INJEX Self Study Program Part 1 What is Diabetes? Diabetes is a disease in which the body does not produce or properly use insulin. Diabetes is a disorder of metabolism -- the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of sugar. What are the different types of Diabetes? Type 1 Diabetes: Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. To make this simple, Type 1 diabetes is an auto-immune disease where the body's immune system destroys the insulin-producing beta cells in the pancreas. This type of diabetes, also known as juvenile-onset diabetes, accounts for 10-15% of all people with the disease. It can appear at any age, although commonly under 40, and is triggered by environmental factors such as viruses, diet or chemicals in people genetically predisposed. People with type 1 diabetes must inject themselves with insulin several times a day and follow a careful diet and exercise plan. Type 2 Diabetes: Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency.
Type 2 Diabetes is the most common form of diabetes, affecting 85-90% of all people with the disease. This type of diabetes is also known as late-onset diabetes. The disease is strongly genetic in origin but lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are major risk factors for its development. Symptoms may not show for many years and, by the time they appear, significant problems may have developed. People with type 2 diabetes are twice as likely to suffer cardiovascular disease. Type 2 diabetes may be treated by dietary changes, exercise and/or tablets. Insulin injections may later be required. Gestational Diabetes: Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2. Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. What is Insulin? Insulin is a hormone with extensive effects on both metabolism and several other body systems (eg, vascular compliance). Insulin causes most of the body's cells to take up glucose from the blood (including liver, muscle and fat tissue cells), storing it as glycogen in the liver and muscle, and stops use of fat as an energy source. When insulin is absent (or low), glucose is not taken up by most body cells and the body begins to use fat as an energy source (i.e., transfer of lipids from adipose tissue to the liver for mobilization as an energy source). As its level is a central metabolic control mechanism, its status is also used as a control signal to other body systems (such as amino acid uptake by body cells). It has several other anabolic effects throughout the body. When control of insulin level fails, Diabetes Mellitus sets in. Insulin is used medically to treat some forms of diabetes mellitus. Patients with Type 1 Diabetes Mellitus depend on external insulin (most commonly injected subcutaneously) for their survival because the hormone is no longer produced internally. Patients with Type 2 Diabetes Mellitus are Insulin Resistant, and because of that, may suffer from a relative insulin deficiency; some patients with Type 2 diabetes may eventually require insulin when other medications fail to control blood glucose levels adequately. Insulin is a peptide hormone composed of 51 amino acid residues and has a Molecular Weight of 5808 Daltons. It is produced in the islets of Langerhans in the Pancreas. The name comes from the Latin insula meaning "island".
What are the different types of Insulin? Manufactured insulin comes in several types. Each type works at a different pace and most people have to use more than one kind to mimic what their bodies used to do all by themselves. Different types of insulin are like different types of Olympic runners. Some types of insulin are like sprinters. They start quickly, get to their top speed and finish fast. Other types of insulin are like marathon runners. They start slower and they keep going slow and steady for a long time. Then there are the ones in between- not as fast as a sprint and not as slow as a marathon. No one type of insulin is better than another. All types are important to keep your diabetes in control. Rapid-acting insulin (very fast acting-meal time insulin), often called lispro (Humalog) and Insulin aspart (Novolog), is the fastest insulin of all. Once injected, it starts to work within 15 minutes. It works hardest (or "peaks") at about an hour or so after injection. It's usually used up in four or five. This kind of insulin is designed so it can be injected right before meals. They should be injected under the skin within 15 minutes before the patient eats. It starts to work about the time the patient starts to eat. These insulins start working in five to 15 minutes and lower the blood sugar most in 45 to 90 minutes. By the time the meal is digested and sugar is beginning to move into the bloodstream, rapid-acting insulin is working the hardest at moving that sugar into the cells. It finishes working in three to four. With regular insulin you have to wait 30 to 45 minutes before eating. Many people like using lispro because it's easier to coordinate eating with this type of insulin. Short-acting insulin (fast acting-meal time insulin), or "regular" insulin, is also used around mealtime. It takes longer to work than rapid-acting insulin does. So the patient takes short-acting insulin about 30 to 45 minutes before he/she plans to eat and it peaks at about two or three. It can keep working for as long as six. Rapid-acting and short-acting insulin are both "clear" insulin. Intermediate-acting insulin (Basal insulin), or NPH (N) and Lente (L), is insulin mixed with a substance that makes the body absorb the insulin more slowly. That's why this type of insulin looks cloudy and has to be mixed before its injected. It takes longer to start to work, and it stays in the patient s body for a longer time. NPH usually begins to work about two to four after injection. It peaks four to 10 after injection, and it keeps working for 10 to 16. Lente lasts even longer. It peaks at four to 12 after injection and stays in the body from 12 to 18. Intermediate-acting insulin works all day if it is taken in the morning. A shot of intermediate-acting insulin in the evening keeps insulin in the patient s body during the night.
Long-acting insulin (Basal insulin), also called Ultralente, starts to work in six to 10 and can stay in the body for 20 or more. It has a peak, but its top speed looks a lot like its normal speed. Long-acting insulin is usually taken in the morning or before bed, like intermediate-acting insulin. Ultra-long-acting insulin called glargine (GLAR-jeen) insulin is injected once a day. This is very long-acting insulin. It starts to lower blood glucose levels about 1 hour after injection, and keeps working evenly for 24 without any peaks. Insulin mixtures (Mixture Insulin) - There may be advantages of using insulin mixtures. They are a combination of rapid-acting insulin with long-acting insulin. i.e. a mix of both basal and mealtime insulins in one solution. Humalog Mix75/25 (75% insulin lispro protamine suspension, 25% insulin lispro injection [rdna origin]) and Humalog Mix50/50 (50% insulin lispro protamine suspension, 50% insulin lispro injection [rdna origin]) are Mixture Insulins. These are used primarily by people with type 2 diabetes. All insulins come dissolved or suspended in liquid; the most commonly used strength is U-100, which means there are 100 units of insulin per ml. Where Insulin should be injected? Insulin can be injected into several places on the human body. Insulin injected near the stomach works fastest. Insulin injected into the thigh works slowest and a shot in the arm works at medium speed. These are good sites to administer insulin shots.
How to store Insulin? (Advice to patients) If you use a whole bottle of insulin within 30 days, keep that bottle of insulin at room temperature. On the label write the date that is 30 days away. That date is when you should throw out the bottle with any insulin left in it. 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. Type Brand Name Onset Peak Duration Comments Very fast acting Fast acting Intermediate acting Humalog Novolog Humulin R Novolin R Velosulin Human 5-15 minutes 30 minutes - 1 hour Iletin II Regular 30 minutes - 2 Humulin L Humulin N Novolin L Novolin N Iletin II Lente Iletin II NPH 1-3 4-6 45-90 minutes 2-5 3-4 6-12 8-14 Long acting Humulin U 4-6 18-28 Ultra-long acting 3-4 Human The fastest-acting insulin available 5-8 Human Often injected before meals to compensate for the sugar intake from food 4-6 Pork-based 20-24 Human 16-20 Pork-based Lantus 1.1 No peak Constant concentration over 24 Mixtures Humulin 50/50 Humulin 70/30 Novolin 70/30 28 Human Usually used in combination with a faster-acting insulin to provide proper control at mealtimes Human Injected once daily at bedtime The numbers refer to percentage of NPH (1st number) and regular (2nd number) Available in vials, pen-fill cartridges, and prefilled syringes Humalog Mix 75/25 75% NPL (a new NPH formulation) and 25% lispro; available in disposable pen.
www.injex.com www.injex.de Dear Associate, Once you have gone through the above study module please do the following: 1. Prepare a data like the one given on page 5 mentioning the type, brand name and manufacturer s name of insulin that are available in your market. 2. Provide the list of various containments of insulin available; like whether it is vial, cartridge or disposable pens. 3. Do open a Skype account as soon as possible. 4. Also ask all your sales personnel to open a Skype account. 5. Email us the various skype IDs. 6. Do feel free to contact us, should you require any further assistance. Thanking you in advance for your co-operation. With best regards, Eswar VP-International Sales Injex Equidyne Systems Inc., USA Skype ID: eswar.injex