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September 15, 2016

The role of insulin in the treatment of diabetes

Diabetes is a chronic disease that develops when the body does not produce enough insulin to meet its needs or when cells do not respond normally to the insulin produced. 

Insulin, a hormone essential to life, supplies cells with their fuel, glucose (or sugar). If the body does not have enough insulin, the concentration of glucose in the blood – its glycemia level – will become elevated. 

In the short-to-long term, too much glucose in the blood will cause damage to the eyes, kidneys, nerves and circulatory system (the heart and blood vessels). This eventually leads to medical complications typically associated with diabetes.

The importance of insulin

When diabetes is not present, insulin is constantly being produced by the body, where it regulates blood glucose and maintains it within a normal range (4 to 6 mmol/L).

If the pancreas is not functioning properly or if the body is unable to adequately use the insulin it produces, the level of glucose in the blood becomes too high (known as “hyperglycemia”) and diabetes  develops

Types of diabetes

Type 1 diabetes, which generally develops in childhood or adolescence, results from the breakdown of pancreatic cells responsible for the production of insulin. People with this form of the disease usually present a complete deficiency of insulin and require daily insulin injections. In addition to their insulin therapy, they must:

  • Balance their diet to obtain the nutrients they need to stay health and avoid major fluctuations in their blood glucose levels. 
  • Exercise to prevent cardiovascular complications associated with diabetes. 
  • Follow a patient education program to learn how to self-administer insulin, use a blood glucose meter, calculate their insulin dose and prevent and treat hypoglycemia.

Frequently associated with obesity, type 2 diabetes can often be explained by the onset of insulin resistance – in other words, the poor use of insulin by the cells. To correct the resulting hyperglycemia, the body reacts by producing large amounts of insulin. Over the years, this overproduction ends up exhausting the pancreas, which becomes unable to produce enough insulin to meet the body’s needs. Here are important facts to keep in mind about type 2 diabetes:

  • Adopting a healthy lifestyle (reaching and maintaining a healthy weight, eating a balanced diet and exercising) can sometimes be enough to correct mild or moderate hyperglycemia. 
  • When lifestyle changes do not have the desired results, type 2 diabetes can be treated with hypoglycemic drugs (drugs taken orally or by injection to lower blood glucose levels).
  • Insulin therapy can sometimes be needed to get a person’s blood glucose under control. 

Self-monitoring of blood glucose: It matters! 

For people with diabetes, measuring their blood glucose levels is a way of life. It is particularly important for those who need insulin injections, since it lets them know if their blood glucose is too high or too low and then adjust the insulin dose accordingly. 

Hypoglycemia is when the blood glucose level is too low (less than 4 mmol/L). It can cause a number of symptoms, such as hunger, shaking, anxiety, drowsiness, confusion and even loss of consciousness, if nothing is done. Hypoglycemia is a serious, yet common problem  that in extreme cases can lead to death. 

Blood glucose testing is done with small portable device called a “blood glucose meter” or glucometer.” There are a variety of models available on the market, each with its own specific features. Your family pharmacist can help you choose the right device based on your needs and instruct you on its proper use.

Here is what the Canadian Diabetes Association recommends on blood sugar testing: 

  • People with type 1 diabetes should test their blood glucose at least three times a day. The same goes for people with type 2 diabetes who self-inject insulin more than once a day. 
  • People with type 2 diabetes following a drug treatment that includes one dose of insulin per day should test their blood glucose at least once a day

This testing lets you see if your treatment is properly controlling your blood glucose or whether you need to adjust your insulin intake. It is also important to keep a log of your test results since they are useful for you, your doctor and any other health professional involved in your care. 

Where to inject insulin

When it comes to insulin, there are different sources (human or analog) and types (based on how quickly they work) that physicians can choose from. Insulin can be rapid-acting, short-acting, intermediate-acting or long-acting. Some products combine two types of insulin to better respond to the needs of users. 

Insulin is injected under the skin (subcutaneously). Injecting it is easy once you have been taught how to do it. Nowadays, most people use an “insulin pen.” It’s a small, portable and discreet device that is simple to use. It comes with an insulin cartridge and needles that are inserted into the device before use. The needles are short and thin, making the injection almost painless.

The main injection sites for insulin are:
 

  • The back of the arms
  • The abdomen (at least 5 cm away from the navel) 
  • The outer side of the thighs
  • The upper buttocks

Constantly injecting at the same site can lead to small fatty deposits (nodules) caused by lipodystrophia. These nodules can look unattractive and prevent insulin from being absorbed properly. To avoid such problems, you need to be taught the proper technique for injecting insulin.
 
A growing number of people with type 1 diabetes are using insulin pumps for their supply of insulin. This tiny electronic device, about the size of a cell phone, can be attached to your belt, carried in your pocket or even secured to a bra strap. The pump mimics the action of a healthy pancreas through the continuous subcutaneous injection of insulin (basal insulin) and additional doses (bolus) on demand (during meals or bouts of hyperglycemia). 

How to store insulin

Unopened vials of insulin must be stored in the refrigerator at a temperature between 2ºC and 8ºC. It’s important to keep insulin away from direct heat and light and never to place it in the freezer. If the drug freezes or is exposed to excessive heat, it must be discarded. The same goes for insulin that has changed colour or appearance. 

Opened vials of insulin can be stored in or out of the refrigerator (at a temperature between 15ºC and 30ºC) for up to one month. The lifespan of a specific product varies based on the brand. To know exactly how to store the insulin you are using, ask your pharmacist or read the manufacturer’s instructions 
 
Insulin must never be exposed to extreme changes in temperature or humidity levels. For example, do not keep it in the car or bathroom. In addition, never used expired insulin. 

Pharmacy services

For many people with diabetes, insulin is an integral part of their treatment. Insulin therapy requires attentiveness and knowledge. If you have any questions or concerns, talk to your family pharmacists.

If you have diabetes, it is extremely important to properly control your blood glucose. If you are having difficulty reaching the targets set by your healthcare professional or if you experience bouts of hyperglycemia or hypoglycemia, speak with your family pharmacists. They can give you advice and recommend changes to your drug therapy, if need be.

Many Uniprix-affiliated pharmacies offer a blood glucose monitoring service and private consultations on diabetes management. Ask about these services. 

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