What's the big deal about insulin?

You've  probably heard the word insulin many times. You probably even know some relatives that talk about going to the pharmacy to buy their insulin. But do you know what it is or why they need it or even how they take insulin? You don’t!!! Well, then this entry is just for you.

Diabetics are the most common group of people who need and take insulin. I’m a diabetic myself, which means I have a chronic illness that causes high blood sugar. High blood sugar is usually caused by resistance to insulin or depreciated production (typically Type 2 diabetes) or flat out no insulin production at all (Type 1 diabetes). I’m a Type 1 diabetic, so my body doesn’t produce insulin at all, which means I need to give myself insulin manually. All Type 1 diabetics and even some Type 2 diabetics need insulin to control their blood sugar.

Insulin is a clear liquid that comes in a vial or sometimes a device that looks a lot like a pen. It even has a cap and button at the top! Starting from this point, I’ll try to answer some questions that people frequently ask me when they see my insulin vial or learn that I’m a diabetic.

HOW DO YOU 'TAKE' YOUR INSULIN? CAN YOU USE PILLS?
Insulin is actually a sensitive hormone made up of amino acids, just like proteins, so we cannot take it in a pill. Just like proteins, insulin has a three-dimensional shape that is important to its activity and ability to work properly in the body. Stomach acid has an incredibly low pH, which destroys the 3D shape of insulin and makes it completely useless to the body. So diabetics can’t take insulin orally without destroying
their medicine.

I’m sure many people have diabetic friends or relatives who take pills to control their diabetes and you may think that they’re taking insulin. However, the chances are that he/she has Type 2 diabetes and that the pill does not contain insulin at all. Type 1 diabetics need insulin, but many Type 2 diabetics use medications that help them to produce more insulin or make their bodies more sensitive to the insulin they already have in their bodies. Those medications are not as sensitive to stomach acid.

IF YOU CAN'T USE PILLS, THEN HOW DO YOU TAKE YOUR INSULIN?
Instead of pills, diabetics frequently deliver insulin with a needle. Yikes!
Don’t worry, I promise it won’t be scary. Diabetics have been using syringes to deliver their insulin since the 1920’s. Before then diabetes in children was considered fatal. So even if syringes seem a little scary, I’m sure all the diabetics since 1920 quickly become comfortable with taking shots. The shots of insulin are usually injecting it into their fatty tissue just below the skin, which is an area called ‘subcutaneous’. When I was first diagnosed, I used syringes and I quickly become accustomed to these subcutaneous injections.

There are other methods being tested, such as using inhalation or a transdermal air gun of sorts, but syringes are by far the most common way to take insulin. A more recent technology, the insulin pump, uses subcutaneous injections as well, but not through a syringe. Instead of a syringe, insulin pumps use a small catheter that is attached to a very accurate pump that does most of the work. I’ll talk a little more about insulin pumps later.

DOESN'T IT HURT TO TAKE YOUR INSULIN WITH A SYRINGE?
The first place many diabetics are taught to take their shot is in the stomach area. I have to admit that it does hurt a little, especially in the beginning. I usually feel a quick sting. And sometimes with bigger injections the area has a burning sensation for a couple minutes afterward. But the pain quickly goes away. Over time the level of pain has dramatically dropped. Also, medical innovation keeps coming up with new delivery systems, small needles, and less painful solutions that make the whole process a lot more comfortable.

WHY DO YOU INJECT INSULIN INTO YOUR STOMACH?
Actually, I don’t have to inject in my stomach. In fact, diabetics are recommended to rotate injections sites around the body. The major rule is that the injection must be in a fatty area. To work smoothly and be released over a longer time, insulin needs to be injected into fat rather than muscle or blood. Injecting into muscle or the bloodstream cause insulin to be dumped into the body all at once and could cause the person’s blood sugar to go down dangerously low in a short period of time (20-30min).

I know a lot of diabetics that use the stomach because it is a convenient spot. When you use your stomach, you can use both hands, you can see the injection site, and usually it’s not a problem to lift your shirt a few inches. Other possible areas are the thighs, upper arms, lower back, and even the butt (I’ve actually never tried this area).

HOW OFTEN DO YOU HAVE TO TAKE INSULIN?
This is a tricky question. The amount of insulin and the type of insulin and the frequency of injections will vary from person to person. Sometimes these factors also change within a single person during the year, while they are sick, or when there is a major stress in their life. To answer this question, I have to generalize and you should understand that there are many exceptions to the following statements.

To start, you should know that normal people make insulin all the time at a low basal rate. When you eat or your blood sugar rises, a normal body will make more insulin to regulate the blood sugar. To try and mimic a normal body, many diabetics use at least two kinds of insulin. The first is long-acting insulin. Usually, long-acting insulin starts working within a few hours and stays active for up to 24 hours. A normal body has only one kind of insulin, but research has created many kinds of insulin, such as long-acting insulin, that has helped diabetics control their blood sugar and more closely resemble a non-diabetic. For example, the long-acting insulin Lantus has three amino acid mutations in the insulin molecule that allow is to slowly absorb into the body and mimic a low basal rate.

The second type is short-acting insulin. Short-acting insulin is supposed to mimic the increase in insulin production when a non-diabetic eats a meal or has a rise in blood sugar. It begins to work within 20 minutes and can be active for 3-5 hours. The word “bolus” usually refers to these short-acting insulin injections. Short-acting insulin is perfect for taking care of rapid changes in blood sugar due to food because it's the fastest to start working and has a similar lifespan as the release of carbohydrates from food.

DO ALL DIABETICS TAKE INSULIN?
Not all diabetics need to take insulin. In the case of Type I diabetes, we will always require insulin, but Type 2 diabetes is frequently controlled by diet and medication (pills) without needing insulin injections. You should read this blog entry if you want to learn more about the different kinds of diabetes.

So that’s a little bit of why and how diabetics take insulin. Next time you hear someone say, “ I need to take my insulin,” you might be able to ask more about their diabetes.

Do you have a question? Comment? Is there something I didn’t talk about that you think belongs here? Please let me know! I’m happy to help.