Insulin – Importance In Diabetes Management

It is often wrongly assumed that insulin injections are harmful for the human body, and can be addictive if taken regularly. Insulin, however, is a natural hormone that is essential for the body’s functioning! Here is Dr. Silviya Irene, Consultant Endocrinologist at Sitaram Bhartia Hospital, South Delhi, discussing some common misconceptions and questions surrounding this topic.

What is Insulin and What Does It Do in the Body?

Insulin is one of the protein hormones secreted by the pancreas, which pushes the glucose from our meals and transfers it into the cells. It plays an important role in utilizing this glucose and giving the cells the energy they need to work. Normally, the pancreas secretes a small basal amount of insulin throughout the day. In addition to the basal amount, the more insulin is released into the bloodstream in order to control the glucose levels that increase with each meal.

Relationship Between Insulin and Diabetes

People with diabetes could be experiencing a combination of the following insulin-related issues:

• Inadequate insulin – Reduced production of insulin in the body wherein, for example, any post-meal spikes in insulin aren’t observed
• Absent insulin – Total absence of insulin in the body such that even the basal secretion itself is not present
• Inefficient insulin – Insulin resistance, that is, a reduced/inadequate response of insulin towards glucose intake, so much so that even high levels of insulin in the blood is not able to carry out its function

“The extent to which your daily life is affected depends on the type of diabetes you are diagnosed with. Patients with Type 1 diabetes experience a total absence of insulin, while Type 2 diabetes is characterized by the inefficient or inadequate response of insulin to glucose,” says Dr. Silviya. It is important to note that one of the ways to increase insulin sensitivity is by regularizing your lifestyle and increasing daily physical activity.

What are the Types of Insulin?

It is essential that people prescribed with insulin are aware of the type of insulin they are advised to take, the role or function of insulin with respect to meals, and the duration of action. This is required so that they are able to make appropriate changes to the dosage, as necessary, and prevent hypoglycemia in any circumstances. Types of insulin based on their duration of action can be categorized as the following:

1. Rapid-acting insulin: A type of insulin that starts working within 15 minutes of injection and continues working for 3-4 hours
2. Short-acting insulin: This type begins functioning 30 minutes after injection and can be used to cover the insulin requirements during meal times. Its duration of action lasts for 5-6 hours.
3. Intermediate-acting insulin: On average, this insulin can act for 8-12 hours.
4. Long-acting insulin: Long-acting types can be used to supplement the basal secretions that may be absent in some people with diabetes as it acts for 24-42 hours.

Where Should I Inject Insulin?

“We usually counsel our patients on the best site for insulin injections during the preliminary consultations. Rotating the site of injection is advised and you will be encouraged to map out a pattern across different areas of the body.” The best areas for injection include –

• The abdomen, leaving a 3-fingers breadth around the umbilicus
• Thigh – the upper and outer part of the mid-thigh
• Arms – the top and back of arms

Tips on Insulin Storage

The ideal temperature to store insulin is between 2-8° C, and it should never be exposed to a temperature beyond 30° C. Insulin should never be allowed to freeze, as it is at risk of losing its potency in such cases. Remember to also discard the insulin after 28 days of opening the cartridge. “We recommend storing insulin in the fridge doors at home. If you’re traveling, carry the insulin with you in an ice-pack. In case you have to travel for longer, you could keep it in a thermos with an ice-pack, especially if refrigeration facilities are not available.” Read: How to Manage Diabetes While Traveling

What are some risks associated with using insulin?

Out of all the queries Dr. Silviya has to assuage, potential risks involved with insulin intake are the most common. Here are some things to keep in mind before you begin using insulin:

• Hypoglycemia

If you have a habit of skipping meals or have irregular meal timings, your regular insulin doses can start to affect your health as it lowers your blood sugars. This can be easily managed by regulating your meals timings. In case you experience symptoms of hypoglycemia such as palpitations, tremors, or dizziness, then follow the ‘rule of 15’ wherein you eat/drink 15 gms of sugar, relax for 15 mins, and monitor your glucose levels thereafter.

• Excessive weight gain

Please note that weight gain occurs only if patients are on very high doses of insulin. Taking small amounts of insulin will not drastically affect your weight. Along with that, the fear of hypoglycemia can trigger binge eating in some people and, thus, lead to weight gain. Sitting in for proper counseling with our Diabetes Educators can help you avoid unnecessary weight gain. A proper diet and regular exercise greatly contribute to a healthy BMI.

• Faulty injection techniques

It is important that you inspect your site of injection for lumps and discoloration before administering the insulin. Recurrent shots at the same place, or the use of the same needle multiple times, can cause lipohypertrophy (LH). This means that lumps begin to form under the skin and, as a result of which, the site becomes unfit for further injections. “Insulin is often the recommended treatment plan for patients dealing with renal or liver issues – even pregnant mothers with gestational diabetes (GDM) are advised insulin, not oral medication! This is because insulin is the safer option and its use should not be a cause of concern,” concluded Dr. Silviya. “We always make our patients take the first shot of insulin in front of us. This helps us ensure they’re using the right technique, and if they need any guidance or have any fears, we can address these there and then.”