Basics: How Insulin Helps Control Blood Glucose Levels
Insulin and glucagon are hormones secreted by islet cells within the pancreas. They are both secreted in response to blood sugar levels, but in opposite fashion!
Insulin is normally secreted by the beta cells of the pancreas. The stimulus for insulin secretion is a HIGH blood glucose…it’s as simple as that! Although there is always a low level of insulin secreted by the pancreas, the amount secreted into the blood increases as the blood glucose rises. Similarly, as blood glucose falls, the amount of insulin secreted by the pancreatic islets goes down.
As can be seen in the picture, insulin has an effect on a number of cells, including muscle, red blood cells, and fat cells. In response to insulin, these cells absorb glucose out of the blood, having the net effect of lowering the high blood glucose levels into the normal range.
Glucagon is secreted by the alpha cells of the pancreatic islets in much the same manner as insulin…except in the opposite direction. If blood glucose is high, then no glucagon is secreted.
When blood glucose goes LOW, however, more and more glucagon is secreted. Like insulin, glucagon has an effect on many cells of the body, but most notably the liver.
Common Conditions Associated With Insulin Resistance
Type 2 Diabetes
Following pioneering work by Bornstein and the Nobel Prize-winning work of Yalow and Berson, the first insulin assays became widely available in the late 1960s it was subsequently confirmed that diabetic patients with so-called or maturity onset or type 2 diabetes had normal or increased plasma insulin levels. Insulin resistance was reported to be a characteristic feature of T2DM in the early 1970s. A progressive inability of the cells to compensate for the prevailing insulin resistance by sufficient hyperinsulinaemia, heralds the clinical onset of this disorder. While twin studies and linkage analyses are consistent with a strong genetic component in the development of type 2 diabetes, several decades of research have failed to identify a predominant genetic abnormality in the majority of cases. The aetiology of T2DM is thought to be polygenic, with environmental factors being superimposed upon this basic predisposition.
Insulin resistance typically predates the development of diabetes and is commonly found in unaffected first-degree relatives. The morbidity of the disorder relates both to the severity of hyperglycaemia and the metabolic consequences of insulin resistance itself. The primary defects in insulin action appear to be in muscle cells and adipocytes, with impaired GLUT 4 translocation resulting in impaired insulin-mediated glucose transport.
Men < 40 mg/dL
Women < 50 mg/dL
What Are The Symptoms Of Insulin Resistance And Prediabetes
Insulin resistance and prediabetes usually have no symptoms. Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck, a condition called acanthosis nigricans. Many small skin growths called skin tags often appear in these same areas.
Even though blood glucose levels are not high enough to cause symptoms for most people, a few research studies have shown that some people with prediabetes may already have early changes in their eyes that can lead to retinopathy. This problem more often occurs in people with diabetes.
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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.
How Do I Take Insulin
Insulin is normally injected under the skin with a very small needle. It can also be taken with an insulin pen. Your doctor will teach you exactly how to inject insulin, but here are the basics:
Wash your hands.
Take the plastic cover off the insulin bottle and wipe the top of the bottle with a cotton swab dipped in alcohol.
Pull back the plunger of the syringe, drawing air into the syringe equal to the dose of insulin that you are taking . Put the syringe needle through the rubber top of the insulin bottle. Inject air into the bottle by pushing the syringe plunger forward. Turn the bottle upside down.
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How Is Type 2 Diabetes Treated
Sometimes people with type 2 diabetes take pills that help the insulin in their bodies work better. Some also need insulin shots or an insulin pump to control their diabetes.
People with type 2 diabetes have to pay a little more attention to what they’re eating and doing than people who don’t have diabetes. They may need to:
- Eat a healthy diet, as determined by the care team.
- Get regular physical activity to achieve a healthy weight and allow insulin to work more effectively.
- Check their blood sugar levels on a regular basis.
- Get treatment for other health problems that can happen more often in people with type 2 diabetes, like high blood pressure or problems with the levels of fats in their blood.
- Have regular checkups with doctors and other people on their diabetes health care team so they can stay healthy and get treatment for any diabetes problems.
People with type 2 diabetes might have to eat smaller food portions and less salt or fat, too. Those who eat healthy foods, stay active, and get to a healthy weight may bring their blood sugar levels into a healthier range. Their doctors may even say they don’t need to take any medicines at all.
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.
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Who Gets Type 2 Diabetes
What makes people more likely to develop type 2 diabetes? No one knows for sure. But experts have a few ideas about what puts a person at greater risk:
- Most people who have type 2 diabetes are overweight.
- People with family members who have diabetes get diabetes more often.
- People who are older than 10 are more likely to develop type 2 diabetes than younger kids.
What Severe Complications Can Occur Because Of Rationing Or Running Out Of Insulin
Diabetic ketoacidosis is an emergency condition that results if you dont have enough insulin to regulate your blood sugar. DKA causes your body to break down fat for energy in the absence of insulin. This leads to a dangerous accumulation of acids known as ketones in your blood that can cause your brain to swell and your body to go into shock.
Signs of diabetic ketoacidosis include:
- Thirst or a very dry mouth
- Frequent urination
- High levels of ketones in your urine
- Nausea, vomiting, or stomach pain
- Difficulty breathing
- A fruity or acetone odor on your breath
- Confusion or acting drunk while sober
DKA is so common and can come on so quickly that it is the first sign of Type 1 diabetes in 20% of cases, and the way many type 1 diabetics are first diagnosed with the condition. If you go into diabetic ketoacidosis, dont try to hide it or make light of it. Treat it as the emergency it is and get to a hospital as soon as possible to recover. Ive had people tell me theyre tired of taking insulin, or that theyre rationing it due to cost. In type 1 diabetes, thats all it takes to end up in a life-threatening situation, says Dr. Zilbermint.
Another complication facing diabetics who use insulin is the potential for hyperglycemia, also known as insulin shock, which involves using too much insulin and causing your blood sugar to drop extremely low. This can cause coma, seizures, and heart attacks, says Dr. Powers.
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How Is Type 2 Diabetes Diagnosed
Doctors can say for sure if a person has diabetes by testing blood samples for glucose. Even if someone doesn’t have any symptoms of type 2 diabetes, doctors may order blood tests to check for it if the person has certain risk factors .
Some kids and teens with diabetes may go to a pediatric endocrinologist â a doctor who specializes in diagnosing and treating children and teens living with diseases of the endocrine system, such as diabetes and growth problems.
What Are The Common Side Effects Of Metformin
Another great thing about metformin is that, compared to other diabetes medications, it typically causes mild side effects. The most common side effects of metformin are related to stomach discomfort, like gas, upset stomach, nausea, diarrhea, or cramping.
You can limit these side effects by:
- Starting with a low dose of metformin and gradually increasing the dose. This gives your body time to get used to the new medication.
- Taking metformin with food. Taking the medication with food will help you feel less sick or nauseous.
- Taking an extended-release version of metformin. Instead of all the medication being released into your body and absorbed at once, metformin ER is released and absorbed over an extended period of time. This makes it easier on your digestive system.
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What Should I Do If My Blood Sugar Gets Too Low
Low blood sugar is also called hypoglycemia . It means your blood sugar level drops below 70. Having low blood sugar is dangerous and needs to be treated right away. Anyone with diabetes can have low blood sugar. You have a greater chance of having low blood sugar if you take insulin or certain pills for diabetes.
Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry, check your blood sugar. Even if you feel none of these things, but think you may have low blood sugar, check it.
If your meter shows that your blood sugar is lower than 70, do one of the following things right away:
- chew 4 glucose tablets
- drink 4 ounces of fruit juice
- drink 4 ounces of regular soda, not diet soda or
- chew 4 pieces of hard candy
After taking one of these treatments, wait for 15 minutes, then check your blood sugar again. Repeat these steps until your blood sugar is 70 or above. After your blood sugar gets back up to 70 or more, eat a snack if your next meal is 1 hour or more away.
If you often have low blood sugar, check your blood sugar before driving and treat it if it is low.
The Basics Of High Blood Sugar
Diabetes is a problem with your body that causes blood sugar levels to rise higher than normal. This is also called hyperglycemia.
When you eat, your body breaks food down into sugar and sends it into the blood. Insulin then helps move the sugar from the blood into your cells. When sugar enters your cells, it is either used as fuel for energy right away or stored for later use. In a person with diabetes, there is a problem with insulin. But, not everyone with diabetes has the same problem.
There are different types of diabetestype 1, type 2 and gestational diabetes. If you have diabetestype 1, type 2 or gestationalyour body either doesn’t make enough insulin, can’t use the insulin well, or both.
Learn more about blood sugar Learn more about insulin
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Diabetes Numbers Warnings And Precautions
If your blood sugar reading is over 400 mg/dL, there is a chance that you have a false reading particularly if you aren’t experiencing any symptoms. For example, if there were food particles on your fingers or you used outdated or improperly stored test strips, you might have gotten an inaccurate reading.
If you re-test your levels and your blood sugar is indeed above 400 mg/dL, follow the advice your doctor has given you whether that includes taking extra insulin or drinking more water and contact him or her for further treatment advice.
If you have symptoms of diabetic ketoacidosis, you may need to seek immediate medical attention. Without treatment, diabetic ketoacidosis can lead to a diabetic coma and death. Diabetes statistics show the condition was the seventh leading cause of death in the U.S. in 2017, according to the ADA, so it’s important to receive the right medical care right away.
The High Blood Sugar Correction Factor:
Correction Factor = 1800 ÷Total Daily Insulin Dose = 1 unit of insulin will reduce the blood sugar so many mg/dl
This can be calculated using the Rule of 1800.
= 1800 ÷ TDI = 1 unit insulin will drop reduce the blood sugar level by 45 mg/dl
While the calculation is 1 unit will drop the blood sugar 45 mg/dl, to make it easier most people will round up or round down the number so the suggested correction factor may be 1 unit of rapid acting insulin will drop the blood sugar 40-50 mg/dl.
Please keep in mind, the estimated insulin regimen is an initial best guess and the dose may need to be modified to keep your blood sugar on target.
Also, there are many variations of insulin therapy. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team.
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How Insulin Treatment Helps Your Blood Sugar
Insulin treatment works in much the same way as natural insulin that the pancreas makes. After you eat, your body breaks down carbohydrates into glucose. That glucose goes into your bloodstream and causes your blood sugar level to rise.
When you take insulin, it helps to move glucose out of your bloodstream and into cells. Your cells use some of that sugar for energy and then store any leftover sugar in your fat, muscles, and liver for later.
Once the sugar moves into your cells, your blood glucose level should go back to normal.
What Causes Blood Sugar To Drop Rapidly Apart From Too Much Insulin
Clearly, then, too much insulin is what causes blood sugar to drop rapidly. But theres more to it than simply taking too much insulin.
Skipping meals or eating less than what youre used to will also mean having too much insulin in the body.
In addition, the bodys sensitivity to insulin can change throughout the day. The greater the insulin sensitivity, the less insulin the body will need. If insulin sensitivity has increased, this will often be due to the combination of exercise and diabetes.
These are probably the most common reasons for low blood sugar, as the blog post What Happens when Blood Sugar is low? points out. NHS inform gives some other reasons, such as:
Fasting. Aside from not taking in any carbs for the insulin to displace, fasting can also lead to not having enough nutrients, which can hinder the bodys digestive abilities.
Similarly, illness can impact the bodys response to glucose. Illness will usually increase blood sugar but it depends on what kind of illness and how your body responds to it which can give low blood sugar. Read more on this topic with Diabetes and the Flu.
Meanwhile, sleep itself may not lower blood sugar, but you can still get low blood sugar in the night for the same reasons you would in in the day.
The only difference is that you cant treat it as effectively because youre well asleep. So, do have carbs ready by your bed, just in case. Read more on Diabetes and Sleep.
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