Insulin For Type 2 Diabetes: Who, When, And Why?
Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later. As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time. In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated. Insulin Resistance and Deficiency in Type 2 Diabetes Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell “burnout.” Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease. When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this proc Continue reading >>
- Stressing The Difference Between Type 1 And Type 2 Diabetes: Why Do We Care?
- This is why it's so important to know the difference between Type 1 and Type 2 diabetes
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
How To Know When You'll Need Insulin
Injecting insulin above and to the side of the belly button can result in more consistent results.(ISTOCKPHOTO) There's no simple way to tell when a patient with type 2 would do best on insulin, says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. But there are guidelines. "In general if a patient has a hemoglobin A1C that is higher than the agreed upon goal and they are not on insulin, we recommend insulin therapy," Dr. Hellman says. The American Diabetes Association (ADA) recommends an A1C of 7% or below, and the American College of Endocrinology and the American Association of Clinical Endocrinologists recommend an A1C of 6.5% or below. If you can't lower your A1C with diet, exercise, or other medications, you may need insulin to do the job. Exceptions to the insulin rule There are exceptions, of course. Someone who otherwise seems to be a good candidate for insulin may not be able to manage such a regimen if he or she has limited vision and dexterity and no family support. Good News About Today's Improved InsulinsAndy switched to once-a-day insulin and uses shorter, thinner needles Read moreMore about using insulin If you do need insulin in the short- or long-term, your doctor may prescribe one of four different types. These vary by how quickly or slowly they reach the bloodstream (the onset), the amount of time they work at maximum strength (the peak time), and how long they continue to be effective (the duration). The goal is to mimic the pancreas The different types of insulin mimic the natural rhythm of a healthy pancreas, which produces a consistent low level of the hormone and occasional bursts of insulin to cope with postmeal boosts in blood sugar. According to the American Diabetes Association (ADA), your need Continue reading >>
Insulin Therapy
Why do I need to take insulin? When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly, so the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood can lead to serious health problems. All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible so you’ll stay healthy. Insulin can’t be taken by mouth. It is usually taken with injections (shots). It can also be taken with an insulin pen or an insulin pump. How often will I need to take insulin? You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day. Do I need to monitor my blood sugar level? Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You can read the results yourself or insert the strip into a machine called an electronic glucose meter. The results will tell you whether or not your blood sugar is in a healthy range. Your doctor will give you additional information about monitoring your blood sugar. When should I take insulin? You and your doctor should discuss when and how you Continue reading >>
Insulin: Who Needs It And Who Doesn't?
Does getting a diagnosis of diabetes automatically mean you will need to start taking insulin? The answer depends on the type of diabetes and how much your condition has progressed. People with type 1 diabetes require supplemental insulin because their bodies can no longer produce insulin themselves. However, type 2 diabetes is different. Less than one-third of those with type 2 diabetes take insulin. The CDC puts the number at about 28 percent. Some experts have long believed that more patients with type 2 diabetes should be on insulin in order to reach their blood glucose and lipid (cholesterol) targets. When you are diagnosed with type 2 diabetes you will probably wonder if, or when, you will need insulin. You may fear injections or you may believe that needing insulin represents a personal failure. So, you resist taking the drug, even when you need it. Whether or not a person with type 2 diabetes needs insulin is based on individual circumstances. The first step? Knowing the facts. Does Everyone With Diabetes Need Insulin? Type 1 and type 2 diabetes are conditions in which you don't have enough insulin or don't react to it well enough to remove glucose from the blood. This creates two problems: High blood glucose levels A lack of stored glucose, the body’s major fuel source The difference between type 1 and type 2 diabetes lies in the cause of this condition. Beta cells, found in the pancreas, produce the body’s insulin. In type 1 diabetes, most of those beta cells have been destroyed, limiting the supply of insulin. As a result, individuals with type 1 diabetes must take insulin to control their blood glucose levels. In type 2 diabetes, the pancreas may still produce insulin, but it either produces insufficient amounts or the body resists the insulin itself. Di Continue reading >>
Insulin For Type 2 Diabetes: When, Why, And How
Blood sugar control is one of the most important parts of type 2 diabetes management. Although you may be able to treat the condition at first with oral medication and lifestyle changes, such as exercise and weight loss, most people with type 2 diabetes eventually need to take insulin by injection. "There are several scenarios in which insulin treatment should start, including in patients with significant hyperglycemia who are symptomatic," explained Alaleh Mazhari, DO, an associate professor of endocrinology at Loyola Medicine in Maywood, Illinois. "In these cases, the need for insulin may be short-term. Other situations include patients who are on multiple diabetic medications with uncontrolled diabetes, and uncontrolled diabetes in pregnancy, to name a few." Here's what you need to know about taking insulin in the short term and the long term. Insulin for Short-Term Blood Sugar Control Doctors use a blood test called a hemoglobin A1C test to measure average blood sugar control over a two- to three-month period. The treatment target for most people with diabetes is an A1C of 7 percent or less; those with higher levels may need a more intensive medication plan. "The American Association of Clinical Endocrinologists recommends starting a person with type 2 diabetes on insulin if their A1C is above 9 percent and they have symptoms," said Mazhari. Symptoms of type 2 diabetes include thirst, hunger, frequent urination, and weight loss. Research published in February 2013 in the journal The Lancet Diabetes & Endocrinology reviewed several studies that focused on the temporary use of insulin to restore sugar control in people with type 2 diabetes. The results showed that a two- to five-week course of short-term intensive insulin therapy (IIT) can induce remission in patients Continue reading >>
- Stressing The Difference Between Type 1 And Type 2 Diabetes: Why Do We Care?
- This is why it's so important to know the difference between Type 1 and Type 2 diabetes
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
Taking Care Of Diabetes
Since our pancreas does not make insulin, we have to take insulin as medicine so that glucose can get from our blood and into our cells to give us energy to do things. Your doctor will tell you how much insulin you need. It can be a little scary at first and there is a lot to understand, that’s why I am here, to help you know what you need to learn. Testing Blood Glucose Because diabetes affects the glucose in your blood, it is important to measure this with a blood glucose meter. You will get used to having your blood glucose meter with you all of the time because checking your glucose level is the only way to know if your diabetes is under control. You always need some glucose in your blood, but not too much. If your blood glucose gets too high or too low it can make you feel sick so you will always want to avoid that. Your doctor will tell you what your glucose levels should be. Low Blood Glucose Low blood glucose happens when you take more insulin than your body needs. It means that too much glucose moved from your blood into your cells, not leaving enough glucose back in the blood (called hypoglycemia). This can be very dangerous. If your blood glucose is low you may feel shaky, start sweating, get a headache, feel dizzy, or your heart may start pounding. These are called symptoms, and they warn you that you need to eat or drink some sugar right away. High Blood Glucose High blood glucose happens when you don’t take enough insulin – when there is too much glucose in your blood (called hyperglycemia). High blood glucose levels can be harder to notice at first, another reason why it is important to test your blood glucose often. Most of the time, you can take insulin so that your high glucose goes down. But if you don’t take insulin and your blood glucose sta Continue reading >>
Insulin And Type 2 Diabetes: What You Should Know
Insulin and Type 2 Diabetes If your health care provider offered you a medication to help you feel better and get your blood sugar under control, would you try it? If so, you might be ready to start taking insulin. Does insulin immediately make you think of type 1 diabetes? Think again. Between 30 and 40 percent of people with type 2 diabetes take insulin. In fact, there are more people with type 2 diabetes who take insulin than type 1 because of the much larger number of people with type 2. Experts believe even more people with type 2 should be taking insulin to control blood sugar -- and the earlier, the better. With an increase in people developing type 2 at a younger age and living longer, more and more people with type 2 will likely be taking insulin. "If you live long enough with type 2 diabetes, odds are good you'll eventually need insulin," says William Polonsky, Ph.D., CDE, associate clinical professor of psychiatry at the University of California, San Diego; founder and president of the Behavioral Diabetes Institute; and author of Diabetes Burnout: What to Do When You Can't Take It Anymore (American Diabetes Association, 1999). Producing Less Insulin Naturally Over Time Research has shown that type 2 diabetes progresses as the ability of the body’s pancreatic beta cells to produce insulin dwindles over time. Your beta cells -- the cells in the pancreas that produce insulin -- slowly lose function. Experts believe that by the time you're diagnosed with type 2 diabetes, you've already lost 50-80 percent of your beta cell function and perhaps the number of beta cells you had. And the loss continues over the years. "About six years after being diagnosed, most people have about a quarter of their beta cell function left," says Anthony McCall, M.D., Ph.D., endocri Continue reading >>
Type 2 Diabetes And Insulin
People with type 2 diabetes do not always have to take insulin right away; that is more common in people with type 1 diabetes. The longer someone has type 2 diabetes, the more likely they will require insulin. Just as in type 1 diabetes, insulin is a way to control your blood glucose level. With type 2 diabetes, though, dietary changes, increasing physical activity, and some oral medications are usually enough to bring your blood glucose to a normal level. To learn about how the hormone insulin works, we have an article that explains the role of insulin. There are several reasons people with type 2 diabetes may want to use insulin: It can quickly bring your blood glucose level down to a healthier range. If your blood glucose level is excessively high when you are diagnosed with type 2 diabetes, the doctor may have you use insulin to lower your blood glucose level—in a way that’s much faster than diet and exercise. Insulin will give your body a respite; it (and especially the beta cells that produce insulin) has been working overtime to try to bring down your blood glucose level. In this scenario, you’d also watch what you eat and exercise, but having your blood glucose under better control may make it easier to adjust to those lifestyle changes. It has fewer side effects than some of the medications: Insulin is a synthetic version of a hormone our bodies produce. Therefore, it interacts with your body in a more natural way than medications do, leading to fewer side effects. The one side effect is hypoglycemia. It can be cheaper. Diabetes medications can be expensive, although there is an array of options that try to cater to people of all economic levels. However, insulin is generally cheaper than medications (on a monthly basis), especially if the doctor wants yo Continue reading >>
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study
Insulin Shock: Warning Signs And Treatment Options
What is insulin shock? After taking an insulin shot, a person with diabetes might on occasion forget to eat (or eat less than they normally do). If this happens, they may end up with too much insulin in their blood. This, in turn, can lead to hypoglycemia, also called low blood sugar. A serious condition called insulin shock may occur if a person: ignores mild hypoglycemia takes too much insulin by mistake misses a meal completely does excessive unusual exercise without changing their carbohydrate intake Insulin shock is a diabetic emergency. It involves symptoms that, if left untreated, can lead to diabetic coma, brain damage, and even death. How insulin works When we consume food or beverages that contain carbohydrates, the body converts them into glucose. Glucose is a type of sugar that fuels the body, giving it the energy it needs to perform everyday functions. Insulin is a hormone that works like a key. It opens the door in the body’s cells so they can absorb glucose and use it as fuel. People with diabetes may lack enough insulin or have cells that aren’t able to use insulin as they should. If the cells of the body aren’t able to absorb the glucose properly, it causes excess glucose in blood. This is called high blood glucose, which is linked with a number of health issues. High blood glucose can cause eye and foot problems, heart disease, stroke, kidney problems, and nerve damage. Insulin shots help people with diabetes use glucose more efficiently. Taking an insulin shot before eating helps the body absorb and use glucose from the food. The result is a more balanced and healthy blood sugar level. Usually, it works great. Sometimes, however, things go wrong. What causes insulin shock? Having too much insulin in your blood can lead to having too little gluco Continue reading >>
Insulin Injection
Insulin injection is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone. Insulin injection is in a class of medications called hormones. Insulin injection is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar. Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Using medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Insulin comes as a solution (liquid) and a suspension (liquid with particles that will settle on standing) to be injected subcutaneousl Continue reading >>
Everything You Need To Know About Insulin
Insulin is a hormone made in your pancreas, a gland located behind your stomach. It allows your body to use glucose for energy. Glucose is a type of sugar found in many carbohydrates. After a meal or snack, the digestive tract breaks down carbohydrates and changes them into glucose. Glucose is then absorbed into your bloodstream through the lining in your small intestine. Once glucose is in your bloodstream, insulin causes cells throughout your body to absorb the sugar and use it for energy. Insulin also helps balance your blood glucose levels. When there’s too much glucose in your bloodstream, insulin signals your body to store the excess in your liver. The stored glucose isn’t released until your blood glucose levels decrease, such as between meals or when your body is stressed or needs an extra boost of energy. Diabetes occurs when your body doesn't use insulin properly or doesn't make enough insulin. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is a type of autoimmune disease. These are diseases in which the body attacks itself. If you have type 1 diabetes, your body can’t make insulin. This is because your immune system has destroyed all of the insulin-producing cells in your pancreas. This disease is more commonly diagnosed in young people, although it can develop in adulthood. In type 2 diabetes, your body has become resistant to the effects of insulin. This means your body needs more insulin to get the same effects. Therefore, your body overproduces insulin to keep blood glucose levels normal. However, after many years of overproduction, the insulin-producing cells in your pancreas burn out. Type 2 diabetes also affects people of any age, but typically develops later in life. Injections of insulin as a replacement or supplement Continue reading >>
“do I Need Insulin For My Type 2 Diabetes?”
After a type 2 diabetes diagnosis, there are four treatment options that you can discuss with your doctor: Diet & Exercise: Learning how to reduce the carbohydrates and overall calories in your diet along with regular exercise for weight loss. Losing weight helps improve insulin sensitivity (gaining weight promotes insulin resistance). For some people with type 2 diabetes, these changes can be enough to achieve healthier blood sugar levels. Oral Medications: There are a variety of oral medications (pills) for improving blood sugars in people with type 2 diabetes. They each are classified by their make-up and the impact on the body. While some pills increase natural insulin production, other pills are designed to decrease the amount of glycogen (which is eventually converted to glucose) secreted by your liver. The 6 primary classifications of pills are, Sulfonylureas, Meglitinides, Biguanides, Thiazolidinediones, Alpha-glucosidase inhibitors, and DPP-4 inhibitors. You may know some of the brand names, like Metformin, Avandia, or Januvia. Your diabetes healthcare team will help you determine the best fit for you. Injectable Medications: Known well as “Byetta” or “Symlin,” these medications are injected, but are very different than insulin. Symlin is known for helping with reducing blood sugars but also for promoting weight loss. Byetta works by increasing your own natural insulin production. Insulin: Lastly, there is insulin, which is administered with a syringe, pen, or pump. While most doctors will take you through the options above before prescribing insulin, this option might be exactly what you need. Insulin is the most powerful hormone in the body for regulating blood sugars, and as a person with type 2 diabetes, you either don’t produce enough to meet you Continue reading >>
Diabetic Shock And Insulin Reactions
Severe hypoglycemia, or diabetic shock, is a serious health risk for anyone with diabetes. Also called insulin reaction, as a consequence of too much insulin, it can occur anytime there is an imbalance between the insulin in your system, the amount of food you eat, or your level of physical activity. It can even happen while you are doing all you think you can do to manage your diabetes. The symptoms of diabetic shock may seem mild at first. But they should not be ignored. If it isn't treated quickly, hypoglycemia can become a very serious condition that causes you to faint, requiring immediate medical attention. Diabetic shock can also lead to a coma and death. It's important that not only you, but your family and others around you, learn to recognize the signs of hypoglycemia and know what to do about them. It could save your life. Hypoglycemia is a low level of blood sugar. The cells in your body use sugar from carbohydrates for energy. Insulin, which normally is made in the pancreas, is necessary for sugar to enter the cells. It helps keep the levels of sugar in the blood from getting too high. It's important to maintain the proper level of sugar in your blood. Levels that are too high can cause severe dehydration, which can be life threatening. Over time, excess sugar in the body does serious damage to organs such as your heart, eyes, and nervous system. Ordinarily, the production of insulin is regulated inside your body so that you naturally have the amount of insulin you need to help control the level of sugar. But if your body doesn't make its own insulin or if it can't effectively use the insulin it does produce, you need to inject insulin as a medicine or take another medication that will increase the amount of insulin your body does make. So if you need to me Continue reading >>
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Diabetes: How To Use Insulin
Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website. What is insulin, and why do I need it? Insulin is a hormone that controls the level of blood sugar (also called glucose) in your body. People with diabetes may not have enough insulin or may not be able to use it properly. The sugar builds up in the blood and overflows into the urine, passing out of your body unused. Over time, high blood sugar levels can cause serious health problems. All people with type 1 diabetes, and some people with type 2 diabetes, need to take insulin to help control their blood sugar levels. (The box below lists the different types of insulin.) The goal in treating diabetes is to keep the blood sugar level within a normal range. Do I need to monitor my blood sugar level? Yes. You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or the office staff can teach you how to use the monitor. You'll need to write down each measurement and show this record to your doctor, so your doctor can tell you how much insulin to take. How often will I need to take insulin? Your doctor will give you a schedule. Most people with diabetes need at least 2 insulin shots a day. Some people need 3 or 4 shots for good blood sugar control. When should I take insulin? If you take Regular insulin or a longer-acting insulin, you should generally take it 15 to 30 minutes before a meal. If you take insulin lispro (brand name: Humalog), which works very quickly, you should generally take it less than 15 minutes before you eat. What is different Continue reading >>
Know When You Need Insulin
No one likes injections. So if you have type 2 diabetes, the prospect of giving yourself regular insulin injections may seem scary. But recent research shows that if you're having trouble keeping your blood glucose at healthy levels A1c levels less than 7 per cent starting insulin treatment sooner rather than later is the best way to avoid compli-cations from diabetes down the road. Insulin is a pancreatic hormone that helps move glucose into cells, where it is used for energy. Unlike people with type 1 diabetes, who are unable to produce their own insulin and require insulin injections to survive, people with type 2 diabetes do produce insulin. A major problem in type 2 diabetes is that cells are less responsive, or more resistant, to the actions of insulin. The pancreas compensates by producing more insulin, but over time it cannot produce enough to overcome the cells' reduced response. Many oral medications used to treat type 2 diabetes stimulate insulin production or improve the body's response to insulin. However, as type 2 diabetes progresses - and it always does - oral medications may not be enough to make up for what the pancreas can no longer manage, and insulin injections may be needed. About 50 per cent of people with type 2 diabetes need insulin in addition to oral medications to control blood glucose levels. Yet in the past, insulin therapy was often delayed. The New England Journal of Medicine has reported that many people with type 2 diabetes are not prescribed insulin until 10 to 15 years after their diagnosis, and often only after complications from the disease have already set in. As experts learn more about how diabetes progresses, this practice of waiting is changing. "Today, the trend is not to delay insulin treatment but rather to begin it as soon Continue reading >>
