Managing Diabetes with Insulin

A doctor may prescribe insulin therapy to a diabetic if the diabetic’s body does not make enough insulin, or it can't effectively use the insulin it does produce.  All people with type 1 diabetes need to inject themselves with insulin one or more times every day.  Many people with type 2 diabetes, and some women with gestational diabetes may also need daily insulin injections.

Insulin therapy regimen includes: 

• the types of insulin taken,
• when insulin is taken and
• how much insulin is taken.

The body produces insulin, which is a hormone that helps convert food into energy. People with diabetes might need insulin injections either because they do not produce sufficient amounts of insulin in their bodies or they can not properly use the insulin that they do produce properly, or both.

Insulin injections have come a long way since they were first used to treat diabetes in the 1920s. There are different types of insulin to meet various needs and different ways to inject insulin.  The insulin injection process itself has become easy and painless.

Insulin is like a key that opens up the locks on the body’s cells so that blood sugar can get inside and be used for energy.  If the glucose can't get into body cells, it builds up in the blood stream. If left untreated, high blood glucose can cause long-term complications.

In addition, insulin brings amino acids – the building blocks of muscle protein – to muscles. Amino acids repair muscular damage and help muscles regain their size and strength. If there isn't enough insulin in a person’s body when muscles have been injured, amino acids can't do their job, and muscles can become very weak.

Almost all of the insulin sold in the United States today is what is known as "human insulin." Developed by scientists, this laboratory-created insulin is made by DNA recombinant technology and is very similar to insulin from a human pancreas. It's available in varieties that are designed to start working within just a few minutes or last for many hours.

Because the digestive juices in the stomach ruin its effectiveness, insulin can't be taken as a pill or capsule.   Currently the only way to take insulin is by injecting it directly into the layer of fat just below the skin. Most people inject insulin with a syringe or insulin pen, although other methods are available.

In the United States, insulin is labeled "U-100."  This means that there are 100 units of insulin per milliliter of fluid in the vial. Some insulin is also available in U-500 strength (this form of insulin is only for people with marked insulin resistance who take doses of more than 200 units per day).

Because insulin in other countries is sometimes sold in U-40 strength, people traveling outside the United States must bring enough U-100 insulin and syringes to last the entire trip.  However, if emergency insulin is needed and the only choice available is U-40 insulin, then syringes marked for U-40 should be used.

There are two different ways that the pancreas naturally secretes insulin:

• Basal insulin is a slow, continuous trickle of insulin that stays at a low level in the blood at all times.
• Bolus insulin is large bursts of insulin that are released when your blood sugar rises, typically after meals.

People with type 1 diabetes need a treatment program that gives them both basal and bolus insulin. 

However, people with Type 2:

• Only need basal insulin because their pancreas can still provide the extra insulin needed for meals, or
• Need both basal and bolus insulin, or
• Do not need any insulin injections.