Insulin
What is Insulin? Insulin is a hormone produced by special cells in the pancreas These cells that are produced are called beta cells Insulin allows the glucose from food we eat to enter the cells of the body to produce energy Cells need glucose to work
What is Insulin? After eating, the blood glucose level rises and causes the pancreas to release insulin Insulin acts as a key to let the glucose in the cells With insulin acting as the key, glucose leaves the blood and goes into the cells Energy is then produced, and the glucose levels return to normal
Insulin and Diabetes In Type 1 diabetes, the pancreas does not produce insulin so insulin injections, inhaled insulin, or an insulin pump is needed In Type 2 diabetes, the pancreas produces some insulin but not enough to meet the demands of the body
Comparison of Insulin Insulin Type Form Color Approximate Length of Action Rapid Acting Aspart (NovoLog ) Lispro (Humalog ) Glulisine (Apidra TM ) Short Acting Regular Intermediate Acting NPH Human Human Human Human Pork Human Pork Clear Clear Clear Clear Milky-white when mixed Onset Peak Duration* 5 10 minutes Less than 15 minutes Less than 15 minutes 30 60 minutes 30 minutes 2 hours 2 4 hours 4-6 hours 1 3 hours 30 90 minutes 30 90 minutes 2 3 hours 3 4 hours 4 10 hours 8 14 hours 3 5 hours 2 4 hours 1 3 hours 3 6 hours 4 6 hours 10 16 hours 16 20 hours Long Acting Detemir (Levemir ) Glargine (Lantus ) Human Human Clear Clear 1 hour 6 8 hours 24 hours 24 hours Mixtures NPH 70% : Regular 30% NPH 50% : Regular 50% Lispro protamine 75% : Lispro 25% Aspart protamine 70% : Aspart 30% * Indicates the usual effective duration
Definitions Onset When the insulin starts working in the body Peak When the insulin reaches its maximum activity in the body Length of action Refers to how long the insulin produces an effect on your blood glucose
Definitions Rapid-acting Insulin Starts working almost immediately Short-acting Insulin Starts working with 15 to 30 minutes Both rapid and short-acting insulin are given to prevent a rise in blood glucose after meals, also know as a bolus dose
Definitions Intermediate and Long-acting Insulin Onset is gradual and their effect last longer Provide basal dose of insulin Basal Steady amount of insulin used throughout the day to meet your body s basic needs
Sources of Insulin Insulin comes in two forms: Purified Pork Synthetic Human Pork insulin Comes from animals and is purified when bottled Hard to find and can be expensive
Sources of Insulin Human insulin Does not actually come from humans Made in a laboratory using DNA technology Most pure insulin available
Strength of Insulin U-100 Most common Means there are 100 units of insulin per milliliter or cubic centimeter (1 vial contains 1000 units of insulin) U-500 More concentrated There are 500 units per ml Reach peak blood levels more slowly because of its greater concentration
Insulin Programs Long-acting plus rapid or short-acting insulin 1-2 shots daily of long-acting insulin 3+ shots daily of rapid or short-acting insulin (before each meal) Intermediate-acting insulin only 2 shots daily, one before breakfast and one before dinner
Insulin Programs Intermediate-acting plus rapid or short-acting insulin 1-2 shots of intermediate-acting insulin daily 3+ shots of rapid or short-acting insulin (before each meal)
Other Options Besides Shots Insulin Pump Uses rapid or short-acting insulin About the size of a pager Deliver to the body through a flexible plastic tube that is attached to the body Provide a continuous drip of insulin all day for your basal insulin and then you add an additional amount when you eat for your bolus insulin
Other Options Besides Shots Insulin Pump Cont. Bolus size is based on the amount of carbohydrates you eat The insulin release mimics your pancreas Eliminate the need for injections, but you have to change the tubing every 3 days using a needle Need to test blood glucose levels more frequently on a pump
Mixing Insulin NEVER mix long-acting insulin with another insulin, they are not compatible Rapid or short-acting insulin should be drawn up first Reason for this is because intermediate-acting insulin contain traces of a retarding agent which delays the onset of these insulins and could contaminate the rapid or short-acting insulin vial
Insulin Storage
Insulin Storage In use vials Can be kept at room temperature as long as it does not go above 86 o F If exposed to extreme temperatures (hot or cold) insulin can loose its potency, throw it away Stable at room temperate for 28 days after opening
Insulin Storage Unopened Vials Store in the refrigerator until opened or the expiration date, whichever comes first Expiration date can be found on each vial
Traveling with Insulin Do NOT put insulin in checked luggage because it could get lost and luggage compartments may not be temperature controlled Carry a written prescription with you in case you need to get more insulin May need to show a prescription label when boarding an airplane, so keep the insulin box
Traveling with Insulin
Traveling with All Other Diabetes Supplies Syringes Empty syringes can be brought onboard of an airplane as long as you have properly labeled insulin Lancets Can be brought onboard an airplane as long as they are capped Glucometers Must bear the manufacturer s name on them to be brought on an airplane
Traveling Always bring extra of all your diabetes supplies when traveling because you never know when you could get stuck unexpectedly for a few extra hours or days ALWAYS BE PREPARED
Syringes and Needles Sizes ¼ cc (25 units) 1 / 3 cc (30 units) ½ cc (50 units) 1 cc (100 units) 2 cc (200 units) Gauge The larger the gauge, the finer the needle
Injecting Insulin 1. Wash your hands 2. Make sure insulin is not expired 3. Wipe each vial with 70% isopropyl alcohol 4. Take syringe and fill the plunger with the amount of air equal to the amount of insulin you need 5. Push the air into the vial of insulin
Injecting Insulin 6. Draw up your short or rapid-acting insulin 7. Make sure no air bubbles are in the syringe 8. If using two vials, draw up second dose 9. Wipe injection site with alcohol swab 10. Inject insulin 11. Hold the syringe like you would a pen and pinch an area of skin
Injecting Insulin 12. Push the needle through the skin at either a 45 o or 90 o angle 13. Push down on the plunger, release the pinched skin and pull the needle straight out
Site Rotation Rotate injections sites within a chosen area of the body to avoid injury Absorption of insulin decreases in time if you use the same site repeatedly Preferred sites are the upper arm, outside and inside the thigh, hips, and the abdomen
Injection Sites
Syringe Disposal Do not throw your used syringe into a trash can Place used syringe in a Sharps Container or old laundry detergent container Once container is filled, seal container and make sure it is marked as a Biohazard container Throw properly marked container in the trash can
Newer Insulin Delivery Devices
Summary Insulin allows the glucose from food we eat to enter the cells of the body to produce energy There are different types and strengths of insulin, make sure you are always using the same unless instructed to switch by your physician Always remember to rotate your sights when giving injections