How Dr. Robert Gabbay, chief medical officer of the Joslin Diabetes Center, answers the question of how to manage diabetes with insulin.
The goal of insulin use is to control blood sugar. When blood sugar is well controlled, complications of diabetes such as eye disease, kidney disease, amputations, heart disease, stroke, etc. People with type 1 diabetes need insulin to survive. people with type 2 diabetes will eventually lose the ability to produce enough insulin and will need (exogenous) insulin to control their blood sugar thereafter.
Which type of insulin to take – short-acting or long-acting – depends on the needs of the patient. If you have type 2 diabetes and your body is still producing a little insulin, you may only need to use long-acting insulin. If you have type 1 diabetes, or if you have type 2 diabetes but have lost the ability to produce more insulin, you will need short-acting insulin for mealtime needs and long-acting insulin for overnight and between meals.
The initial insulin dose is based on body weight, but this is only the beginning. Subsequently, the dose of insulin depends on the blood glucose level measured at home. Blood glucose measurements help determine if the insulin is appropriate so that adjustments can be made accordingly. To prevent blood glucose from fluctuating too high or too low, it is important to measure blood glucose frequently. Eventually, the patient will fully understand how to adjust the insulin dose based on blood glucose levels, the amount of carbohydrates consumed, and the exercise regimen.
Insulin can be injected using a syringe, insulin pen or pump, inhaled insulin, or injected subcutaneously using a needleless jet syringe. Most patients use pens or needles and syringes because these supplies are inexpensive. Inhaled insulin is usually indicated for patients who are less comfortable with insulin injections, especially those with type 2 diabetes. The insulin pump dose can be fine-tuned if blood glucose is checked frequently and there is a need or if you are skilled at injecting.
If you need to store unopened insulin, place the vial or insulin pen in the refrigerator until the expiration date. When ready to inject, remove only one at a time. Once opened, it can be stored at room temperature for about 1 month or so.
Many people with diabetes are apprehensive about how they will start using insulin. This is an extremely common thought, but there is no need to worry. Insulin injections are usually less harmful than blood glucose testing. In addition, the needles are now thinner and the injections are more comfortable. Once the anxiety is overcome, patients will find that insulin can help manage their diabetes better.