Diabetes, or diabetes mellitus, is a chronic and potentially life-threatening condition in which the body’s ability to produce insulin is compromised, resulting in high blood glucose levels (hyperglycemia).
Elevated blood glucose levels over time can lead to damage in various parts of the body, such as the eyes, kidneys, nerves, heart, and can even cause a stroke. Approximately 300 Australians are diagnosed with diabetes daily, making it the fastest-growing chronic condition in the country. The main types of diabetes include type 1, type 2, and gestational diabetes.
Type 1 Diabetes
Type 1 diabetes occurs when the pancreas stops producing insulin, necessitating daily insulin injections. This type of diabetes typically affects younger individuals and is not linked to lifestyle factors. In type 1 diabetes, the immune system attacks the cells in the pancreas responsible for insulin production.
Individuals with type 1 diabetes need to carefully monitor their blood sugar levels throughout the day and adjust their insulin dosage accordingly. It is important for them to follow a healthy diet, engage in regular physical activity, and work closely with healthcare providers to manage their condition effectively.
Complications of untreated or poorly managed type 1 diabetes can include heart disease, stroke, nerve damage, kidney damage, and vision problems. Therefore, it is crucial for individuals with type 1 diabetes to prioritize their health and adhere to their treatment plan to prevent complications.
Type 2 Diabetes
Type 2 diabetes is characterized by inadequate insulin production or the body’s ineffective use of insulin, accounting for 85-90% of all diabetes cases. Lifestyle factors, such as being overweight and lack of physical activity, play a significant role in the development of type 2 diabetes. Some ethnic backgrounds have a higher predisposition to this type of diabetes.
Gestational Diabetes
Gestational diabetes affects 5-10% of pregnant women and often resolves after childbirth. Management of gestational diabetes involves consultation with a dietitian, regular exercise, blood glucose monitoring, and, if necessary, insulin injections.
Insulin Role
The pancreas produces insulin, which is responsible for regulating blood glucose levels by transporting glucose into cells for energy. Insufficient insulin leads to the accumulation of glucose in the bloodstream. Individuals with diabetes may require insulin injections to manage their blood glucose levels effectively.
In addition to regulating blood glucose levels, insulin also plays a crucial role in storing excess glucose as glycogen in the liver and muscles. This stored glycogen can be converted back into glucose when needed, providing a constant source of energy for the body.
Furthermore, insulin helps to promote the uptake of amino acids into cells, facilitating protein synthesis and tissue growth. It also inhibits the breakdown of fats, promoting fat storage and preventing excessive breakdown for energy.
Insulin Injection
The administration of insulin varies for individuals with type 1 and some type 2 diabetes, often requiring multiple daily injections. Healthcare professionals provide education on insulin use, assist in dose adjustments, monitor progress, and may recommend changes in the type of insulin over time.
Insulin Types
Insulin is classified into different categories based on its duration of action, ranging from rapid-acting to long-acting insulin. Different combinations of insulin types cater to individual requirements, with options such as rapid-acting, short-acting, intermediate-acting, mixed, and long-acting insulins.
Rapid-Acting Insulin
Rapid-acting insulin begins to work within minutes after injection and is ideal for lowering blood glucose levels after meals. Some available rapid-acting insulin types in Australia include Fiasp, NovoRapid, Humalog, and Apidra.
Short-Acting Insulin
Short-acting insulin has a slower onset compared to rapid-acting insulins and should be administered before meals. It affects blood glucose levels within 2 to 5 hours after injection and lasts for up to 8 hours.
Intermediate-Acting Insulin
Intermediate-acting insulins start working within 60 to 90 minutes after injection, peak between 4 to 12 hours, and provide effects for up to 24 hours. Examples of intermediate-acting insulins in Australia are Humulin NPH and Protaphane.
Long-Acting Insulin
Long-acting insulins offer basal insulin coverage throughout the day and night, with various types available to meet different needs.
- Lantus® (glargine insulin) – provides slow, steady release without peak action, lasting up to 24 hours and usually administered once a day
- Toujeo (glargine insulin) – has a strength of 300 units per ml, providing a slower, steadier glucose profile, given once daily via a disposable pen
- Levemir® (detemir insulin) – offers a slow, steady release lasting up to 18 hours and is typically injected twice daily
These long-acting insulins are clear and do not require mixing before injection.
Mixed Insulin
Mixed insulin combines rapid or short-acting insulin with intermediate-acting insulin. Various mixed insulin types are available in Australia with different ratios and durations of action.
Examples of 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 strength of 100 units per ml in Australia.
One exception is Toujeo, a once-daily insulin with a strength of 300 units per ml. Consultation with a healthcare professional is recommended before transitioning between Lantus and Toujeo.
Insulin injection devices
Insulin can be administered using syringes, insulin pens, or insulin pumps, depending on individual preference and requirements.
Insulin syringes
Syringes are available in different measurements and needle lengths, typically used for insulin administration. Most adults now prefer insulin pens for their convenience in daily insulin injections.
Insulin pens
Insulin companies offer disposable or reusable pens for insulin delivery, with proper disposal and usage guidelines provided by healthcare providers. Disposable pens contain insulin cartridges and are discarded empty, while reusable pens require a 3 ml insulin cartridge.
Insulin pumps
An insulin pump is a small device that delivers rapid-acting insulin beneath the skin, programmable to provide continuous insulin delivery or bursts after meals. Healthcare provider guidance is essential before starting insulin pump therapy.
For individuals with type 1 diabetes, the cost of insulin pump therapy is often covered by private insurance, with disposable extras subsidized by the NDSS for eligible individuals.
Insulin injection sites
To ensure proper insulin absorption, injections should be administered into the subcutaneous fatty tissue layer rather than muscle or blood vessels. The abdomen is the fastest site for insulin absorption, followed by the upper arms, buttocks, and thighs.
Factors that speed insulin absorption
Several factors can affect insulin absorption, such as exercising in the thighs or arms, high temperatures at the injection site, massaging the injection area, and accidentally injecting into muscle tissue.
Factors that delay insulin absorption
Insulin absorption may be delayed by overusing injection sites, leading to lumps or scars, or by using cold insulin for injections. Additionally, factors such as injecting into scar tissue, using expired insulin, injecting into areas with poor blood circulation, or injecting too shallow or too deep can also impact insulin absorption rates. It is important for individuals with diabetes to rotate injection sites regularly and follow proper injection techniques to ensure optimal insulin absorption.
Disposal of used insulin syringes
Used syringes, pen needles, cannulas, and lancets should be disposed of in a puncture-proof sharps container to prevent accidental injuries. These containers are available through pharmacies, local councils, or state diabetes organizations, with specific disposal procedures varying by location.
Individuals can contact diabetes organizations, their state Health Department, or local council for assistance with proper disposal methods.
Insulin storage
Unopened insulin should be stored in the refrigerator at a temperature between 2-8 °C to maintain its efficacy. Once opened, insulin can be stored at room temperature for up to one month, avoiding exposure to extreme temperatures to prevent degradation. Insulated carry bags are recommended for transporting insulin to maintain its effectiveness.
It is important to check the expiration date on insulin packaging before use. Expired insulin may not work as effectively in controlling blood sugar levels.
Insulin vials or pens should be kept away from direct sunlight and heat sources, as exposure to these conditions can degrade the insulin. Additionally, insulin should not be frozen, as this can also affect its potency.
Proper disposal of insulin needles and syringes is important to prevent needle-stick injuries. Sharps containers or puncture-proof containers should be used to dispose of used needles and syringes.
Insulin safety
Do not use insulin if it shows signs of contamination, such as clear insulin turning cloudy, cloudy insulin containing lumps or flakes, insulin past its expiration date, frozen insulin, or insulin that has been left out of the fridge for over a month.
Record your blood glucose levels and insulin doses
Keeping records of blood glucose levels can help individuals adjust their insulin dosage as needed to maintain optimal control over their diabetes.
Insulin plays a crucial role in regulating blood glucose levels for individuals with diabetes, aiding in the movement of glucose into cells for energy production. Glucose, the body’s primary energy source, is derived from carbohydrates in the diet.
How does insulin work?
Insulin is essential for glucose metabolism, facilitating the transfer of glucose into cells for energy storage. Proper regulation of blood sugar levels is dependent on the presence of insulin in the body.
In diabetes, the inability of glucose to enter cells for energy leads to elevated sugar levels in the bloodstream.
High blood sugar levels
Short term effects
Elevated blood sugar levels can result in common diabetes symptoms in the short term. Severe dehydration and high blood sugar levels may lead to hyperosmolar hyperglycemic state (HHS) in individuals with type 2 diabetes.
Severe lack of insulin
The absence of insulin can trigger life-threatening diabetic ketoacidosis (DKA) in individuals with type 1 or some type 2 diabetes, serving as an indication of diabetes onset. This condition requires immediate medical attention.
Long term effects
Prolonged elevated blood sugar levels can result in diabetes complications affecting various parts of the body, emphasizing the importance of proper blood sugar control.
Using insulin as a treatment
Insulin serves as a primary treatment for managing blood sugar levels and reducing the risks of complications associated with diabetes. Maintaining a balance of physical activity, a healthy diet, and insulin therapy is essential to prevent long-term complications and ensure overall well-being.
Regular healthcare visits and diabetes screenings are crucial in detecting early signs of complications and preventing potential health issues.
Getting insulin on prescription
Insulin is available by prescription, including pens and needles, with free prescriptions provided in Scotland, Wales, and Northern Ireland. Individuals under 60 in England may require a medical exemption certificate for free prescriptions.
Healthcare providers prescribe specific types of insulin based on individual needs and requirements.
Taking insulin
Insulin can be administered as a liquid via insulin pens and needles or through an insulin pump. The NHS offers insulin pumps for select type 1 diabetes patients, enhancing convenience and precision in insulin delivery.
Learning how to inject
Healthcare teams provide education on insulin injections and dosage adjustment, with support groups and helplines available for additional guidance and support.
Storing insulin
Storing a three-month supply of insulin is recommended, with proper refrigeration at temperatures below 6°C. Insulin should not be frozen, kept out of the fridge for more than 28 days, or exposed to sunlight or heat. It is essential to adhere to specific storage instructions provided by healthcare providers or outlined in the product leaflet.
Insulin storage tips include checking expiration dates, storing spare insulin in the fridge, and preventing exposure to extreme temperatures to ensure insulin efficacy and stability.
Stay Cool with Insulin Bags
Keep your insulin safe and sound while on the move with our range of cool bags. Whether you are traveling or facing extreme weather conditions, you can find detailed recommendations on how to store your insulin properly on our diabetes and travel webpages.