Diabetes mellitus is a long-term condition in which the body loses its ability to produce insulin, leading to elevated blood glucose levels that can harm the eyes, kidneys, nerves, and increase the risk of heart disease and stroke. Approximately 300 Australians are diagnosed with diabetes each day.
Diabetes is the fastest-growing chronic disease in Australia, encompassing various types such as type 1, type 2, and gestational diabetes.
It is essential for individuals with diabetes to manage their condition through a combination of medication, healthy eating, regular physical activity, and monitoring blood glucose levels. Complications from diabetes can be prevented or delayed with proper management and lifestyle changes.
Educating oneself about diabetes, its symptoms, and risk factors is crucial for early detection and treatment. Regular check-ups with healthcare professionals, such as doctors, dietitians, and endocrinologists, are important for monitoring diabetes control and preventing complications.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys insulin-producing beta cells in the pancreas. This results in a lack of insulin production, leading to high blood glucose levels. People with type 1 diabetes require insulin injections or an insulin pump to manage their blood sugar levels.
Type 1 diabetes is usually diagnosed in children and young adults, but it can occur at any age. Unlike type 2 diabetes, type 1 diabetes is not caused by lifestyle factors such as diet and exercise. Research suggests that a combination of genetic and environmental factors may contribute to the development of type 1 diabetes.
Type 2 Diabetes
Type 2 diabetes develops when the pancreas does not generate enough insulin or when insulin is not functioning effectively, leading to increased blood glucose levels. Lifestyle factors such as obesity, lack of physical activity, and poor diet contribute to the development of type 2 diabetes. In addition, certain ethnic groups, such as African Americans, Hispanic Americans, Native Americans, and Asian Americans, are at higher risk for developing type 2 diabetes. It is important for individuals at risk to make healthy lifestyle choices, such as maintaining a healthy weight, staying physically active, and eating a balanced diet, to reduce their risk of developing type 2 diabetes.
Gestational Diabetes
Gestational diabetes impacts 5-10% of pregnant women and raises the likelihood of developing type 2 diabetes in the future. Management involves following a healthy diet, engaging in physical activity, and sometimes necessitating insulin injections.
Women with gestational diabetes are advised to monitor their blood sugar levels regularly and work closely with their healthcare provider to manage their condition. Maintaining a healthy weight before and during pregnancy can also help reduce the risk of developing gestational diabetes.
In addition to diet and exercise, some women may require insulin injections to help control their blood sugar levels. It is important for women with gestational diabetes to carefully follow their healthcare provider’s recommendations to ensure the health of both themselves and their baby.
Insulin
Insulin assists in moving glucose into cells for energy production. Individuals with type 1 diabetes require regular insulin injections for survival, while those with type 2 diabetes may also need insulin to regulate blood glucose levels.
Insulin Management
Individuals with diabetes might require multiple daily insulin injections. Learning to effectively manage insulin doses, blood glucose levels, and lifestyle changes is vital for successful treatment.
Types of Insulin
Insulin is classified based on its duration of action, varying from fast-acting to long-acting. Different combinations of insulin types are utilized based on individual requirements.
Rapid-Acting Insulin
Fast-acting insulin initiates its effects within minutes post-injection and has a rapid onset of action. It aids in managing blood glucose levels after meals to prevent hypoglycemia.
Popular fast-acting insulin varieties include Fiasp, NovoRapid, Humalog, and Apidra.
Short-Acting Insulin
Short-acting insulin takes longer to start working compared to fast-acting insulins and is typically injected 30 minutes before a meal.
Intermediate-Acting Insulin
Intermediate-acting insulins, also known as basal insulins, have an extended duration of action and function continuously to maintain steady blood glucose levels.
Common intermediate-acting insulins in Australia include Humulin NPH and Protaphane.
Long-Acting Insulin
Long-acting insulins deliver a basal level of insulin throughout the day with a single injection. They aid in managing blood glucose levels in between meals and overnight.
- Lantus (glargine insulin) – provides slow, consistent release with no peak action, lasting up to 24 hours, typically injected once daily
- Toujeo – 3 times the concentration of regular Lantus, lasting a minimum of 24 hours, offering a slower and steadier glucose profile
- Levemir (detemir insulin) – gradual, steady release with no peak action, lasting up to 18 hours, usually injected twice daily
Long-acting insulins do not necessitate mixing before administration.
Short-acting and Intermediate-acting Insulins
Mixed insulins combine fast-acting or short-acting insulin with intermediate-acting insulin:
- NovoMix 30
- Humalog Mix 25
- Humalog Mix 50
- Ryzodeg 70:30
- Mixtard 30/70
- Mixtard 50/50
- Humulin 30/70
In Australia, these insulins are standardized at 100 units per ml. Toujeo, with a concentration of 300 units per ml, is an exception. Prior to switching between Lantus and Toujeo, consult with a healthcare professional.
Insulin Delivery Devices
Insulin Syringes
Available in various sizes and needle lengths, designed for single-use, and provided free to registered Australians, with most adults opting for insulin pens.
Insulin Pens
Disposable pens come prefilled with insulin, while reusable pens necessitate cartridge insertion. Discard pen cartridges if insulin remains after one month. Seek guidance from your healthcare provider for appropriate pen selection.
Insulin Pumps
A programmable device administering continuous insulin doses into the body, utilizing only fast-acting insulin. Carefully consider with your healthcare team before utilizing a pump.
Insulin Injection and Absorption
Insulin Absorption Factors
- Exercised areas – Injecting insulin into areas that have been recently exercised can help increase absorption rates.
- High temperatures – Heat can increase blood flow to the injection site, leading to faster absorption of insulin.
- Massage around the injection site – Massaging the area after injection can help distribute the insulin and promote absorption.
- Injecting into muscle – Injecting insulin into the muscle instead of the fat layer can result in quicker absorption.
Insulin Absorption Deterrents
- Overuse of the same site – Repeatedly injecting insulin into the same site can cause scar tissue to build up, leading to slower absorption.
- Injecting cold insulin – Cold insulin can be more viscous and take longer to absorb, so it’s best to let it warm up to room temperature before injecting.
Disposal of Used Needles
Utilize approved sharps containers for disposal, adhering to local guidelines provided by health authorities or organizations.
Proper Insulin Storage
- Store unopened insulin appropriately
- Avoid extreme temperatures as they can compromise insulin efficacy
Recognizing Unusable Insulin
- Cloudy or contaminated insulin
- Expired or exposed to improper temperatures
- Insulin vials or cartridges utilized beyond one month
Blood Glucose Monitoring
Regular monitoring aids in effectively adjusting your insulin dosage.
Comprising of 100 units per 1 ml, consumed before meals to regulate glucose levels during food absorption.
Consult your healthcare provider for dosages and timing to optimize results, especially in carbohydrate counting for managing type 1 diabetes.
Adjust your short-acting insulin dose based on your weight, diabetes type, level of physical activity, and other medications being taken.
Changes to your dose
In addition to modifying your dose for meals, you may need to alter your insulin dose when unwell, stressed, in extreme weather conditions, during exercise, when commencing or discontinuing other medications, through menopause, pregnancy, growth phases, religious fasts, or changes in daily routine.
Testing your blood glucose
Regularly check your blood glucose levels to ensure the adequacy of your insulin dose. Your healthcare team can provide guidance on appropriate testing techniques.
It is important to keep a record of your blood glucose levels to track any patterns or changes. This information can help you and your healthcare team make adjustments to your insulin regimen as needed.
When testing your blood glucose, make sure to wash your hands with soap and water before pricking your finger. Use a clean lancet each time to minimize the risk of infection. Follow the instructions provided with your glucometer for accurate readings.
If you experience symptoms of low or high blood sugar, such as dizziness, confusion, sweating, or extreme thirst, check your blood glucose levels immediately and follow the appropriate treatment plan recommended by your healthcare provider.
How to take it
Many individuals utilize insulin pens or pumps for fast-acting insulin. Various pens and pumps are available, each requiring specific instructions.
Using an insulin pen
Your diabetes specialist will demonstrate how to utilize an insulin pen for injections. It is imperative to meticulously follow the pen’s instructions.
- Begin by washing your hands
- Use a new needle for each injection
- Ensure no air is in the pen before injecting
- Select the correct dose on the pen
- Rotate injection sites
- Administer at a perpendicular angle
- Hold for 10 seconds post-injection
- Properly dispose of used needles
Varying injection sites prevents skin nodules that can impact insulin absorption.
Using an insulin pump
Insulin pumps deliver a continuous insulin supply via a small tube under the skin. They can enhance blood glucose control compared to injections.
Pumps provide background insulin and mealtime doses. Learn to proficiently manage pump settings.
Pumps are available in tethered and patch varieties, suitable for specific age groups and conditions.
NHS guidelines outline the availability and eligibility criteria for insulin pumps.
Taking insulin safely
To prevent errors in insulin dosing, acquaint yourself with your insulin type, dosage, injection technique, and hospital protocols.
It is important to always double check the type of insulin you are using before each dose to avoid any mix-ups. Be sure to keep your insulin stored properly according to the manufacturer’s instructions to maintain its effectiveness. Additionally, always use a clean and sterile needle and syringe for each injection to reduce the risk of infection.
If you have a problem with your insulin pen
The reliability of insulin pens is crucial for effective blood glucose management. Consult healthcare professionals if any issues are suspected.
How long to take it for
Insulin is an essential requirement for type 1 diabetes throughout life and may be necessary for type 2 diabetes if alternative treatments are unsuccessful. Adhere to medical advice for optimal insulin utilization.
Efficient insulin management diminishes the risk of short and long-term diabetes complications.
Discuss any concerns regarding insulin treatment with healthcare providers.
If you forget to take it
Inadequate insulin intake heightens the risk of elevated blood sugar and diabetes complications. Monitor glucose levels, seek guidance if necessary, and refrain from doubling doses.
If you take too much
An excess of insulin can lead to low blood sugar levels. Exercise caution regarding meals, physical activity, and alcohol consumption to prevent hypoglycemia.
Symptoms of a hypo
Acknowledge hypoglycemia symptoms and promptly address them with recommended treatment.
Nighttime hypoglycemia can occur. Inform your diabetes team if these episodes happen frequently.
Low blood sugar is indicated by levels below 4mmol/L.
Treating a hypo
If experiencing hypoglycemic symptoms, follow provided instructions for treatment.
- Consume sugary snacks or beverages immediately
- Check your blood glucose level 10-15 minutes after sugar consumption. If it has improved, proceed to step 3. If still low, consume more sugar and recheck after 10 minutes.
- Once your blood sugar surpasses 4mmol/L, consume a slow-release carbohydrate like a sandwich or cookies, or your next scheduled meal.
- Upon feeling better and achieving stable blood sugar levels, you can resume your insulin treatment.
Always carry glucose tablets or high-sugar snacks in case of a hypoglycemic episode.
Avoid driving, cycling, or operating machinery if you have overdosed on insulin, even in the absence of symptoms, and wait a minimum of 45 minutes after recovering from a hypoglycemic episode before driving.
If you’ve taken excess insulin, try to have someone accompany you.
Important: Severe hypos
If you experience severe hypoglycemia accompanied by drowsiness or unconsciousness, ensure your loved ones are aware of how to administer a glucagon injection and when to contact emergency services.
Educate yourself on the side effects of fast-acting insulin, including severe hypoglycemic episodes.