What Is Insulin

GENERAL INFORMATION:

What is insulin? Insulin is a hormone that is made by the pancreas and helps to keep blood sugar levels normal. Insulin works by moving sugar from the blood into the cells to be used for energy. People who have type 1 diabetes make very little or no insulin. They must take insulin every day. People who have type 2 diabetes may also need to take insulin because their body does not produce enough.

What are the different types of insulin? There are several types of insulin that can be used to lower blood sugar. Some types of insulin are clear and some are cloudy. Each type of insulin has a different onset (how soon it starts to work in the blood), peak response and duration. The peak response is when the insulin has the greatest effect on blood sugar levels, and the duration is how long the insulin continues to work. Rapid-acting or regular insulin are used to lower blood sugar after eating a meal. Intermediate or long-acting types of insulin are used to lower blood sugar throughout the day and night. The following are types of insulin, and their onset, peak, and duration:

• Rapid-acting:
  
  
  • Insulin lispro (Humalog®), Aspart (Novolog®), and glulisine (Apidra®) are clear. They begin to work within about 15 minutes, and peak in about 1 hour. They keep working for about 2 to 4 hours.
    
    
  
  
• Regular or short-acting:
  
  
  • Regular insulin is a clear insulin. It begins working within about 30 minutes, and peaks in about 2 to 3 hours. It keeps working for about 3 to 6 hours.
    
    
  
  
• Intermediate-acting:
  
  
  • NPH is a cloudy insulin. It begins working within 2 to 4 hours, and peaks in about 4 to 12 hours. It keeps working for about 12 to 18 hours.
    
    
  
  
• Long-acting: Long-acting insulins are clear.
  
  
  • Detemir (Levemir®): This long-acting insulin begins working within 48 minutes to 2 hours and does not have a peak. It keeps working for up to 24 hours.
    
    
  • Glargine (Lantus®): This long-acting insulin begins working within 2 to 4 hours and does not have a peak. It keeps working for about 20 to 24 hours.
  
  
• Insulin mixtures: Intermediate-acting and rapid-acting or regular insulin are also found in several premixed forms. Premixed insulin is cloudy and it works through the day and after meals. It may be a good choice for people who have trouble mixing insulin because of poor eyesight or other health problems.

What will my insulin treatment plan be? Some people use only one type of insulin and some use a combination of two or more types. The type and amount of insulin that you need depends on many things. Your caregiver will work with you to find the treatment plan that works best for you. Your insulin needs may change because of illness, stress, other medicines, diet changes, or physical activity. You will also need to check your blood sugar often to see how well your insulin treatment plan is working.

How is insulin measured?

• Insulin is measured in units. Insulin is available in "U100" or "U500". U100 is the most common type of insulin. It has 100 units of insulin in 1 mL of solution. You must inject U100 insulin with U100 syringes.
  
  
• U500 insulin has 500 units of insulin in 1 mL. This type of insulin is rarely used, and mainly for people who are insulin-resistant. Insulin resistance is a condition where a person’s body cannot respond to and use insulin as it should. A special type of syringe is needed for U500 insulin.

How is insulin usually given?

• Syringes: Most people take insulin by injecting it under the skin with a syringe. Insulin syringes come in three different sizes. You may use a three-tenths (3/10) cc, a one-half (1/2) cc, or a one (1) cc insulin syringe. The type of syringe you should use depends on how much insulin you take (dose). For example, if your insulin dose is 30 units or less, you would use a three-tenths (3/10) cc syringe. If your dose is 50 units or less, you would use a one-half (½) cc syringe. You would use a 1 cc syringe if your dose is up to 100 units. One cc is the same amount as one milliliter, or mL.
  
  
• Insulin pump: An insulin pump is a small computerized device that can be worn on a belt or in a pocket. The pump gives a dose of insulin after meals. The pump also gives a small amount of insulin throughout the day and night to keep blood sugars normal. The insulin is given through a small plastic tube called a catheter which is placed into the skin through a small needle. The catheter is taped to the skin to keep it in place.
  
  
• Other: Some devices can be used to make giving syringe injections easier. Other devices can be used in place of a syringe. Ask your caregiver to help you choose and use the device that is right for you.
  
  
  • Spring-loaded syringe holders: Syringe holders hide the syringe needle so that you will not see the needle going into the skin. To inject the insulin, you press a button to insert the needle automatically.
    
    
  • Insulin pens: An insulin pen looks like a writing pen and can be used to inject insulin. An insulin pen has a cartridge of insulin and a disposable needle inside of it. There are two types of pens. One pen type is reusable and the other is disposable. The reusable pen has a pre-filled insulin cartridge that can be replaced with another cartridge when the insulin has been used. Disposable pens are thrown away when the insulin cartridge is empty.

What is another way that insulin may be given? There is a powder form of insulin which is breathed in (inhaled). Insulin powder can be used only by adults. The powder is inhaled using a special inhaler device. Insulin powder should not be used by people who smoke or recently quit smoking (in the last six months). Insulin powder should also not be used by people with lung diseases such as asthma or emphysema. Your caregiver will talk to you about the different types of insulin and which of these are right for you.

How do I store insulin and make sure it is safe to use? It is important to store your insulin correctly so that it works well. Never freeze insulin. If insulin has been frozen or exposed to very warm temperatures (above 85° F), throw it away. Always follow the directions for storage on the label or package insert that came with the insulin.

• Injectable insulin:
  
  
  • Unopened insulin: It is best to store unopened bottles of insulin and pen syringes in the refrigerator. Unopened bottles and pen syringes are good until the expiration date on the box or bottle if they are kept refrigerated. Always check the expiration date before using. Do not use insulin after the expiration date. Unopened insulin bottles can also be kept at room temperature if you cannot keep them refrigerated. Keep the insulin in a cool, dry place away from direct heat and sunlight.
    
    
  • Opened insulin:
    
    
    • Insulin bottles: Store opened insulin bottles in the refrigerator or in a cool, dry place at room temperature. Injecting cold insulin may make the injection more painful or cause irritation at the injection site.
      
      
    • Insulin pens: Store insulin pens that you are currently using at room temperature only . Ask your caregiver how long you can use the insulin pen once you have opened it. Keep the insulin pen away from direct heat and sunlight when at room temperature.
      
      
    • Traveling with insulin: Be careful to protect insulin from direct sunlight when you are traveling. It is best to keep the insulin in a cool pack to make sure the temperature of the insulin stays below 86° F (30° C).
  
  
• Insulin powder: Insulin powder should be stored in a dry place at room temperature. Keep the insulin powder away from humid places, steam and water. Do not refrigerate, freeze, or expose insulin powder to heat.

What are some other important tips to remember?

• Before taking insulin: Always look at the insulin before using it. Do not use your insulin if there are any changes to it. Changes to look for are clumps and color changes. Cloudy insulin (NPH and insulin mixtures) that has small, white, hard particles that will not mix should be thrown away. Also, clear insulin (rapid-acting, regular, and long-acting) should be thrown away if it is cloudy.
  
  
• Extra bottles of insulin: If you buy extra bottles of insulin, always store them in the refrigerator. Use the insulin with the closest expiration date first.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about insulin and how it is used to treat diabetes. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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