Section Three DIABETES MEDICATION INSULIN This section will tell you: About insulin. How to care and store your insulin. When to take your insulin. Different ways of taking insulin. WHAT IS INSULIN? Insulin is a natural hormone made in your pancreas. It helps keep your blood glucose in a normal range by moving glucose from your blood into your cells. Insulin cannot be taken as a pill because the acids in your stomach would destroy it. Therefore, if you must take insulin, you will need to take shots and/or use an insulin inhaler. You take insulin to keep your blood glucose controlled throughout the day. Your doctor will determine the amount of your dose, how many times a day you should take it, and when to take your insulin injections. Some people may need to take insulin three or four times a day, while others may be able to control their blood glucose with only two injections. Treatment plans are different for each individual person. Caring for your insulin Check the expiration date on the bottle of insulin-do not use if expired. Do not freeze insulin. The bottle of insulin you are using may be kept at room temperature (86 F) for up to 30 days. Keep insulin away from direct sunlight or heat source (radiator, heater). Keep extra bottles of insulin on hand and store in refrigerator. Inspect the bottle of insulin before using. 3-1
Humalog (lispro), NovoLog (aspart), Lantus (glargine), Apidra (glulisine), Levemir (detemir), and Regular insulin should be clear in color. All other insulin should be cloudy When you travel by plane, keep your insulin, syringes, blood glucose meter, glucose source, and all other medications with you. When you travel by car, be sure to keep your insulin cool. INSULIN INFORMATION You will need to know the type of insulin, the concentration, the source and timing of action of insulin. Types There are many different types of insulins. All insulins lower blood glucose. You may be taking more than one type of insulin. There is a large letter or numbers on the bottle of insulin that tells you the type. Humalog (lispro) NovoLog (aspart) Apidra (glulisine) R = Regular N = NPH 50/50 = 50% NPH and 50% Regular 70/30 = 70% NPH and 30% Regular 75/25 = 75% NPL and 25% Humalog Insulin Lantus (glargine) and Levemir (detemir) are types of insulin that do not peak Concentration Insulin is measured in units. Your insulin bottle has 100 units in each milliliter (ml) or cubic centimeter (cc) of fluid in each bottle. This concentration is known as U-100. Source and species 3-2
This tells you where your insulin comes from. Most people use human insulin or insulin analogs. Human insulin does not come from humans but is made in the laboratory by a special process. Guideline for when to take Humalog NovoLog (lispro)... Just before eating (aspart)... Just before eating Apidra (glulisine)... About 15 minutes before eating Regular (R)... About 30 minutes before eating 70/30 and 50/50... About 30 minutes before eating 75/25... Just before eating NPH (N) / Lente / Ultralente/Lantus... Varies Lantus (glargine)... Same time each day Levemir (detemir)... Same time each day Timing of action, (onset, peak, and duration) Onset of action how soon insulin begins to work after taking the injection Peak effect when insulin will be working the hardest (this may be the time when you are most likely to have your blood glucose drop too low) Duration of Action how long the insulin works TIMING AND ACTION OF INSULIN Duration of Insulin type Onset of action Peak effect action 3-3
NovoLog (aspart) < 5 minutes 30-90 minutes 2-4 hours Humalog (lispro) < 5 minutes 1-3 hours 3-5 hours Apidra (glulisine) 15 minutes 55 minutes 2-3 hours Regular 30 minutes 2-3 hours 4-6 hours NPH / Lente 2-4 hours 6-10 hours 15-24 hours Lantus (glargine) 1 hour No Pronounced Peak 24 hours Levemir (detemir) 1 hour 6-8 hours 24 hours 70/30 and 50/50 (mixture of NPH & Reg.) R = 30 minutes N = 1-2 hours R = 2-4 hours N = 6-10 hours R = 6-8 hours N = 15-24 hours 75/25 (mixture of NPL & lispro) within 15 min, 30-90 min, 2-4 hours, INSULIN PENS There are two basic types of insulin pens: 3-4
Both types of pens require a needle that is attached to the pen. The dose of insulin is measured by dialing in the dose. The disposable pen with insulin cartridge-once the cartridge is empty, the pen is thrown away. The re-useable pen with insulin cartridge-once the cartridge is empty, a new one is inserted. For more information regarding the insulin pen, talk to your diabetes educator. INSULIN PUMP THERAPY Another insulin delivery device is known as the insulin pump. It delivers a constant supply of insulin as well as delivering doses of insulin before meals. An insulin pump may be used for people with type 1 diabetes and some people with type 2 who need insulin. People who use an insulin pump need special training and must monitor blood glucose values four or more times each day. Ask your doctor, nurse, or diabetes educator for more information. 3-5