Diabetes Treatment – Insulin

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Diabetes Treatment – Insulin - What is it for

What is Insulin?

Insulin is a hormone produced by the pancreas that allows the body to use blood sugar for energy. Carbohydrates, a type of nutrient found in starchy foods such as bread, noodles, potatoes and rice, are converted into sugar and absorbed into the bloodstream. Insulin allows sugar from the bloodstream to enter the body cells and be used to create energy or be stored for future use.

People with diabetes are unable to fully use the sugar in their bloodstream either because their bodies do not make enough insulin or the cells do not respond well to insulin, a situation known as insulin resistance. Hence, they would need more insulin to get the same effects.

Insulin Therapy

There are two main groups of patients with diabetes and their treatment could be different.

Type 1 Diabetes Mellitus (T1DM) requires the use of insulin and the patient needs to control their diet.
Type 2 Diabetes Mellitus (T2DM) patients may be treated with oral medications and need to control their diet. In some T2DM patients, they may also require insulin injections.

Insulin is injected into the fatty tissue that is between the skin and muscle layer.

Starting on insulin when already on oral tablets for T2DM patients

T2DM is a progressive illness. This means that what you did at the beginning to control your condition through your diet, exercise or medications may change over time.　

As your diabetes progresses, the management of your condition can change from diet and exercise alone, to adding oral diabetes medications. Patients who have had diabetes for a long time may naturally find that they progress to a combination of oral diabetes medications and insulin.

Some T2DM patients might feel that once they have started insulin, it could mean that their condition is now very serious or they have "failed" in controlling their diabetes. However, it is important to understand that this is a natural progression of the disease. If your diabetes is not controlled, it can lead to serious health complications such as an increased risk of heart disease and eye or kidney problems.

If you are on insulin, you should know how to:

　Measure out your insulin doses
　Inject insulin yourself (and not rely on others) as far as possible
　Adjust your diet and activity to your insulin injections

Types of Insulin

There are several types of insulin. They differ mainly in how quickly they start to lower blood sugar once injected, and how long their effects last in the body.

Type	When to take it	When the medication starts working after you have injected it	How long does the medication effect last after you have injected it
Rapid-acting　 - Apidra® - Novorapid® - Humalog®	Immediately before a meal	10-20 minutes	2-4 hours
Short-acting　 - Actrapid® HM - Humulin® R	30 minutes before a meal	30 minutes	6-8 hours
Intermediate-acting　 - Humulin® N - Insulatard® HM	Before breakfast and/or at bedtime	1-3 hours	16-24 hours
Long-acting　 - Levemir® - Lantus® - Toujeo® - Tresiba® - Soliqua® *	Daily at the same time (eg. bedtime)	3-4 hours	Variable. Up to 24 hours for Levemir®, Lantus® and Soliqua®. May last more than 24h for Toujeo® and Tresiba®.
Pre-mixed These are mixtures of rapid/ short-acting and intermediate/ long-acting insulins - Humalog® Mix - Novomix® 30 - Mixtard® 30 - Humulin® 30/70 - Ryzodeg®	Variable, inject before meals. Refer to your medication label for timing of injection for your specific type of pre-mixed insulin	Variable	Variable, 14 to more than 24 hours

Low blood sugar (hypoglycemia) is more likely to occur around the time of maximum action. High blood sugar (hyperglycemia) is more likely to occur before the insulin starts acting or when its action is ending.　

*Soliqua® is a combination of long-acting insulin and lixisenatide (another type of diabetes medication class known as GLP1 agonist)