- What is diabetes?
- What are the types of diabetes?
- What are the symptoms of diabetes?
- What are examples of insulin preparations available?
- For what type of diabetes is insulin prescribed?
- What are the side effects of insulin?
- What is the dosage and how is insulin administrated?
- What are the contraindications, warnings, and precautions for insulin?
- Which drugs interact with insulin?
- How well does insulin treat diabetes?
- What is the mechanism of action (how it works) for insulin?
What is diabetes?
What are the symptoms of diabetes?
Symptoms of diabetes include
What are examples of insulin preparations available?
Examples of rapid acting insulin
- Apidra (insulin glulisine): Supplied in a cartridge, vial, prefilled pen (Solostar)
- Novolog (insulin aspart): Supplied in a cartridge, vial, prefilled pen (FlexPen)
- Humalog: (insulin lispro): Supplied in a cartridge, vial, prefilled pen (Kwik Pen)
Examples of short acting insulin
- Novolin R, Humulin R (regular insulin): Supplied in a vial
Examples of intermediate acting insulin
- Humulin N, Novolin N (NPH): Supplied in a vial, pen (Humulin N pen)
Examples of long acting insulin
For what type of diabetes is insulin prescribed?
Indications for insulin
What are the side effects of insulin?
|Common Side Effects||Frequency||Serious||Frequency|
|Headache||12% to 35%||Allergic reactions||n/a|
|Injection site reaction||n/a|
|* n/a = not available|
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What is the dosage and how is insulin administrated?
Dosage and Administration of insulin
- A meal should be consumed within 30 minutes after administering regular insulin
- Insulin usually is administered by subcutaneous injection into the abdominal wall, thigh, buttocks (gluteal region), or upper arm. Injection sites should be rotated within the same region.
- Some insulins (for example, regular insulin) also may be administered intravenously.
- The dose is individualized for each patient.
- A combination of short or rapid acting and intermediate or long acting insulin typically are used
- Some patients may develop resistance to insulin and require increasing doses.
- Multiple daily insulin injections or continuous subcutaneous infusions via a pump closely mimic pancreatic insulin secretion.
- Insulin sliding scales (doses of insulin that are based on the glucose level ) may be used for managing critically ill hospitalized patients.
What are the contraindications, warnings, and precautions for insulin?
- Hypoglycemia (low blood sugar)
- Hypersensitivity to insulin or its excipients (inactive co-ingredients)
Warnings and Precautions
- Hypoglycemia may occur and is the most common side effect of insulin treatment.
- Severe, life-threatening allergic reactions, including anaphylaxis, may occur.
- Hypokalemia (low blood potassium) may occur because insulin stimulates movement of potassium from blood into cells. Combining insulin with potassium-lowering drugs may increase the risk of hypokalemia.
- Hepatic (liver) impairment may reduce the insulin requirement.
- Renal (kidney) dysfunction may reduce the insulin requirement.
- Illness, emotional disturbance, or other stress may alter the insulin requirement.
- Intravenous administration increases the risk of hypoglycemia and hypokalemia.
Which drugs interact with insulin?
Insulin Drug Interactions
|Drug or Drug Class||Effect||Recommendation|
|Beta blockers (for example, propranolol [Inderal, Inderal LA, Innopran XL], atenolol [Tenormin])||Beta blockers may mask symptoms of hypoglycemia or prolong hypoglycemia and alter glucose metabolism||Avoid combination if possible|
|repaglinide (Prandin)||Increased risk of hypoglycemia and heart attack (myocardial infarction)||Avoid combination if possible|
|rosiglitazone (Avandia) or rosiglitazone combination products||Increased incidence of hypoglycemia, fluid retention, ischemia (manifest by angina or heart pain), congestive heart failure||Avoid combination if possible|
|Thiazides and thiazide combination products||Hyperglycemia; may reduce effect of insulin||Monitor glucose levels and adjust accordingly|
|Corticosteroids||Hyperglycemia; may reduce effect of insulin||Monitor glucose levels and adjust accordingly|
|Estrogens||Hyperglycemia; may reduce effect of insulin||Monitor therapy and adjust as needed|
|levofloxacin (Levaquin) and other fluoroquinolones||Increased risk of hypoglycemia or hyperglycemia||Use with caution, monitor therapy|
|Monoamine oxidase inhibitors (MAOIs)||MAIOs may increase insulin secretion. Combination increases risk of prolonged hypoglycemia.||Monitor glucose levels and adjust accordingly|
|Sulfonylureas||Increased risk of hypoglycemia and||Monitor glucose levels and adjust accordingly|
|Thyroid hormones||Thyroid hormones may increase insulin requirement||Monitor glucose levels and adjust accordingly|
|Yohimbe||Yohimbe may increase risk of hypoglycemia||Caution is advised|
How well does insulin treat diabetes?
Efficacy of insulin
- In a 24 week study of patients with type 1 diabetes, regular human subcutaneous insulin (mean dose = 18.3 IU) before breakfast and dinner plus human insulin isophane suspension twice daily (mean dose = 37.1 IU) reduced HbA1c by 0.4% from baseline and fasting glucose by -6 mg/dl.
- In a 24 week study of patients with type 2 diabetes, regular human subcutaneous insulin (mean dose = 25.5 IU) before breakfast and dinner plus human insulin isophane suspension twice daily (mean dose = 52.3 IU) reduced HbA1c by 0.6% from baseline and fasting glucose by -6 mg/dl.
What is the mechanism of action (how it works) for insulin?
Pharmacology (mechanism of action) of insulin
Insulin is a hormone secreted by the pancreas. It regulates the movement of glucose from blood into cells. Insulin lowers blood glucose by stimulating peripheral glucose uptake primarily by skeletal muscle cells and fat, and by inhibiting glucose production and release by the liver. Insulin inhibits lipolysis (breakdown of fat), proteolysis (breakdown of proteins), and gluconeogenesis (manufacture of glucose). It also increases protein synthesis and conversion of excess glucose into fat. Insulins used to treat diabetes are pharmacologically similar to the naturally produced hormone. Patients with diabetes are insensitive to insulin and do not produce enough insulin which leads to hyperglycemia and symptoms of diabetes. Exogenous insulin preparations replace insulin in diabetics, increasing the uptake of glucose by cells and reducing the short and long term consequences of diabetes.
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There are a variety of types and preparations of insulin for the treatment of type 1 and type 2 diabetes, gestational diabetes, diabetes during pregnancy, metabolic syndrome, and insulin resistance. Human insulin preparations and regular insulin are made by recombinant DNA technology. Examples of preparations of insulin include rapid acting insulin (Apirda, Novolog, Humalog), short acting insulin (Novolin R, Humulin R), intermediate acting insulin (Humulin N, Novolin N, and long lasting insulin (Lantus, Levemir). Common side effects of insulin include hypoglycemia, headache, weight gain, rash, itching, flu-like symptoms, lipoatrophy, and reaction at the site of injection. Warnings, precautions, and drug interactions should be reviewed prior to taking insulin.
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Common Medical Abbreviations List
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include: ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease. ARF: Acute renal (kidney) failure cap: Capsule. CPAP: Continuous positive airway pressure. A treatment for sleep apnea. DJD: Degenerative joint disease. Another term for osteoarthritis. DM: Diabetes mellitus. Type 1 and type 2 diabetes HA: Headache IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis JT: Joint N/V: Nausea or vomiting. p.o.: By mouth. From the Latin terminology per os. q.i.d.: Four times daily. As in taking a medicine four times daily. RA: Rheumatoid arthritis SOB: Shortness of breath. T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
Diabetes Symptoms in Men
Diabetes mellitus is a disease in which a person's blood sugar (blood glucose) is either too high (hyperglycemia) or too low (hypoglycemia) due to problems with insulin regulation in the body. There are two main types of diabetes mellitus, type 1 and type 2. Type 1 diabetes usually occurs during childhood, while type 2 diabetes usually occurs during adulthood, however, rates of both types of diabetes in children, adolescents, and teens is increasing. More men than women have diabetes in the US, and the disease can affect men differently than women.Warning symptoms of diabetes that men have and women do not include low testosterone (low-t), sexual problems, impotence (erectile dysfunction), decreased interest in sex, and retrograde ejaculation. Type 1 and type 2 diabetes symptoms and signs that are the same in men and women include skin infections, numbness or tingling in the feet or hands, nausea, excessive thirst or hunger, fatigue, irritability, blurred vision, weight gain, weight loss, urinary tract infections (URIs), and kidney problems. Treatment for type 1 diabetes is insulin, and treatment for type 2 diabetes are lifestyle changes like eating a healthy diet, getting exercise daily, and if necessary, diabetes medications.
Diabetes (Type 1 and Type 2)
Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. There are no signs or symptoms of insulin resistance. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Learning how to avoid gestational diabetes is possible and maintaining a healthy weight and diet before and during pregnancy can help. Discover risk factors, tests and treatments for, and signs and symptoms of gestational diabetes.
Diabetes Treatment (Type 1 and Type 2 Medications and Diet)
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with: insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with: weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Type 1 vs Type 2 Diabetes (Similarities and Differences)
Diabetes mellitus is a metabolic condition in which a person's blood sugar (glucose) levels are too high. Over 29.1 million children and adults in the US have diabetes. Of that, 8.1 million people have diabetes and don't even know it. Type 1 diabetes (insulin-dependent, juvenile) is caused by a problem with insulin production by the pancreas. Type 2 diabetes (non-insulin dependent) is caused by: Eating a lot of foods and drinking beverages with simple carbohydrates (pizza, white breads, pastas, cereals, pastries, etc.) and simple sugars (donuts, candy, etc.) Consuming too many products with artificial sweeteners (We found out that they are bad for us!) Lack of activity Exercise Stress Genetics While the signs and symptoms of both types of diabetes are the same, which include: Increased urination Increased hunger Increased thirst Unexplained weight loss. However, the treatments are different. Type 1 diabetes is insulin dependent, which means a person with this type of diabetes requires treatment with insulin. People with type 2 diabetes require medication, lifestyle changes like eating a healthy diet, and getting regular exercise.
Type 2 Diabetes
Type 2 diabetes is a chronic condition that may be reversible with diet and lifestyle changes. Symptoms include excessive thirst, frequent urination, weight loss, fatigue, and an unusual odor to your urine. Most people don't know they have type 2 diabetes until they have a routine blood test. Treatment options include medications, a type 2 diabetes diet, and other lifestyle changes.
Diabetic Ketoacidosis (Causes, Symptoms, Treatment, Complications)
Diabetic ketoacidosis (DKA) is a complication of type 1 diabetes that is life threatening. If a person thinks they may have diabetic ketoacidosis they should seek medical care immediately. Diabetic ketoacidosis happens when a person's insulin levels in the blood become dangerously low. Symptoms of diabetic ketoacidosis include dehydration, abdominal pain, confusion, and nausea and vomiting. Diabetic ketoacidosis needs medical treatment. It cannot be treated at home.
Diabetes and Foot Problems (Treatment)
Diabetes related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Type 1 Diabetes (Symptoms, Causes, Diet, Treatment, Life Expectancy)
Type 1 diabetes mellitus (juvenile) is an auto-immune disease with no known cause at this time, although there are a few risk factors. Symptoms of type 1 diabetes include frequent urination, unintentional weight loss, dry and itchy skin, vision problems, wounds that heal slowly, and excessive thirst. Type 1 diabetes is diagnosed with blood tests. A healthy lifestyle and controlling blood glucose levels can improve life expectancy.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
A diabetic diet, or diabetes diet helps keep blood glucose levels in the target range for patients. Exercise and medication may also help stabilize blood glucose levels. Keeping track of when you take your diabetic medicine, keeping track of food choices, eating the proper amount of fruits, vegetables, carbohydrates, and fats will also help maintain proper blood glucose levels. Foods that raise blood sugar levels are "high glycemic index foods;" examples include: Pumpkin Melons Popcorn Short-grain white rice Foods that help maintain good blood sugar levels are foods that are low on the glycemic index, for example: Rolled or steel-cut oats Many fruits Non-starchy vegetables Beans Legumes Lentils
Eye Problems and Diabetes
Diabetes and eye problems are generally caused by high blood sugar levels over an extended period of time. Types of eye problems in a person with diabetes include glaucoma, cataracts, and retinopathy. Examples of symptoms include blurred vision, headaches, eye aches, pain, halos around lights, loss of vision, watering eyes. Treatment for eye problems in people with diabetes depend on the type of eye problem. Prevention of eye problems include reducing blood pressure, cholesterol levels, quitting smoking, and maintaining proper blood glucose levels.
Diabetes and Kidney Disease
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Drug Allergy (Medication Allergy)
Drug or medication allergies are caused when the immune system mistakenly creates an immune response to a medication. Symptoms of a drug allergic reaction include: Hives Rash Itchy skin or eyes Dizziness Nausea Diarrhea Fainting Anxiety The most common drugs that people are allergic to include: Penicillins and penicillin type drugs Sulfa drugs Insulin Iodine Treatment may involve antihistamines or corticosteroids. An Epipen may be used for life-threatening anaphylactic symptoms.
Tips for Managing Type 1 and 2 Diabetes at Home
Managing your diabetes is a full time commitment. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information will enable you to mange your diabetes at home successfully.
Diabetes: Caring for Your Diabetes at Special Times
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Treatment & Diagnosis
Medications & Supplements
Prevention & Wellness
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.