What Is The Best Insulin?

Best Insulin Regimen For Type 1’s

For people with type 1 diabetes, long-acting insulin may be a better treatment choice than intermediate-acting insulin…. Different types of insulin are used to manage type 1 diabetes with insulin injections. Long-acting insulin takes about one hour to begin lowering blood sugar levels and lasts up to 26 hours, while intermediate-acting insulin takes one to three hours to begin lowering blood sugar levels and lasts up to 16 hours. In the new review, researchers led by Dr. Andrea Tricco of St. Michael’s Hospital in Toronto analyzed data from 39 studies. The studies compared once- and twice-daily doses of the long-acting and intermediate-acting insulin and concluded that the long-acting version was safer and more effective. “In patients with type 1 diabetes, we found that long-acting insulin is superior to intermediate-acting insulin when it came to controlling blood sugar, preventing weight gain and treating severe hypoglycemia,” Tricco said in a hospital news release. Compared to intermediate-acting insulin, long-acting insulin also significantly improved hemoglobin A1C levels. “Those taking intermediate-acting insulin were more likely to gain weight,” said Tricco, who is assistant professor in the University of Toronto’s School of Public Health. “They gained an average of four to six pounds more than the participants who took most long-acting insulin doses.” The researchers also found that people with type 1 diabetes who took long-acting insulin were 38 percent less likely to develop severe hypoglycemia than those who took intermediate-acting insulin. “With this information, patients and their doctors should tailor their choice of insulin according to preference, cost and accessibility,” Tricco said in the news release. BMJ, Oct. 1 Continue reading >>

Insulin Treatment For Type 2 Diabetes: When To Start, Which To Use

Many patients with type 2 diabetes eventually need insulin, as their ability to produce their own insulin from pancreatic beta cells declines progressively.1 The questions remain as to when insulin therapy should be started, and which regimen is the most appropriate. Guidelines from professional societies differ on these points,2,3 as do individual clinicians. Moreover, antidiabetic treatment is an evolving topic. Many new drugs—oral agents as well as injectable analogues of glucagon-like peptide-1 (GLP1) and insulin formulations—have become available in the last 15 years. In this paper, I advocate an individualized approach and review the indications for insulin treatment, the available preparations, the pros and cons of each regimen, and how the properties of each type of insulin influence attempts to intensify the regimen. Coexisting physiologic and medical conditions such as pregnancy and chronic renal failure and drugs such as glucocorticoids may alter insulin requirements. I will not cover these special situations, as they deserve separate, detailed discussions. WHEN SHOULD INSULIN BE STARTED? TWO VIEWS Early on, patients can be adequately managed with lifestyle modifications and oral hypoglycemic agents or injections of a GLP1 analogue, either alone or in combination with oral medication. Later, some patients reach a point at which insulin therapy becomes the main treatment, similar to patients with type 1 diabetes. The American Diabetes Association (ADA), in a consensus statement,2 has called for using insulin early in the disease if lifestyle management and monotherapy with metformin (Glucophage) fail to control glucose or if lifestyle management is not adequate and metformin is contraindicated. The ADA’s goal hemoglobin A1c level is less than 7% for most Continue reading >>

2018 New Insulin Pump Comparisons And Reviews

Insulin pumps are NOT commodities. There are differences between systems (some subtle, some obvious) that make certain pumps better options for certain individuals. It is astounding that so many people are given little to no choice when it comes to selecting an insulin pump. Given that pump warranties last longer than the average marriage, it makes sense to invest some time in comparing the various devices before making a selection. Every member of our clinical team has personal and professional experience with every make and model of insulin pump. We are not employed by any pump company, and we are not easily pressured (although really good chocolate has been known to sway our opinion a bit), so we can offer you fair and impartial information/insight. Please use our pump comparisons to help make an educated decision. We have listed the positive and negative features that are unique to each pump. Features that are common to all pumps, such as allowing for multiple basal patterns, are not included. At the end of the day, the choice is yours. If you would like some expert input, feel free to contact our office and schedule some time to meet or speak with one of our clinicians. And for assistance applying your pump to achieve the best possible glucose management, please reach out. Continue reading >>

Is Newly Approved Tresiba The Best Long-acting Insulin?

Comparing long-acting insulins? Newly approved Tresiba may come out ahead. With the exception of NPH insulin (the original long-acting insulin—examples include Humulin N and Novolin N), they are all going to cost you. So, if you are already paying big bucks for your long-acting insulin, here are some things to think about: What does a long-acting or basal insulin do for me? This is your baseline insulin, the insulin that is secreted to control your sugars when you are not eating (in the fasting state). Put another way, basal Insulin is used to suppress liver glucose production and help you maintain normal sugars even when you aren’t eating. What are my options? The old-school and well respected NPH insulin has been around forever and is considered intermediate acting. Levemir and Lantus were then joined this year by Toujeo and now Tresiba as the main players. Toujeo is basically Lantus (which was losing its patent) and may not gain any traction in the market. These insulins are typically administered once daily to provide basal insulin levels. Basaglar was just approved by the FDA and think of Basaglar as the Lantus “generic” or copycat–that will be available soon and let’s hope it’s cheaper than Lantus. What is Tresiba? Tresiba (insulin degludec) is the longest acting insulin available and there don’t appear to be any coming down the pipeline that give this duration of coverage. What makes Tresiba a hero is the long duration of action (>40 hours) with less fluctuation in blood levels of the drug. It’s given once a day. Is Tresiba the best long-acting insulin? This can only be answered on an individual basis and along with your provider. Lantus, Levemir and Tresiba may have some modest advantages over NPH (less symptomatic and nighttime hypoglycemia) i Continue reading >>

Selecting An Insulin Program For Type 1 Diabetes

For people with Type 1 diabetes, is there really anything more personal and significant in your life than your insulin program? In a way, your insulin program defines your lifestyle. It can either dictate your meal, sleep, and activity schedules, or it can set you up for successful control of your diabetes. Unfortunately, most people are given little choice or education on how to select the insulin program that best meets their needs. As a matter of fact, many people probably put more thought and effort into choosing a car — perhaps because they have a better idea of what they’re looking for. So what should you look for in an insulin program, and how do you know if the one you’re following is really the best one for you? Read on for some tips on this important decision. What’s in an insulin program? Every insulin program for people with Type 1 diabetes should include a basal, or “background,” insulin. Basal insulin is necessary to cover the liver’s secretion of glucose throughout the day and night, which provides the cells with a continuous supply of glucose to burn for energy. Insufficient basal insulin at any time will result in a sharp rise in blood glucose level and can also lead to the buildup of ketones, acidic by-products of fat-burning that can accumulate in large amounts if no glucose is being burned simultaneously. If high blood glucose and ketones are not treated promptly, a life-threatening condition called diabetic ketoacidosis can develop. Each person’s basal insulin requirements are unique, but typically they are higher during the early morning and lower in the middle of the day. This is due to the nighttime production of blood-sugar-raising hormones and to the enhanced insulin sensitivity that comes with daytime physical activity. Basal i Continue reading >>

Best Insulin Injection Sites: Absorption Time And Rotation

Insulin is a hormone that helps manage diabetes when it is injected into the body. It can't be taken as a pill or oral medication. This is because the enzymes in the stomach will break down the insulin before it reaches the bloodstream. Insulin injections are one of many ways to treat and manage diabetes. Others include dietary and lifestyle changes, and oral medications. For people who require insulin injections, there are different types of insulin available. It is important to understand and follow the instructions that the doctor provides about how and where to inject insulin. Common injection sites Insulin is injected into the layer of fat directly under this skin, known as subcutaneous tissue. It is injected with a small needle or a device that looks like a pen. There are several different sites where insulin can be injected, including: Abdomen The abdomen is a common site for insulin injection that many people with diabetes choose to use. To give an injection into the abdomen, take a pinch of the fatty tissue from either side between the waist and the hipbones. It should be about 2 inches away from the belly button. This site is easy to access and some people report that it causes less discomfort than other sites. Upper Arms The upper arm is another site where insulin injections can be given. The needle should be placed into the back of the arm (tricep area), about halfway between the elbow and the shoulder. The main disadvantage of this site is that it is very difficult to use for self-administration and may require somebody else to do it. It may be more comfortable to inject into the non-dominant arm. This means injecting into the left arm of a right-handed person or the right arm of a left-handed person. Thighs The thigh is also a very easy area for self-injec 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 >>

5 Types Of Insulin And How They Work

What you need to know If you have to take insulin to treat diabetes, there’s good news: You have choices. There are five types of insulin. They vary by onset (how soon they start to work), peak (how long they take to kick into full effect) and duration (how long they stay in your body). You may have to take more than one type of insulin, and these needs may change over time (and can vary depending on your type of diabetes). Find out more about the insulin types best for you. Rapid-acting insulin What it’s called: Humalog (lispro), NovoLog (aspart), Apidra (glulisine) Rapid-acting insulin is taken just before or after meals, to control spikes in blood sugar. This type is typically used in addition to a longer-acting insulin. It often works in 15 minutes, peaks between 30 and 90 minutes, and lasts 3 to 5 hours. “You can take it a few minutes before eating or as you sit down to eat, and it starts to work very quickly,” says Manisha Chandalia, MD, director of the Stark Diabetes Center at the University of Texas Medical Branch, in Galveston. Short-acting insulin What it’s called: Humulin R, Novolin R Short-acting insulin covers your insulin needs during meals. It is taken about 30 minutes to an hour before a meal to help control blood sugar levels. This type of insulin takes effect in about 30 minutes to one hour, and peaks after two to four hours. Its effects tend to last about five to eight hours. “The biggest advantage of short-acting insulin is that you don't have to take it at each meal. You can take it at breakfast and supper and still have good control because it lasts a little longer,” Dr. Chandalia says. Intermediate-acting insulin What it’s called: Humulin N (NPH), Novolin N (NPH) Intermediate-acting insulin can control blood sugar levels for about Continue reading >>

Types Of Insulin For Diabetes Treatment

Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last. The types of insulin include: Rapid-acting Short-acting Intermediate-acting Long-acting Pre-mixed What Type of Insulin Is Best for My Diabetes? Your doctor will work with you to prescribe the type of insulin that's best for you and your diabetes. Making that choice will depend on many things, including: How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.) Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin. Your willingness to give yourself multiple injections per day Your age Your goals for managing your blood sugar Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes. The chart below lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when it best lowers blood sugar) and duration (how long insulin continues to work). These three things may vary. The final column offers some insight into the "coverage" provided by the different insulin types in relation to mealtime. Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management Rapid-Acting Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with Continue reading >>

What Is The Best Insulin Type And Regimen For Pregnant Women With Preexisting Diabetes?

PubMed Health. A service of the National Library of Medicine, National Institutes of Health. Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD011880.pub2 Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. What is the best insulin type and regimen for pregnant women with preexisting diabetes? Link to full article: [ Cochrane Library ] The insulin needs of pregnant women with type 1 or 2 diabetes change during pregnancy . Insulin is available in many forms, which affect how often and when the insulin is given. These forms vary in the time needed before the insulin has its effect, how long the effect may last, and whether it is made from animals or humans, which may be important personally or culturally. This review looked at the safest and most effective types and ways of giving insulin during pregnancy. Women with type 1 or 2 diabetes are at increased risk of complications during pregnancy and birth. They are more likely to experience pregnancy loss (stillbirth, miscarriage ), high blood pressure and preeclampsia (high blood pressure associated with swelling and protein in the urine ), and have large babies (called macrosomia, when the baby is 4 kg or more at birth) that result in injury to the mother or baby. The likelihood of having a caesarean is increased. Mothers and babies may have complications related to managing blood glucose levels. The baby is more likely to become overweight and develop type 2 diabetes . We wanted to find out the best type of insulin and regimen to use during pregnancy. We found five randomised trials (N = 554 women and 554 babies) in October 2016. Each trial looked at different insulin types and ways of giving the i Continue reading >>

Insulin: Compare Common Options For Insulin Therapy

Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. The goal of insulin therapy is to maintain blood sugar levels within your target range. Insulin is usually administered in the fat under your skin using a syringe, insulin pen or insulin pump. Which insulin regimen is best for you depends on factors such as the type of diabetes you have, how much your blood sugar fluctuates throughout the day and your lifestyle. Each insulin type is characterized by: How long it takes to begin working (onset) When it's working the hardest (peak) How long it lasts, ranging from about 3 to 26 hours Many types of insulin are available. Here's how they compare. Keep in mind that your doctor may prescribe a mixture of insulin types to use throughout the day and night. Insulin type and name Onset Peak How long it lasts Rapid-acting Insulin aspart (NovoLog) Insulin glulisine (Apidra) Insulin lispro (Humalog) 5-15 min. 45-75 min. 3-4 hours Short-acting Insulin regular (Humulin R, Novolin R) 30-45 min. 2-4 hours 6-8 hours Intermediate-acting Insulin NPH (Humulin N, Novolin N) 2 hours 4-12 hours 16-24 hours Long-acting Insulin glargine (Lantus/ Toujeo) Insulin detemir (Levemir) 2 hours No clear peak 14-24 hours In some cases, premixed insulin — a combination of specific proportions of intermediate-acting and short- or rapid-acting insulin in one bottle or insulin pen — may be an option. Continue reading >>

Choosing Best Body Site For An Insulin Shot

In the past, doctors and nurses told patients to rotate their insulin shots to different sites on their bodies. Now we know that it's best to take insulin shots in the part of the body that matches the insulin action a person wants. See Illustration: Sites for Injecting Insulin Injection Areas and Action Insulin enters the bloodstream faster from some areas of the body than from others. Where you take your shot can affect your blood sugar levels. Generally, insulin enters the blood: Fastest from the abdomen (stomach area). A little slower from the arms. Even more slowly from the legs. Slowest from the buttocks. Exercising can also speed up the amount of time it takes for the insulin to enter your blood. You can figure out where to take your shot based on how quickly or slowly you want the insulin to enter your bloodstream. For example, if you're going to be exercising, such as walking or doing any kind of lifting, you probably don't want to take your shot in your leg or arm. Exercising those areas quickens the amount of time it takes for the insulin to get into your blood stream. This can cause your blood sugar to drop suddenly during or right after you exercise. If you plan to eat right after taking your shot, you might use a site on your stomach. That way the insulin will be available faster to handle the rise in your blood sugar after the meal. Rotate Sites in the Same Area Follow these guidelines when you choose a site to take your shot. Try to be consistent in where you take your shots. Always take your shot of fast-acting insulin in the stomach or arm. Take slower-acting insulin in the leg or buttocks. Try to avoid using the exact spot you used for your last shot. For example, space your next shot just an inch or so from your last previous shot. If you use the sam Continue reading >>

A Complete List Of Diabetes Medications

Diabetes is a condition that leads to high levels of blood glucose (or sugar) in the body. This happens when your body can’t make or use insulin like it’s supposed to. Insulin is a substance that helps your body use the sugar from the food you eat. There are two different types of diabetes: type 1 diabetes and type 2 diabetes. People with both types of diabetes need medications to help keep their blood sugar levels normal. The types of drugs that can treat you depend on the type of diabetes you have. This article gives you information about drugs that treat both types of diabetes to help give you an idea of the treatment options available to you. Insulin Insulin is the most common type of medication used in type 1 diabetes treatment. It’s also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is. Options include: Short-acting insulin regular insulin (Humulin and Novolin) Rapid-acting insulins Intermediate-acting insulin Long-acting insulins Combination insulins NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart) Humalog Mix 75/25 (insulin lispro protamine-insulin lispro) Humalog Mix 50/50 (insulin lispro protamine-insulin lispro) Humulin 70/30 (human insulin NPH-human insulin regular) Novolin 70/30 (human insulin NPH-human insulin regular) Ryzodeg (insulin degludec-insulin aspart) Amylinomimetic drug Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drug. It’s an injectable drug used before meals. It works by delaying the time your stomach takes to empty itself. It reduces glucagon secretion after meals. This lowers your blood sugar. It also reduces appetite through a central mechanism. Most medications for type 2 diabetes are o Continue reading >>

Insulin Pump Rundown

Choosing an insulin pump doesn’t have to be an overwhelming process. Should you go with a more traditional pump where you can monitor your insulin levels directly? Are you looking for a model that works with a BGM monitor and allows you to administer insulin via a remote? Maybe you need a pump that offers integration with a CGM system. What about size? Color? To use tubes or not to use tubes? Presenting the options so you can find out what pump best fits your lifestyle is our goal. So, with several models on the market, let us help you sort through the choices by taking a look at what’s available and breaking down the various features of each. We’ve separated the pumps into four categories: pumps that incorporate or work with a Blood Glucose Monitor (BGM) and offer Continuous Glucose Monitoring (CGM), pumps with just CGM capability, pumps with just a BGM, and standalone pumps that don’t work with a BGM or offer CGM. Hybrid Closed-Loop System The 670 G system is the newest member to the Medtronic pump family and the first hybrid closed-loop system. In other ways, it is a like a “basal modulator” where you have to still bolus but it predicts your basal rate. Every 5 minutes, the auto-mode option (hybrid closed-loop) automatically adjusts basal insulin delivery based on your sugar levels to keep you range. It is excellent at catching lows because it stops your insulin dosage 30 minutes before you reach your pre-selected low limits, then it will automatically restart insulin when your levels recover. Possible concerns: excessive alerts and extended menu that needs clearing. Only approved for ages 14+ because it has a total daily dose requirement of at least 8 units a day. Feeling of loss of control of management with closed-loop system. Pumps with BGM and CGM ca 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 >>