Insulin Therapy for Diabetics – Types, Indications, Complications
Diabetes is an endocrine disorder define as an elevated blood sugar in the body either due to the pancreas not producing enough insulin or there is insulin resistance in the body. Cases of diabetics worldwide are increasing making it a leading cause of morbidity not just in my country but to the rest of the world. Since the last century, diabetes management has evolved; different oral hypoglycemics are popping up, changes in diet management, increasing non-pharmacologic therapies, and a variety of insulin types to cater to the different needs of a diabetic.
Insulin is a hormone produced in our body by the pancreas; its main purpose is to regulate carbohydrate and fat metabolism. Since its first extraction from the pancreas in 1921 and its first use as an injection against diabetes in 1922, Insulin therapy has evolved and has produced a handful of types.
Types of Insulin
Basal Insulin - this type of insulin usually covers one whole day, and its levels don’t usually have a “peak” like other insulin types hence hypoglycemia is usually low in this type compared to other insulin types. This is usually given once a day either in the morning or before going to sleep, and is suitable for diabetics who want less injections.
Intermediate Acting Insulin – this type of insulin usually has an effect of 12 hours, so this is usually given twice a day. Compared to your basal insulin, this has a peak action, so be on the lookout for hypoglycemia. This can be given to diabetics who, let’s say just want their PM sugar levels to be low and their AM levels to be the same or vice versa. You could adjust the dose depending on your activity.
Short Acting Insulin – this type of insulin has an onset of action of 30 minutes and peaks at around 2 to 4 hours. This is usually given 30 minutes prior a meal, so when you start eating, the effects of this insulin kicks in. This type is usually combined with your basal or your intermediate insulin to cover for those glucose spikes after taking a meal. The dose of this insulin usually depends on the blood sugar level prior to having a meal.
Rapid Acting Insulin – this insulin has an onset of action faster than your short acting insulin. This usually takes effect around 5-10 minutes and peaks at 30-75 minutes. Compared to your short acting insulin, this type could be given right before a meal, as it will have its effect in time for the meal. Same with your short acting insulin, this type could be combined with your basal and intermediate insulin to cover for those post-meal spikes.
Premixed Insulin – this insulin type is a combination between a long acting one (intermediate) and a short acting or a rapid acting type. This type has lesser injections compared to when you combined them separately. This has a fast initial effect and it lasts longer. With this type of insulin, you need not skip a meal as you might be prone to having hypoglycemia if you missed a meal.
The major complication of insulin therapy is hypoglycemia, so religious checking of one’s blood sugar should be done when on insulin therapy. Hypoglycemia same with your hyperglycemia is an emergency. Other complications include, infection on injection site, minimal bleeding, etc.
Insulin is one of are armamentarium against diabetes, seek physician consult before starting on insulin and don’t use it without proper guidance. Below is a review of the different insulin types with their brand names.
Diabetes Mellitus is usually known with two types, Type 1 diabetes or previously known as insulin dependent diabetes mellitus and type 2 diabetes or formerly known as non-insulin dependent diabetes mellitus, however there are other types of diabetes mellitus which are not that common to people
Diabetes is a leading cause of morbidity and mortality worldwide. Knowing pharmacologic and non-pharmacologic treatment options are a huge advantage against the disease.