Insulin Treatment for Diabetes Mellitus

• In type 1 diabetes, the pancreas does not make insulin.
• In type 2 diabetes, the body does not use or respond to insulin properly (called insulin resistance). Also, in some people, the pancreas does not make enough insulin.

• The type of diabetes.
• The treatment goals.
• Your medical history.

People with type 1 diabetes and some with type 2 diabetes will need to take insulin as part of their treatment plan. Ask questions to understand your insulin treatment so you can be active in managing your diabetes.

Types of insulin

Insulin molecules are delicate. Insulin is destroyed by enzymes in the stomach or intestine. For this reason, insulin is not given in pill form. It is either injected under the skin or inhaled into the lungs.

You may use more than one type of insulin. The different types of insulin are described below. It is important to know the onset, peak, and duration of the type of insulin you take. The onset is when it starts lowering blood glucose. The peak is when it works the strongest. The duration is how long it works.

Insulin comes in different strengths. The most common strength is U-100, or 100 units per 1 mL of insulin. It is important to make sure you are using the right strength of insulin with the right syringe.

Rapid-acting insulin:

• Onset: Within 15 minutes.
• Peak: About 1–2 hours.
• Duration: 2–4 hours.
• Works well when taken right before a meal to quickly lower your blood glucose.
• This type of insulin is available as an injection and an inhaler. You and your health care provider will decide if an injection or inhaler is best for you.

Short-acting insulin:

• Onset: Within 30 minutes.
• Peak: 2–3 hours.
• Duration: 3–6 hours.
• Should be taken about 30 minutes before you start eating a meal.

Intermediate-acting insulin:

• Onset: Within 1.5–4 hours.
• Peak: 4–12 hours.
• Duration: 12–18 hours.
• Lowers your blood glucose for a longer period of time. However, it does not work as well for lowering blood glucose right after a meal. Usually used 1–2 times per day.

Long-acting insulin:

• Mimics the small amount of insulin that your pancreas usually makes throughout the day.
• Onset: Within 2 hours.
• Peak: There is no peak. Long-acting insulins lower blood glucose levels evenly throughout the day.
• Duration: At least 24 hours. Long-acting insulins should be used one or two times a day.

Concentrated insulin:

• Concentrated insulins are available in higher concentrations than U-100 insulins. Concentrated insulins are helpful for people who require high doses of insulin, usually more than 100 units per day. Concentrated insulins deliver the same amount of insulin but in a smaller volume.
• Concentrated insulins are available as:
  • Humulin (Regular insulin U-500) has 500 units per 1 mL of insulin. This insulin should only be used only with the U-500 syringe or U-500 insulin pen. Do not use another type of syringe with this insulin. The wrong type of syringe can cause serious problems such as low blood glucose.
  • Humalog (Insulin Lispro, U-200) and Tresiba (Insulin degludec, U-200) have 200 units per 1 mL of insulin. These insulins are only available as a U-200 pen.
  • Toujeo (Insulin glargine, U-300) has 300 units per 1 mL of insulin. This insulin is only available as a U-300 pen.

Common terms related to insulin treatment:

Some terms that you might hear include:

Basal insulin or background insulin

• This is the constant amount of insulin that keeps your blood glucose levels stable when you are not eating. People who have type 1 diabetes need basal insulin in a nonstop (continuous) or steady dose 24 hours a day. People with type 2 diabetes may also get basal insulin.
• Usually, intermediate-acting or long-acting insulin is used one or two times a day to manage glucose levels.

Bolus insulin

• This refers to meal-related insulin (prandial insulin).
• Blood glucose rises quickly after a meal (postprandial). Rapid-acting or short-acting insulin can be used before a meal (preprandial) to help control blood glucose after the meal.
• You may be told to adjust the amount of bolus insulin that you take based on how much carbohydrate is in your meal.

Correction insulin

This may also be called a correction dose or supplemental dose. This is a small amount of rapid-acting or short-acting insulin that can be used to lower your blood glucose if it is too high. You may be told to check your blood glucose at certain times of the day and use correction insulin as needed.

Tight control, intensive therapy, or basal-bolus insulin therapy

These terms are used for insulin plans that keep your blood glucose as close to your target as possible. They prevent your blood glucose from getting too high at any time of day, but especially after meals. People who have tight control of their diabetes have fewer long-term problems caused by diabetes.

Insulins are also available as mixtures of basal and bolus insulins. Using a premixed insulin decreases the number of injections you might need everyday. Talk to your health care provider to see if an insulin mixture is right for you.

What are the risks?

• Low blood glucose (hypoglycemia).
• Weight gain.
• Bruising or irritation at the injection site.

Some of these side effects can be caused by incorrect insulin doses and improper injection technique. Be sure to learn how to inject insulin properly.

Supplies needed:

• Soap and water.
• Insulin.
• Insulin syringe or insulin pen needles.
• Alcohol wipes.
• Blood glucose meter.
• Blood glucose test strips and lancets.
• A disposal container for sharp items (sharps container), such as an empty plastic bottle with a cover.

How to use insulin

• Prescribe the type and amount of insulin that you need.
• Tell you when you should inject your insulin.

Usually, you will give yourself insulin injections. Other people can also be taught how to give you injections. You will use a type of syringe that is made only for insulin. Some people may have an insulin pump that delivers insulin steadily through a tube (cannula) that is placed under the skin.

Insulin is also available in an inhaled form. An inhaler delivers bolus insulin doses. Inhaled insulin does not require injections, but most people will still need to use basal insulin that is injected.

Injection sites

• Abdomen. Generally, the abdomen is the best place to inject insulin. However, you should avoid any area that is less than 2 inches (5 cm) from your belly button.
• Front of thigh.
• Upper, outer side of thigh.
• Upper, outer side of arm.
• Upper, outer part of buttock.

• Give your injection in a slightly different place each time. This helps to prevent irritation and improve absorption.
• Avoid injecting into areas that have scar tissue.

Follow these instructions at home:

Eating and drinking

• Talk with your health care provider or pharmacist about the type of insulin you should take and when you should take it. You should know when your insulin peaksand how long it lasts. You need this information to plan mealtimes and exercise.
• Follow instructions from your health care provider about a healthy meal plan. Do not skip meals.
• Drink enough fluid to keep your urine pale yellow.
• Follow your sick day plan whenever you cannot eat or drink normally. Make this plan in advance with your health care provider.

Lifestyle

• Work with your health care provider to manage your weight, blood pressure, cholesterol, and stress.
• Exercise regularly.
• Avoid drinking alcohol.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Check your blood glucose as told. Your health care provider will tell you how often and when you should check your blood glucose. Your health care provider will also tell you what your glucose levels should be.
• Make sure to check your blood glucose before and after you exercise. If you exercise longer or in a different way than usual, check your blood glucose more often.
• Make sure you know the symptoms of high and low blood sugar and how to treat these.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Carry a medical alert card or wear medical alert jewelry.
• Keep all follow-up visits. This is important.

Summary

• Diabetes is a long-term disease. It occurs when the body does not properly use glucose. Glucose levels are controlled by a hormone called insulin.
• Insulin treatment varies depending on your type of diabetes, your treatment goals, and your medical history.
• Talk with your health care provider or pharmacist about the type of insulin you should take and when you should take it.
• Check your blood glucose as told by your health care provider. Your health care provider will tell you how often and when you should check your blood glucose, and what your glucose levels should be.
• Know the symptoms of high and low blood glucose and how to treat them.