Everything You Wanted to Know about INSULIN!

Transcription

1 Everything You Wanted to Know about INSULIN! What is Insulin? Life would not exist without insulin. In order to utilize the glucose (energy) found within the carbohydrate-laden foods we consume, insulin must be present to facilitate its (glucose) absorption. The pancreas is a dual organ of both exocrine and endocrine functions. The endocrine functions revolve around the production of the hormones insulin by the beta pancreatic cells and glucagon by the alpha pancreatic cells. Insulin is the main hormone responsible for lowering blood glucose and is indirectly responsible for the utilization of carbohydrates, proteins and fats. There are several hormones with the ability to raise blood sugar (glucagon, norepinephrine, and cortisol). In the healthy individual, when food is digested, glucose levels in the bloodstream rise. The pancreas then releases insulin, which helps the cells take up glucose. Once inside the muscle or liver cells, glucose can also be converted into glycogen (a stored form of glucose that can be used as an emergency energy source) Insulin was discovered in 1921, for the treatment of Type 1 (Juvenile onset) diabetes mellitus. This condition usually occurs in adolescence, but can also occur at any age. In the diabetic, for some unknown reason the body s immune system starts to attack its own beta cells until they eventually lose their ability to produce insulin. Ironically, the exocrine functions of the pancreas, which produce digestive enzymes such as pancreatic amylase (which digests complex carbohydrates), pancreatic protease (which digests protein), and pancreatic lipase (which digest fat) are not affected. Similarly, the alpha pancreatic cells, which produce the hormone glucagon do not lose their function either. Before insulin, Type 1 diabetics would eventually die from malnutrition or starvation. In the absence of insulin, sugar in the blood is unable to be utilized for energy. The body is then forced to break down fatty acids and form ketone bodies, which are then excreted in the urine. When ketone bodies and extremely high levels of glucose begin to build up in the blood stream, the blood becomes acidified leading to a condition known as called ketoacidosis (a serious condition which may lead to coma or death). High levels of sugar in the blood and urine impair the body s ability to fight infection (bacteria thrive in a high glucose environment) and eventually cause organ failure if blood sugar

2 remains uncontrolled. The symptoms of Type 1 diabetes usually come on suddenly. They include: Increased thirst Increased urination Increased hunger Sudden weight loss Feeling very tired Insulin also plays an essential role in fat and protein metabolism. It promotes the transport of amino acids from the bloodstream into muscle and other cells. Once inside these cells, the amino acids can then be synthesized into new proteins (amino acids are the building blocks of all protein molecules). Insulin also reduces the breakdown (catabolism) of proteins in the body. This relationship to protein metabolism caused speculation among bodybuilders regarding the anabolic properties of insulin. Insulin, however, does not discriminate when lowering blood sugar (glucose can wind up in fat cells just as easily as it can wind up in muscle cells). In a clinical setting, those patients taking the most amount of insulin tended to be the most overweight. A bodybuilder by the name of Tim Belknap was one of the biggest guys on the scene during the 1980s. At only 5 2, he weighed over 200 pounds. When he revealed that he was a Type 1 Diabetic, other bodybuilders took note. As a result, bodybuilders started experimenting with insulin to see if it had any anabolic properties. Do not misunderstand the seriousness of Type 1 diabetes. Regulating blood sugar with careful diet, timing of insulin, energy output, and dosages requires testing your blood sugar several times a day. Because people do not live like robots and no two days are exactly the same, insulin dosages have to be altered accordingly.

3 Most bodybuilders eat 6 to 8 meals a day. This requires the diabetic to test their blood sugar before eating to make sure that going into the meal their blood sugar is less than 120 mg/dl; otherwise, they have to take the appropriate amount of Humalog/Novolog insulin to bring their blood sugar to a normal pre-meal level (normal blood sugar is mg/dl). One unit of Humalog insulin (depending on height, weight or gender) lowers blood sugar about 30 to 50 points. Diabetics should also test their blood sugar 2 after a meal to make sure that their post-prandial blood sugar is less than 140 mg/dl; otherwise, they should take additional units of Humalog to bring that number closer to normal. To benefit from the anabolic properties of insulin, diabetics need to have tight control of their blood sugar. When blood sugar is 180mg/dl (the threshold for sugar in the blood), the kidneys start to spill sugar in the urine and the liver starts to secrete more glucose thus raising the blood sugar even higher. No energy (glucose) can get to your cells without insulin; therefore, you should never let your blood sugar get this high. It requires a tremendous amount of planning and understanding of how your body reacts to different stimuli (food, training, cardio, rest, timing of different insulin s and dosages) in order to keep your blood sugar below the 140mg/dL threshold. There have been many advances in the treatment of Type 1 diabetes. In 2001, Aventis Pharmaceuticals created an insulin analog, Lantus (Glargine), which acts for 24 without any peak. In theory, this would allow the diabetic to take one insulin shot in the evening acting as their basal (baseline) insulin requirement for the day. Basal insulin (LANTUS) injections are different from bolus insulin (HUMALOG) injections needed to cover meals. A diabetic could not just take short acting (humalog) insulin to maintain blood sugar control. Basal insulin is also needed to cover post meal blood sugar levels. Lantus gives the diabetic more freedom since they no longer need to worry about becoming hypoglycemic (previously experienced with the older NPH or Lente insulin due to their delayed 6 hour peaking time). Now, all the diabetic has to do is take Humalog (onset: 10 to 15 min) or HUMULIN- R [regular] (onset: 30 min to 60 min.) insulin every time they eat. That means if you eat 10 times a day, you need to take 10 insulin shots. However, things are not that simple. What if you are not eating carbohydrates? Or you are eating carbohydrates mixed with fat and protein? You have to keep in mind that different factors alter how fast or slow your blood sugar will rise. If you are following a low carb diet,

4 some of the protein you eat will be turned to glucose (it just happens over a much slower time period-- anywhere from 4-6 ). I would recommend that diabetics following a low carb diet use more regular (humulin-r) insulin due to the slower onset and longer half-life. If your blood sugar is normal prior to your meal, you can omit waiting the half hour lag time that it takes for regular insulin to work because protein and fat delay the absorption of carbohydrates (and thus delay increases in blood glucose levels). If, however, blood glucose does elevate too quickly, you could combine regular (humulin-r) insulin with Humalog thus immediately normalizing blood sugar (with humalog) while Regular insulin will take care of the delayed blood glucose peak. Type 1 diabetics have to realize that athletes are especially challenging for many physicians to properly dose because they do not understand the lifestyle. They can only estimate using complex formula s how much insulin you require. My best advice is to educate yourself on the different types of insulin available as they all have different onset and peak times. You have to see how each one reacts with different amounts of food and exercise. If you are diligent with keeping your blood sugars as close to normal as possible, you can capitalize on the anabolic properties of insulin. Keep in mind that more is not better. If you abuse insulin you run the risk of getting fat. You do not want to feed the insulin, you want to follow your diet and have the insulin feed the food that you need to grow. Also, if you are taking growth hormone (GH), you might need to increase your morning basal insulin (Lantus, Lente, NPH, or Ultralente). Where do we get exogenous insulin? There are three major pharmaceutical companies that manufacture insulin (Elli Lilly, Nova Nordisc, and Avantis). Insulin available in the U.S. is called U- 100 Insulin. This means that there are 100 units of insulin in 1 cc. The only other commercially available insulin is U-500, which means that there are 500 unites of insulin in 1 cc. This type of insulin is reserved for persons with severe insulin resistance and daily requirements are 100 or more units per injection. Types of Insulin: Regular insulin (Humulin-R) has an onset of action (begins to reduce blood sugar) within 30 minutes of injection, reaches a peak effect at 1 to 3, and has effects that last 6-8.

5 NPH insulin is an insulin with an intermediate duration of action. It has an onset of action starting about 2 following injection, a peak effect 4-12 after injection, and duration of action of Lente insulin also has an intermediate duration of action. It has an onset of action 2-4 after injection, a peak activity 6-12 after injection, and a duration of action of 18 to 26. Ultralente insulin is long-acting with an onset of action 4-8 after injection, a peak effect after injection, and a duration of action of more than 36. Ultra rapid-acting insulin, (Humalog lispro ), by Eli Lilly or Novolog (insulin Aspart) by Nova Nordisc is a chemically-modified, natural insulin. It was approved by the FDA in June, As compared to regular insulin, insulin lispro has a more rapid onset of action, an earlier peak effect, and a shorter duration of action. It reaches peak activity half an hour to 2.5 after injection. Therefore, insulin lispro should be injected 15 minutes before a meal as compared to regular insulin which is injected minutes before a meal. The chemical changes provide Humalog with a faster onset of action (15 minutes) and a shorter duration of action (3 to 5 ) than regular human insulin. It reaches peak activity 1 to 3 after injection. Insulin glargine, developed by Aventis Pharmaceuticals, is an insulin preparation that has its chemical composition slightly altered. Insulin glargine has a slower onset of action (70 minutes) and a longer duration of action (24 ) than regular human insulin. Its activity does not peak. This is the newest insulin available (only by prescription). It serves as a basal insulin and as a replacement for peaking insulins such as NPH, Lente, and Ultralente. Most physicians recommend taking 1 dose in the evening, however, new studies reveal that splitting the total basal insulin 12 apart seems to work better for some diabetics that are very sensitive to insulin. This insulin serves as your basal insulin, much like an insulin pump would. Detemir is a long acting insulin still under development. Detemir is covalently acylated with fatty acids on lysine at position 29. Thus, it helps to increase the binding to albumin (in the blood) and thus delays its absorption. This is a potentially great new basal insulin.

6 OTHER PREPARATIONS: 70/30 Insulin: 30% regular insulin & 70% long acting insulin 50/50 Insulin: 50% NPH insulin & 50% regular insulin 75/25 Insulin: 25 % Humalog insulin & 75% NPH insulin. ****Regular (rapid onset of action, short duration of action) and NPH (slower onset of action, longer duration of action) human insulin used to be the most commonly used insulin preparations. However, with the invention of Humalog/ Novolog insulin, diabetics no longer have to wait the dreaded half hour before eating to wait for the regular insulin to start working. These newer insulins work within minutes. That means, a diabetic could basically dose and eat. The problem with Humalog remains that it works too fast. It is virtually gone before all the food has a chance to be absorbed. When you eat carbohydrates with protein or fat, it delays the absorption of carbohydrates into the bloodstream. Therefore, if you took Humalog insulin, your blood sugar would appear within normal range for the first 1 to 2 after eating, but then would rapidly rise when the insulin stopped working. Type Brand Name Onset Peak Very fast acting Fast acting **Recommen ded for Bodybuilders Humalog ( Lispro) Novolog ( Aspart) Humulin R Novolin R Velosulin Human- used in insulin pumps 5-15 minutes 30 minutes - 1 hour minut es 2-5 Durati on Comments Human The fastestacting insulin available Human Often injected before meals to compensate for the sugar intake from food Iletin II 30 minutes Pork-based

7 Intermediate acting Regular 2 Humulin L Humulin N Novolin L Novolin N Human Iletin II Lente Iletin II NPH Long acting Humulin U Ultra-long acting Lantus ( glargine) Detemir 1.1 Bound to Albumin for a much slower absorption time No peak No peak Consta nt concen tration over 24 Pork-based Human Usually used in combination with a fasteracting insulin to provide proper control at mealtimes Human Injected once daily at bedtime ( if incredibly insulin sensitive 2 times daily) Still in Clinical Trials: Insulin Analog Mixtures Humulin 50/50 Humulin 70/30 Novolin 70/30 Varies Varies Varies The numbers refer to percentage of NPH (1st number) and

8 Humalog Mix 75/25 Varies Varies Varies regular (2nd number) Available in vials, pen-fill cartridges, and prefilled syringes 75% NPL (a new NPH formulation) and 25% lispro; available in disposable pen. (image from: PDR - Physician s Desk Reference, Second Edition Medical Economics Company, Montvale, NJ. pp. i-ii) Most people who use insulin inject it with a needle and syringe, but there are several other devices that are available. These include: (image from: PDR - Physician s Desk Reference, Second Edition Medical Economics Company, Montvale, NJ. pp. i-ii)

9 Where should you inject? You can inject insulin into several places on your body. Insulin injected near the stomach works fastest. Insulin injected into the thigh works slowest. Insulin injected into the arm works at medium speed. Also, if you inject insulin into an exercising muscle, this speeds up the rate of absorption and changes its action and peak times. How to store it These are good places to give yourself insulin shots. If you use a whole bottle of insulin within 30 days, keep that bottle of insulin at room temperature. Although this remains the recommended practice, as long as insulin is not exposed to any harsh changes in temperature, it can be left un-refrigerated for up to 2 to 3 months. If you don't use a whole bottle within thirty days then you should store it in the refrigerator all of the time. If insulin gets too hot or too cold, it doesn't work right. So, don't keep insulin in the freezer or in the glove compartment of your car during warm weather. Keep at least one extra bottle of insulin around your house. Store extra insulin in the refrigerator. BODYBUILDING APPLICATIONS: Recently, insulin has become quite popular among bodybuilders due to the anabolic effect it can offer. With well-timed injections, insulin will

10 help to shuttle glucose and amino acids into the muscles more efficiently. In America, regular human insulin is available without a prescription under the name Humulin-R by Eli Lilly and Company or Nova Nordisc. It costs about $30 for a 10 ml vial with strength of 100 IU per ml. Hypoglycemia is a state in which blood glucose levels are too low. It is a common and potentially fatal reaction experienced by insulin users. Before a bodybuilder begins taking insulin, it is critical that he or she understands the warning signs and symptoms of hypoglycemia (cold, clammy, shaky, and nauseous). If you experience any of those warning signs, immediately consume a food or drink containing sugar (such as candy or a carbohydrate drink). This will treat mild to moderate hypoglycemia and prevent a severe state of hypoglycemia. Severe hypoglycemia is a serious condition that may require medical attention. Symptoms include disorientation, seizure, unconsciousness, and death. In some cases an injection of glucagons (a pancreatic hormone which raises blood glucose) may be necessary if the person become unconscious and is unable to consume a sugar beverage. Insulin is used in a wide variety of ways. Most bodybuilders choose to use it immediately after a workout or first thing in the morning. There are many theories as to what the best dosages of insulin in a nondiabetic are. First, it is probably best to use regular insulin. First-time users should start at a low dosage and gradually work up. For example, first begin with 2 IU and then increase the dosage by 1 IU every consecutive shot. This will allow the bodybuilder to safely determine a correct dosage. Another method for determining how much insulin to take is to use carbohydrate counting. Diabetics have been doing this for years. 1 unit of insulin covers approximately 10 grams of carbohydrate in men and 10 to 15 grams in women. Therefore, if you eat 2 cups of cooked oatmeal (60 grams of carbohydrates), then you would need 6 units of regular insulin. Insulin dosages can vary significantly among individuals and is dependent upon insulin sensitivity and the use of other drugs. Bodybuilders using growth hormone and thyroid will have higher insulin requirements, and therefore, will be able to handle higher dosages.

11 Humulin-R should be injected subcutaneously only with a U-100 insulin syringe. It is currently the trend to take insulin first thing in the morning with food and your daily injection of growth hormone. Always remember to consume carbohydrates and protein following your insulin and GH injections. Some athletes find this application of insulin very beneficial for putting on mass, while others will tend to put on excess fat using insulin in this manner. Every person s metabolism is different, therefore, a blood glucose monitor would be prudent to make sure your blood sugar isn t dropping to quickly. Many bodybuilders take creatine monohydrate with their morning meal and insulin injection since the insulin will help to force the creatine into the muscles. Many athletes will get sleepy after injecting insulin. This may be a symptom of hypoglycemia, therefore, the person should probably consume more carbohydrates with their morning meals. Avoid the temptation to go to taka a nap since the insulin may take its peak effect during sleep and significantly drop glucose levels. Humulin R usually remains active for only 4 with a peak at about two ; therefore, athletes should stay awake for the 4 after injecting. Humalog has become popular in bodybuilding circles because of it ultra fast action and short duration. It does its job within 1 hour, and then within 3 it is almost completely out of your system, thereby, reducing the chances of hypoglycemia. Humalog is only available with a prescription unlike other types of insulin that can be purchased over-the-counter. Injecting insulin 30 minutes prior to the end of your workout is a dangerous practice. Bodybuilders do this because when reading the package insert of regular insulin, it clearly states wait ½ hour after injection of Regular insulin before eating. This is true if you are sedentary and do not produce any insulin. For the bodybuilder who carries a great deal of muscle and already produces insulin, regular insulin works much faster. The more muscle you have the more sensitive to insulin your cells will be. This is why Humalog can pack quite a punch on the already insulin-sensitive bodybuilder. Some athletes have been known to inject a few IUs of insulin before lifting to improve their pump. This practice is extremely risky and best left to athletes with experience using insulin. It is also relevant to note

12 that muscle repair and growth begins in the and days following heavy exercise. It is doubtful that the use of insulin just prior to a workout will have any anabolic effects at this time. However, use of insulin prior to a workout will certainly expose you to a much greater risk of serious harm. Effective Dose: 1 IU per grams of carbohydrate, or 1 IU of insulin for every 20lbs of lean body weight. If someone weighs 300 pound (with 50 pounds of fat), calculate insulin requirements based on 250 pounds (7.5 units per day). Variables to consider when taking insulin: The type, amount and timing of food consumed Glycemic index (the glucose elevating effect) of the food consumed Body weight Timing of insulin administration in relation to food intake and exercise Individual variation: Two different people, even if they are of a similar height, weight and other personal characteristics, can respond in a very different way to a given dose of insulin. Risk Reduction Advice: Insulin can be very risky if you do not know what you are doing. If you have the mentality that MORE IS BETTER, I recommend avoid even trying insulin. This hormone can be potentially fatal if taken recklessly, because normal blood sugar is mg/dl. If your blood sugar falls below 20 mg/dl you run the risk of permanent brain damage, coma, or even death. It is important to realize the POWER of insulin. Many describe it as the most anabolic hormone in the human body. It has no doubt been a factor in increasing appetite and the effectiveness of growth hormone, therefore, resulting in added muscle growth. However, insulin is not for everyone. It can be very dangerous if you are not aware of the many variables that go along with injecting insulin. One day of being irresponsible with your insulin dose could be potentially fatal. Take your time to educate yourself on diet, different types of

13 insulin, and the role of insulin in the human body before you take on the responsibility of adding insulin to your current bodybuilding bag of tricks. The risk may not be the worth the reward in some cases. So, know all the facts before trying INSULIN.