Introduction to Insulin Your guide to taking insulin
Introduction Insulin helps control the level of blood glucose in the body. Everyone with type 1 diabetes must take insulin, and many people with type 2 diabetes also benefit from taking insulin. Millions of Americans take insulin as an important part of their diabetes treatment program. This booklet will help you understand: The American Academy of Family Physicians Foundation has favorably reviewed this material through 2007. Favorable review means that medical information is accurate, but does not imply endorsement of any conclusions presented. what insulin is and why you need it how insulin helps lower blood glucose the types of insulin and how they work the different ways to take insulin how to store insulin and dispose of syringes, and what hypoglycemia (low blood glucose) is and how to treat it The Keeping Well With Diabetes patient education materials were developed using information from the following sources: The American Association of Diabetes Educators, The American Diabetes Association, The American Dietetic Association, and The American Association of Clinical Endocrinologists. These booklets do not replace the advice of your healthcare provider. Be sure to consult your healthcare provider regarding your individual diabetes treatment plan. 1
What is insulin? Your body changes most of the food you eat into glucose, a type of sugar. Glucose travels in the blood to all the cells in your body. Insulin is a hormone made by your body to help glucose move from the blood into your body cells. Your body cells need glucose for energy. Why do I need insulin? Your body needs the right amount of insulin and glucose all the time to work properly. Insulin helps your body cells get the amount of glucose they need. When you have diabetes, your body does not make any insulin, it does not make enough insulin, or the insulin it makes does not work right. Taking insulin when you need it helps control blood glucose levels so your body cells will have the energy they need to keep you feeling well. The insulin you take is working properly if it keeps your glucose levels near normal. Why do I have to inject insulin? The only way to get insulin into your body is to inject it with a syringe or a delivery system such as an insulin pen or pump. Insulin cannot be taken as a pill because it would be destroyed by the stomach during digestion. The good news is that the needles in syringes and other insulin delivery systems are short, very fine, and easy to use. 2 3
Why is blood glucose control important? Keeping blood glucose levels as close to normal as possible lowers your risk for serious health problems from diabetes, such as heart disease or stroke. Testing your blood glucose helps ensure you are getting the right amount of insulin, at the right time, to control your blood glucose levels. It is important to test your blood glucose levels often with a blood glucose meter. It is also important to keep a diary or record of your test results. This will show you how well insulin is controlling your blood glucose levels. Your healthcare provider will also do an A1C blood test. This is a test that measures how well your blood glucose levels have been controlled over 2 to 3 months. If insulin is not working properly, your dose may need to be adjusted. You may need to check your blood glucose level before and after meals, at bedtime, and at other times during the day. A blood glucose test taken 1 to 2 hours after a meal is called a postprandial reading. Glucose levels may rise substantially after you eat. Controlling these post-meal levels may be important in preventing health problems. You and your healthcare provider will decide what your blood glucose goals should be. Blood Glucose Goals (Plasma Values)* Please refer to the instruction manual for your glucose meter to determine whether it reports the results as plasma or whole blood glucose. * Adapted from the American College of Endocrinology (ACE). Consensus Statement on Guidelines for Glycemic Control. Endocrine Practice. 2002;8 (Suppl 1):S5-S11. 4 5
What are the different types of insulin? The types of insulin differ in their onset of action (when they start to work), their time of peak action (when they are working the most to control blood glucose levels), and their duration of action in the body (how long they work). There are several types of insulin. Rapidor short-acting insulin is usually taken before meals. Intermediate- or long-acting insulin is usually taken during the day, at bedtime, or at both times. Premixed insulin provides both short- or rapid-acting and intermediate- or long-acting insulin in a single preparation. These insulin preparations are usually taken before breakfast, before the evening meal, or at both times. Types of Insulin Onset and Duration of Action* * The duration of action of any insulin may vary in different persons or in the same person at different times. Because of this variation, time periods indicated here should be considered general guidelines only. You and your healthcare provider will decide what type of insulin is best for you. It may take a while to find the right type and dose of insulin. 6 7
What is an insulin plan? An insulin plan tells you what type of insulin to take and when to take it. Your plan will be based on when and how much you eat and your exercise habits. The goal of an insulin plan is to keep your blood glucose levels as close to normal as possible by imitating how your body made insulin before you had diabetes. 1 injection of intermediate- or longacting insulin this plan is often used by people with type 2 diabetes who also take diabetes pills. The injection is usually taken at bedtime to provide insulin coverage during the night and to prevent high fasting blood glucose in the morning. Normal Glucose Level Your healthcare provider will help you develop an insulin plan that is right for you and your lifestyle. The following graphs show how insulin helps control your changing blood glucose levels over time. 2 injections of Regular and NPH insulin this plan requires mixing Regular and NPH insulin. One injection is given in the morning 30 minutes before breakfast and the other before dinner. The short-acting Regular insulin quickly lowers blood glucose after a meal (postprandial). The intermediate-acting 8 9
NPH insulin provides insulin coverage for the rest of the day. For convenience, you may want to use a premixed insulin formulation. The most commonly used premixed insulin contains 70% NPH insulin and 30% Regular insulin. 2 Injections of a premixed insulin analog this plan can give you more control over the timing of your meals and activity. The rapid-acting insulin analog part of the premix (30%) starts working right away. You can eat as soon as you take your insulin. The intermediate-acting part (70%) provides longer-term insulin coverage. Intensive insulin therapy this plan can give you even more flexibility when it comes to meals and activity level. It usually means taking an intermediate- or long-acting insulin with a rapid-acting insulin analog 3 or more times a day. An example of a 4-injection plan would be 3 injections of a rapid-acting insulin analog before meals and 1 injection of an intermediate- or longacting insulin. This plan is intended to mimic your body s natural flow of insulin release. Talk with your diabetes-care team if you are interested in intensive insulin therapy. For more information, ask your healthcare provider for a copy of Intensive Insulin Therapy, part of the Keeping Well With Diabetes series. 10 11
How do I inject insulin? Many people inject insulin with a syringe. Insulin delivery systems are another safe and easy way to inject insulin. An example of a system made by Novo Nordisk is: Novolin InnoLet Human Insulin (rdna origin) a disposable delivery system prefilled with NPH or 70/30 premixed insulin. It is an accurate, convenient, affordable alternative to syringes and vials. Other insulin delivery systems include InDuo, a combination blood glucose monitoring and insulin dosing system, and Innovo, a delivery system that remembers your last dose of insulin and how long ago you took it. Talk to your diabetes-care team, or visit our insulindevice.com website, for more information on insulin delivery systems. Where can I inject insulin? Insulin works best when injected into the fat layer just beneath the skin. Some areas of the body to use include the: abdomen (except a 2-inch circle around your belly button) thighs (top and outer parts), and backs of the upper arms Regular and rapidacting insulin should be clear. NPH and premixed insulin should be cloudy. Look at your insulin before you inject it. No insulin should have floating pieces in it or flakes or clumps on the bottle. Do not use insulin if you see any flakes, clumps, or other material floating in it. Insulin may work better if you inject it in the same general areas each day, such as in 12 13
the abdomen in the morning and the thigh at bedtime. Insulin should be injected in the same areas, but not the same exact spot, to avoid the buildup of lumps or scar tissue. Where you inject insulin can affect how rapidly it works. Before you begin taking insulin, be sure you understand how to prepare and inject insulin, and how fast it may work. Ask your healthcare provider where you should inject your insulin. How do I store insulin and dispose of syringes? Novolin InnoLet Human Insulin (rdna origin) doser Keep unopened insulin vials in the refrigerator. You can store an open vial of insulin at room temperature. Just be sure to keep it away from too much heat or cold and out of bright light and sunlight. If you use insulin cartridges or prefilled insulin delivery systems, follow the directions inside the package about proper use, storage, and disposal. Never use insulin after the expiration date on the label. All needle tips and syringes are disposable, which means you should use them only once and throw them away. Put all syringes and needles in a container that you can t punch a hole in, and that has a screw-on or tight-fitting lid. An example of this is a special sharps container sold by pharmacies. Many states have laws on the proper disposal of diabetes products. Talk to your pharmacist or local waste authority about how to dispose of diabetes products correctly. Sharps Sharps disposal disposal container container 14 15
Does taking insulin cause side effects? Allergies or other side effects with the kinds of insulin made today are rare. If you have redness, swelling, or itching at the place where you inject, tell your healthcare provider. Changing to a different kind of insulin will probably solve this problem. Both medicines from your healthcare provider and medicine you buy yourself, such as aspirin or cough syrup, can affect your blood glucose. Be sure all your healthcare providers know what medicines you are taking, including insulin. What is hypoglycemia? Hypoglycemia means your blood glucose is low. Usually, this is a blood glucose level below 70 mg/dl. Your body isn t getting the energy it needs. This is a serious problem that must be treated right away. Low blood glucose can be caused by: missing a meal or eating later than usual too much insulin increased activity stress any other imbalance in your body s need for glucose or insulin 16 17
How do I recognize and treat hypoglycemia? The warning signs of low blood glucose include feeling: sweaty or clammy sleepy or tired dizzy or uncoordinated irritable or confused restless during sleep weak or shaky hungry Some people may not feel any signs of low blood glucose before they have a problem. This is another reason why frequent blood glucose testing is important. If you have any of these signs, check your blood glucose level right away. If you can t test, treat for low blood glucose anyway rather than wait. You can treat low blood glucose by quickly eating or drinking foods containing a fast-acting carbohydrate, such as: 3 to 4 glucose tablets 1/2 can of a regular soda soft drink pop (not diet!) soda!) a 4-ounce glass of regular fruit juice (such as orange, apple, or grape juice) 3 to 5 hard candies you can eat chew quickly, such as 3 peppermints. It is important to always have a treatment for low blood glucose available. If not treated promptly, hypoglycemia can cause a seizure or make you pass out. Keep a glucagon emergency kit handy. An injection of glucagon will raise your blood glucose very quickly. 3 peppermints 4-ounces of orange juice 18 19
Diabetes care is a team effort. Managing diabetes every day can be difficult at times. Work with your diabetes-care team and tell your family and close friends the warning signs of hypoglycemia. You can live a full and happy life with diabetes! What have I learned? After you read this booklet and talk to your healthcare provider, be sure you know the following: The types and amounts of insulin you take The time or times you inject insulin How and where to give an insulin injection How to store your insulin How and when to test your blood glucose The signs and treatment of hypoglycemia When to contact your healthcare provider Keeping Well With Diabetes We re pleased to offer you this booklet as part of the Keeping Well With Diabetes patient education program. But Keeping Well With Diabetes can bring you so much more. When you become a member of Keeping Well With Diabetes, a FREE program just for people who take insulin, you'll receive tools and materials that can make a difference in your daily life. Simply complete and return the postage-paid card in this booklet, call 1-800-474-KWWD (1-800-474-5993), or visit our website at www.kwwd.com. At Keeping Well With Diabetes Online, you ll find useful information on living with diabetes, online newsletters, and NovoTrack, a unique site that provides you with your own Personal Scorecard to keep track of your diabetes management. Novo Nordisk has been a world leader in diabetes care and treatment for more than 80 years. We do all we can every single day to continue to bring you new products and new services designed to help you keep well with diabetes. 20
For additional information on Novo Nordisk products designed to make living with diabetes easier, or to become a member of Keeping Well With Diabetes, a free program just for insulin users, call us at 1-800-727-6500. Visit us online at www.novonordisk-us.com. Any change in insulin should be made cautiously and only under medical supervision. Novo Nordisk is a worldwide leader in diabetes care. NovoPen, Novolin, PenFill, InnoLet, Innovo and NovoTrack are registered trademarks of Novo Nordisk A/S. InDuo is a trademark of LifeScan, Inc., a Johnson & Johnson company. www.novonordisk-us.com The photographs used in this booklet are for illustration only. The models in the photographs do not necessarily have diabetes or other ailments or use or endorse any products mentioned. Copyright 2003 Novo Nordisk Pharmaceuticals, Inc. 5/2004 125841 Printed in the U.S.A.