Diabetes mellitus, commonly known as diabetes, is a persistent condition in which the body’s ability to produce insulin is compromised, leading to elevated levels of glucose in the blood.
Elevated blood sugar levels, over time, can result in damage to the eyes, kidneys, nerves, heart, and increase the risk of stroke. In Australia, diabetes is the fastest-growing chronic ailment, with primary types including type 1, type 2, and gestational diabetes.
Types of Diabetes
Type 1 diabetes arises when the pancreas ceases to produce insulin, necessitating lifelong insulin injections. It is not influenced by lifestyle choices. Type 2 diabetes develops when the pancreas is unable to produce enough insulin or when the produced insulin is not effectively used, affecting 85-90% of individuals with diabetes. Certain ethnic groups are more predisposed to type 2 diabetes.
Gestational Diabetes
Gestational diabetes affects 5-10% of pregnant women and can potentially lead to type 2 diabetes later in life. Treatment involves diet, physical activity, and potentially insulin injections.
Insulin Function and Types
The role of insulin is to transport glucose from the bloodstream into cells for energy generation. Insulin is produced by beta cells in the pancreas. There are different types of insulin, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin. Rapid-acting insulin is taken just before or with a meal to help control blood sugar spikes, while long-acting insulin helps maintain stable blood sugar levels throughout the day.
Insulin Administration
Types of Insulin
Rapid-acting insulin works promptly after meals, short-acting insulin has a slower onset, and intermediate/long-acting insulins serve as basal insulin. Different brands are available for each type in Australia.
- Lantus (glargine insulin) – provides a steady release without peak action, lasting up to 24 hours and administered once daily
- Toujeo (glargine insulin) – 3 times concentration, 300 units per ml, lasting at least 24 hours, administered via disposable pen only
- Levemir (detemir insulin) – steady release without peak action, lasting up to 18 hours, generally administered twice daily
These long-acting insulins are clear and do not require mixing before injection.
Mixed insulin
Mixed insulin combines fast-acting or short-acting insulin with intermediate-acting insulin.
Available mixed insulins in Australia include NovoMix 30, Humalog Mix 25, Humalog Mix 50, Ryzodeg 70:30, Mixtard 30/70, Mixtard 50/50, and Humulin 30/70, all with a strength of 100 units per ml, except for Toujeo at 300 units per ml. Consult a healthcare professional before switching between Lantus and Toujeo.
Insulin injection devices
Insulin can be administered via syringes, pens, or pumps.
Insulin syringes
Insulin pens
Pen needles are disposable and come in various lengths and gauges.
Insulin pumps
Insulin injection sites
To ensure proper absorption, insulin should be injected into the subcutaneous layer of fatty tissue rather than muscle or blood.
The abdomen provides the quickest absorption site, while absorption is slower in the arms, buttocks, and thighs.
It is important to rotate injection sites within the same general area to prevent lipodystrophy, a condition characterized by lumps or dents in the skin caused by repeated injections in the same spot. By rotating sites, you can ensure more consistent insulin absorption and minimize the risk of developing skin abnormalities.
Factors that speed insulin absorption
Factors that delay insulin absorption
Repeated use of the same injection site or using cold insulin can delay insulin absorption.
Other factors that can delay insulin absorption include:
- Injecting into scar tissue or areas with poor blood flow
- Exercising immediately after injection
- Injecting into muscle instead of fatty tissue
- Using expired or improperly stored insulin
Disposal of used insulin syringes
Insulin storage
Insulin should be stored correctly, refrigerated before opening, and kept at room temperature afterward.
Extreme temperatures can compromise insulin effectiveness, and insulated carry bags are available for transportation.
It is important to check the expiration date on insulin vials and pens and never use expired insulin. Additionally, insulin should be kept away from direct sunlight and heat sources to maintain its potency.
Insulin safety
Expired or cloudy insulin should not be used, and used vials or cartridges should be disposed of appropriately. It is important to always check the expiration date on insulin vials and cartridges before use. Insulin that has expired may not work effectively in controlling blood sugar levels. Additionally, insulin that appears cloudy or discolored should also not be used, as it may be a sign of contamination or degradation. Proper disposal of used insulin vials or cartridges is crucial to prevent accidental needle sticks or reuse of contaminated products.
Record your blood glucose levels and insulin doses
StatPearls [Internet].
Authors
Affiliations
Introduction
Insulin is a crucial anabolic hormone involved in regulating energy utilization. Beta cells in the pancreas produce insulin based on glucose and other substance levels. Insulin plays a key role in determining the body’s metabolic state and helps to regulate blood sugar levels. Without adequate insulin production, individuals may develop conditions such as diabetes, which can lead to various health complications.
Fundamentals
Definitions of Key Metabolic Processes
Metabolism is the collective term for all the chemical processes that occur within an organism to maintain life. These processes can be classified into two main categories: catabolism and anabolism.
Catabolism refers to the breakdown of larger molecules into smaller molecules, releasing energy in the process. Examples of catabolic processes include glycolysis, the breakdown of glucose to produce energy, and the citric acid cycle, which extracts energy from carbohydrates, fats, and proteins.
Anabolism involves the synthesis of complex molecules from simpler molecules, requiring energy input. One example of anabolic process is protein synthesis, where amino acids are combined to form proteins necessary for growth and repair.
Overall, metabolism is essential for the survival of all living organisms, providing the energy and building blocks needed for growth, maintenance, and reproduction.
Cellular Level
Molecular Level
Function
Role in Glucose Metabolism
Role in Glycogen Metabolism
Role in Lipid Metabolism
Role in Protein Metabolism
Role in Inflammation and Vasodilation
Clinical Significance
Review Questions
References
Below are some recent publications on advancements in diabetes treatment:
– Eleftheriadou I, Tentolouris A, Tentolouris N, Papanas N. Expert Opin Pharmacother. 2019 Jun; 20 (9):1153-1160. [PubMed : 30958725]
– Kuzulugil D, Papeix G, Luu J, Kerridge RK. Curr Opin Anaesthesiol. 2019 Jun; 32 (3):398-404. [PMC free article : PMC6522201] [PubMed : 30958402]
– Athyros VG, Polyzos SA, Kountouras J, Katsiki N, Anagnostis P, Doumas M, Mantzoros CS. Curr Vasc Pharmacol. 2020; 18 (2):172-181. [PubMed : 30961499]
– Papamichou D, Panagiotakos DB, Itsiopoulos C. Nutr Metab Cardiovasc Dis. 2019 Jun; 29 (6):531-543. [PubMed : 30952576]
It’s important to note that Elizabeth Vargas, Neena Joy, and Maria Alicia Carrillo Sepulveda have disclosed no relevant financial relationships with ineligible companies.