When you have Type 1 diabetes, you need to use insulin, a hormone normally produced in the pancreas, because your body doesn’t make it. Some people with Type 2 diabetes — but not all — also use insulin.
Among adults with diabetes, about 30 percent were using insulin in 2011, according to data from the Centers for Disease Control and Prevention. As health professionals recognize the value of better blood sugar control, they have become less hesitant to prescribe insulin, says Evan Sisson, a certified diabetes educator and an associate professor at the Virginia Commonwealth University School of Pharmacy in Richmond.
Insulin helps your body use sugar, or glucose, from carbohydrates in the foods you eat. “After we eat or drink, our blood sugar level starts to rise, and the beta cells in our pancreas are signaled to release insulin into our bloodstream,” says Ellie Kagan, a pediatric nurse practitioner and diabetes educator at Mt. Washington Pediatric Hospital in Baltimore.
[Read: 11 Tips for Testing Your Blood Sugar at Home.]
“I often describe insulin as an Uber driver,” Kagan says. “Because the glucose can’t directly enter the cells, it needs a driver, or insulin, to take it there. When there are enough Uber drivers to deliver the glucose, the glucose levels naturally go down after a meal and the cells are fueled.”
Another way to think of insulin is like a key that unlocks glucose entrance into the cells of the body, says Dr. Natasha Akhter, assistant professor in the Division of Endocrinology at the Department of Medicine at Duke University in Durham, North Carolina.
There are many different types of insulin in the U.S. “They differ in how quickly they work, when they peak and how long their effects last,” Kagan says. Here are a few examples shared by Akhter:
— Rapid-acting insulin acts within 15 to 30 minutes and lasts about three to four hours.
— Short-acting (also called regular) insulin acts within 30 minutes to an hour and can last five to eight hours.
— Intermediate-acting insulin (also called NPH) works within 90 minutes to two hours and has a peak action in four hours.
— Long-acting insulin works within an hour and may last 24 hours.
— Ultra long-acting insulin also works within an hour and may last up to 48 hours.
There also are versions that combine, say, intermediate-acting and regular insulin or intermediate and rapid-acting insulin.
“The standard practice is to have patients with diabetes on once-a-day basal insulin, which can be the long-acting or ultra long-acting. Rapid-acting is usually added three times a day for mealtime,” Akhter says. The amount of rapid-acting insulin used may depend on your blood sugar and the number of carbs you eat during a meal.
[See: The 12 Best Diets to Prevent and Manage Diabetes.]
However, insulin use for each diabetes patient will differ. For instance, if you have high blood sugar even after fasting, long-acting insulin would be beneficial. If your fasting blood sugar is normal but the blood sugar gets elevated after meals, then rapid-acting insulin would be more appropriate, Kagan says.
You and your health professionals will work together to consider insulin onset (when it lowers blood glucose), peak time (when it’s working at maximum strength) and duration (how long it continues to lower blood sugar), so you are using the right type of insulin regularly.
“We try to find out about a person’s life and what they eat to match their insulin to that,” Sisson says.
Unlike other medications, which often come in a pill form, insulin is usually taken as an injection. “It can’t be taken as a pill because it would be broken down during digestion, just like protein in food,” Kagan says. “It must be injected so that it works properly, just like the insulin produced in our bodies.” However, the U.S. Food and Drug Administration recently approved an inhaled insulin, Afrezza. In people with Type 1 diabetes, this new form of insulin still must be used with long-acting insulin. Also, inhaled insulin can’t be used by someone with asthma or chronic obstructive pulmonary disorder, or COPD, Sisson says.
There are also people who use an insulin pump, which can deliver insulin in a stable continuous dose or a surge dose around mealtime. Some people with diabetes prefer insulin pumps over injections, according to the American Diabetes Association.
Because many people still use injections to take insulin, it can trigger the fear of needles or self-injections. Yet today’s injection devices are small enough to carry around like an ink pen, and the needles used are tiny. “Sometimes patients are hesitant but once they try it, they say, ‘Is that all it is?'” Sisson says.
One important component of using insulin is getting the dose right. If it’s not right, you could develop low blood sugar, or hypoglycemia. “It can happen if a higher-than-necessary dose of insulin is taken after skipping a meal or sometimes when other oral hypoglycemic medications are used inappropriately,” Akhter says.
[See: 6 Tips to Keep Diabetics Out of the Hospital.]
Low blood sugar is the most common and serious side effect of insulin — and the risk is higher in those receiving continuous insulin therapy, Kagan says. That’s why you need to consult your doctor or a certified diabetes educator to get a better handle on using insulin if you are required to take it.
Another possible side effect is something called lipohypertrophy, or extra lumps of fat under the skin around a commonly used injection site. That can occur if you don’t rotate your injection site. “It may be unsightly, mildly painful and may change the timing and completeness of insulin action,” Kagan says.
It’s also possible to develop an infection at the injection site. Make sure to wash your hands with soap and water before you do an insulin injection.
More from U.S. News
Which Medical Screenings Should You Have in 2017?
7 Things Not to Say to Someone With Diabetes
How Does Insulin Work? originally appeared on usnews.com
