WHAT IS INSULIN

GENERAL INFORMATION:

What is insulin?

Insulin is a hormone made by the pancreas. Insulin acts as a "key" to move sugar from the blood into cells to be used for energy. People with type 1 diabetes make little or no insulin on their own. They must have insulin shots every day. Sometimes people with type 2 diabetes also need to take insulin shots. Insulin cannot be taken as a pill because the acids in the stomach would destroy it. Because of this, it must be given as an injection (shot).

Human insulin is the most common type of insulin. It is made using bacteria or yeast. In the past, insulin was available from a beef source, but this kind of insulin is no longer made. Pork insulin is still made for patients who are stable on pork insulin. Never change from one brand of insulin to another without checking with your caregiver first. Do not switch from pork to human insulin without checking with your caregiver first.

What types of insulin are there?

There are several types of insulin. Each type is different depending on its onset (how soon it starts to work in the blood), peak and duration. The peak is when the insulin is working the hardest and the duration is how long it lasts. Some people take a combination of two or more types of insulin, and need two to three shots a day.

Actions may vary with the type of insulin you use. The actions are also affected by where in your body you inject the insulin. The actions also vary depending on how you give yourself the shot. Exercise and diet can also affect the onset, peak, and duration of insulin. The following chart describes the common types of insulin.

Rapid-acting: This type of insulin will begin to work within 15 minutes, and should be injected right before a meal. It should not be injected more than 15 minutes before eating. It may also be given right after a meal.

Lispro (Humalog®), Insulin Aspart (Novolog®)
Onset: 10 to 15 minutes
Peak: 30 to 90 minutes
Duration: 3 to 5 hours
Short-acting: Short-acting insulin is also called Regular insulin and will begin to work 30 to 45 minutes after it is given. It should be injected 30 to 45 minutes before a meal.
Regular

Onset: 30 to 60 minutes

Peak: 2 to 3 hours

Duration: 4 to 6 hours

Intermediate-acting: This type of insulin may take longer to work than Regular insulin. Lente® insulin lasts a little longer than NPH insulin. Both insulins are used to control blood sugar between meals. When given right before bedtime, this insulin will control blood sugar during the night. NPH, Lente®

Onset: 2 to 4 hours

Peak: 4 to 8 hours

Duration: 10 to 20 hours

Long-acting: Long-acting insulins last an entire day and are usually given in the morning or at bedtime.

Ultralente®

Onset: 6 to 10 hours

Peak: none

Duration: 20 to 30 hours

Glargine (Lantus®)

Onset: 1 to 2 hours

Peak: none

Duration: 24 hours

Insulin mixtures: Insulins also come premixed with a short-acting and an intermediate-acting insulin. Insulin mixtures control blood sugar at meal time and throughout the day. If the insulin mixture has Regular insulin, it should be given 30 to 45 minutes before a meal. If it the insulin mixture has a rapid-acting insulin, it should be injected no more than 15 minutes before a meal. The following are insulin mixtures:

50/50 mix of 50 percent NPH and 50 percent Regular insulin.

70/30 mix of 70 percent of an intermediate-acting insulin and 30 percent Regular insulin or aspart insulin.

75/25 mix of 75 percent intermediate-acting insulin and 25 percent Lispro insulin.

How does insulin look and how is it measured? Ask your caregiver which kind of insulin you need, how much you need, and which syringe you should use.

Rapid-acting insulins, Regular insulin and Glargine insulin are clear. Intermediate-acting insulins, Ultralente® insulin and insulin mixtures are a milky or cloudy color.

Insulin is measured in units. It is available in "U100" or "U500". U100 is the most common and 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. You will use a U500 syringe for this type of insulin. Read the insulin bottle carefully to be sure you are taking the right kind of insulin.

If you are taking both U100 and U500 insulin types, it is very important that you use the right syringe for each type of insulin. If the wrong syringe is used, you may be giving yourself too much or too little insulin. Store the U100 insulin with the U100 syringes. Store the U500 insulin with the U500 syringes. This may help you to use the right syringes to draw up your insulin dosage.

Insulin syringes come in three different sizes. You may use a 3/10 cc, a 1/2 cc, or a one (1) cc insulin syringe, depending on how much insulin you take. One cc is the same amount as one milliliter, or mL.

Spring-loaded syringe holders, and pen syringes may be available for you to use. There are also pre-filled syringes, which may hold one or more doses of insulin. Read the directions for using these devices to get the right dose, and avoid accidentally getting stuck with the needle. You must prime (prepare) pen syringes before each insulin injection. Priming the pen helps to make sure that insulin will come out when you press the injection button. It also removes extra air from the pen so that you get the right dose. Some syringe types also have a blood-testing device. Ask your caregiver to help you select and use the device that is right for you.

How to do I store insulin and make sure it is safe to use?

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. As you buy more insulin, rotate the supply (move the bottles and pen syringes) so that you use the oldest ones first. 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 (in a cool, dry place) if you are not able to keep them refrigerated. Unopened bottles of insulin kept at room temperature are good for about 28 days.

Opened insulin: You may store opened insulin bottles in a cool, dry place at room temperature, or in the refrigerator. Injecting cold insulin may make the injection more painful or cause irritation at the injection site. An open bottle is good for 28 days in a cool, dry place outside the refrigerator. Do not let your insulin get too warm or too cold. Store pen syringes that you are currently using at room temperature only . Always follow the directions about storage on the label or package insert that came with the insulin.

NEVER freeze insulin. If insulin has been frozen or exposed to very warm temperatures (above 85° F), throw it away .

How insulin should look:

If intermediate-acting insulins, Ultralente® insulin, and insulin mixtures have small, white, hard particles that will not mix, throw the insulin away . Also throw it away if it looks "frosty" and sticks to the sides of the bottle.

Rapid-acting insulins, Regular insulin, and Glargine insulin should always look clear. Do not use these insulins if they look cloudy.

Always look at the insulin before using it. Check for changes to it, including seeing clumps, or finding frosting or moisture on the inside of the bottle. A change in how clear the insulin was, or color changes are also reasons not to use the insulin. Throw the insulin away, and use a new bottle.

Always keep a spare bottle of each kind of insulin. Keep regular insulin on hand for emergencies and sick days. This is important even if you do not need to take insulin every day.

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).

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.