Diabetes, also known as diabetes mellitus, is a long-term condition that can be life-threatening. It occurs when the body is unable to efficiently produce insulin, resulting in high levels of glucose in the blood known as hyperglycemia. Over time, this can lead to complications such as damage to the eyes, kidneys, nerves, as well as heart disease and stroke. In Australia, approximately 300 people are diagnosed with diabetes every day, making it the fastest-growing chronic condition in the country. The main types of diabetes are type 1, type 2, and gestational diabetes.
Type 1 diabetes
Type 1 diabetes is characterized by the pancreas ceasing to produce insulin. Without insulin, glucose levels in the blood become elevated, leading to severe health issues. Type 1 diabetes can develop in both children and adults, often due to genetic factors, although the exact causes remain unknown. Immunological factors are thought to play a role in triggering type 1 diabetes.
Type 2 diabetes
Type 2 diabetes occurs when the pancreas either does not produce enough insulin or when the body becomes resistant to insulin. Lifestyle choices, genetic factors, and ethnic background can all contribute to the development of type 2 diabetes. Managing type 2 diabetes typically involves adopting a healthy diet, engaging in regular physical activity, and sometimes using insulin injections over time.
It is important for individuals with type 2 diabetes to monitor their blood sugar levels regularly to ensure they are within a healthy range. Additionally, regular check-ups with healthcare providers, such as doctors and dietitians, can help in managing the condition effectively.
Complications of uncontrolled type 2 diabetes can include heart disease, stroke, kidney disease, nerve damage, and vision problems. By making lifestyle changes and following a treatment plan, individuals with type 2 diabetes can reduce their risk of these complications and lead a healthier life.
Gestational diabetes
Gestational diabetes affects approximately 5-10% of pregnant women and usually disappears after childbirth. Women who have had gestational diabetes are at a higher risk of developing type 2 diabetes later in life. Treatment for gestational diabetes often involves dietary changes, exercise, and occasionally insulin injections.
Insulin for diabetes
Insulin is crucial for maintaining normal blood glucose levels. Individuals with type 1 diabetes require regular insulin injections to stay alive. Some individuals with type 2 diabetes may also need insulin injections to effectively manage their blood glucose levels.
Insulin can be administered through injections with a syringe, insulin pen, or insulin pump. It is important for individuals to monitor their blood glucose levels regularly to determine the appropriate dosage of insulin needed.
In addition to injections, some individuals with diabetes may also use insulin inhalers or insulin patches as alternative methods of delivery. It is important for individuals with diabetes to work closely with their healthcare team to develop a personalized insulin treatment plan that meets their individual needs.
Starting on insulin
People with type 1 diabetes need to inject insulin multiple times a day, while some individuals with type 2 diabetes may require insulin when other treatments are no longer effective. Various insulin delivery devices can help make the process of injections more manageable and customizable.
It’s important for individuals starting on insulin to work closely with their healthcare team to determine the right type of insulin, dosage, and injection schedule. Monitoring blood sugar levels regularly is essential to ensure the insulin therapy is effective in controlling blood sugar levels.
Insulin pens and insulin pumps are popular insulin delivery devices that offer convenient and discreet ways to administer insulin. These devices come with different features to suit individual needs and preferences.
Proper injection technique is crucial to ensure the insulin is delivered effectively. It’s important to rotate injection sites to prevent lipodystrophy, a condition caused by repeatedly injecting insulin into the same area.
Overall, starting on insulin may seem overwhelming at first, but with proper education, support, and guidance from healthcare professionals, individuals can successfully manage their diabetes and lead a healthy life.
Types of insulin
Insulin types have different durations of action in the body. Rapid-acting insulins are used to manage blood glucose levels around meal times, whereas longer-acting insulins provide overall glucose control. Understanding the characteristics of each insulin type is essential for effective diabetes management.
Rapid-acting insulin
Rapid-acting insulin works quickly after injection, lowering blood glucose levels following meals. It should be taken with or immediately after eating. There are multiple options for rapid-acting insulin, and new varieties are continuously being developed.
Short-acting insulin
Short-acting insulin begins working within 30 minutes and lasts for 6-8 hours. It is typically administered 30 minutes before a meal to help manage blood glucose levels before and after eating.
Intermediate-acting insulin
Intermediate-acting insulins work between meals to maintain stable blood glucose levels throughout the day. Understanding the distinctions between intermediate-acting and long-acting insulins is critical for effective management of diabetes.
Long-acting insulin
Long-acting insulins provide a consistent release of insulin over an extended period, helping to maintain steady blood glucose levels. Knowledge of how each type of insulin functions and when to administer them is vital for successful diabetes treatment.
- Lantus (glargine insulin) – Offers a stable release of insulin without a clear peak period. One injection can last up to 24 hours and is typically administered once a day, although twice-daily dosing is also an option.
- Toujeo (glargine insulin) – Has a concentration of 300 units per ml, three times higher than other insulins in Australia. It is administered once daily, lasting for at least 24 hours, and comes in a disposable pen. Provides a slower and more consistent glucose profile.
- Levemir (detemir insulin) – Provides a steady release of insulin without a clear peak period, lasting up to 18 hours. It is typically injected twice daily.
Although these long-acting insulins do not require mixing before injection, they provide a consistent release of insulin over time.
Mixed insulin
Mixed insulin combines rapid-acting or short-acting insulin with intermediate-acting insulin in a pre-mixed form.
In Australia, currently available mixed insulins 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 concentration of 100 units per ml. (Different strengths may be available in other countries.)
An exception is Toujeo, a once-daily long-acting insulin with a concentration of 300 units/ml. Before switching between Lantus and Toujeo, it’s important to consult with a healthcare professional.
Insulin injection devices
Various devices can be used to administer insulin, including syringes, insulin pens, and insulin pumps.
Insulin syringes
Syringes are available in 30-unit, 50-unit, and 100-unit sizes, with needle lengths ranging from 6 to 8 mm. Syringes are single-use and are provided free of charge to registered Australians. Many adults now prefer the convenience of insulin pens for injections.
Insulin pens
Insulin pens, whether disposable or reusable, are designed for specific insulin brands. Disposable pens come with pre-filled cartridges and are discarded after use or when empty, typically lasting for a month. Reusable pens require cartridges to be inserted and are designed by insulin manufacturers.
Pen needles are disposable, with lengths varying from 4 to 12.7 mm, although shorter needles are usually recommended. The thickness of the needle (gauge) varies, with higher gauge needles being thinner.
Insulin pumps
An insulin pump is a small device that holds and delivers insulin from outside the body through thin tubing into the fatty tissue. Only rapid-acting insulin can be used with insulin pumps. The pump can be programmed to deliver insulin continuously or in specific doses.
Insulin injection sites
Insulin injections are administered into the subcutaneous layer of the skin, not directly into the blood or muscle. The rate of insulin absorption can vary depending on the injection site, with the abdomen offering the quickest absorption.
Factors that speed insulin absorption
Factors that can affect insulin absorption include the area where injections are given, high temperatures, massaging the injection site, and injecting into muscle tissue, which can lead to quicker absorption of insulin. Additionally, physical activity can also speed up the absorption of insulin into the bloodstream. It is important for individuals with diabetes to be aware of these factors in order to effectively manage their insulin levels and blood sugar control.
Factors that delay insulin absorption
Insulin absorption can be delayed by overusing injection sites or using insulin that is cold.
Disposal of used insulin syringes
Used syringes, pen needles, cannulas, and lancets should be disposed of in puncture-proof sharps containers, which can be obtained from pharmacies or diabetes organizations.
It is important to never throw used sharps in the regular trash or recycling bins, as they can pose a risk to sanitation workers and others. By properly disposing of used insulin syringes in sharps containers, you are helping to protect the environment and prevent accidental injuries.
Remember to always keep sharps containers out of reach of children and pets, and never attempt to recap needles or break them before disposal. Once the sharps container is full, seal it tightly and follow local regulations for proper disposal, such as dropping it off at a collection site or using a mail-back program.
Insulin storage
Proper storage of insulin involves refrigeration, storing at room temperature, avoiding freezing, and protecting from direct sunlight. Insulated carry bags are available for transporting insulin.
Insulin safety
Do not use insulin if it has changed in appearance, reached its expiration date, been exposed to extreme temperatures, or left out of the refrigerator for an extended period of time.
Record your blood glucose levels and insulin doses
Monitoring blood glucose levels is essential for adjusting insulin doses. The pancreas regulates blood sugar levels through the production of insulin, glucagon, and other hormones.
Glucagon
In conjunction with other hormones, glucagon, a pancreatic hormone, plays a crucial role in regulating blood glucose levels, working in tandem with beta cells that secrete insulin.
Glucagon and insulin work together to maintain stable blood glucose levels. Glucagon helps raise blood glucose levels by converting stored glucose in the liver and preventing the storage of new glucose. It also aids in producing glucose from alternate sources.
On the other hand, insulin transports glucose from the blood into cells for energy production. The body has a feedback mechanism to regulate the need for glucagon. Problems with glucagon production can lead to blood glucose issues. While low levels of glucagon are rare, they can result in low blood sugar, particularly in infants.
Although high levels of glucagon are uncommon, they can lead to diabetes mellitus and unexpected weight loss. Hypoglycemia, or low blood sugar, can manifest as symptoms like shakiness or confusion. Severe low blood sugar may necessitate treatment with glucagon.
Emergency glucagon can be administered using an injection kit, an auto-injector pen, or a dry nasal spray. Potential side effects may include nausea, vomiting, headaches, and redness at the injection site.
If severe hypoglycemia is treated with glucagon, consciousness should be regained within 15 minutes. If not, a repeat dose may be necessary. Follow up with a source of fast-acting sugar and contact your healthcare provider.
Insulin not only regulates the absorption of glucose by cells for energy but also influences other metabolic processes. Issues with insulin production can lead to diabetes, with type 1 diabetes stemming from insufficient insulin production and type 2 diabetes often associated with lifestyle factors.
If you suspect any issues related to insulin, it is important to consult with a healthcare provider for evaluation. Diabetes management should be conducted under medical supervision, including discussions about treatment options, blood sugar monitoring, and lifestyle adjustments.