The General Principles Of Sliding Scale Therapy Are:
- The amount of carbohydrate to be eaten at each meal is pre-set.
- The basal insulin dose doesnt change. You take the same long-acting insulin dose no matter what the blood glucose level.
- The bolus insulin is based on the blood sugar level before the meal or at bedtime
- Pre-mixed insulin doses are based on the blood sugar level before the meal
How Should I Use Regular Insulin
Use insulin exactly as directed. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Regular insulin is injected under the skin. A healthcare provider may teach you how to properly use the medication by yourself. Regular insulin must not be given with a pump. Do not inject this medicine into a vein or a muscle.
Read and carefully follow any Instructions for Use provided with your medicine. Do not use insulin if you don’t understand all instructions for proper use. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.
Your care provider will show you where on your body to inject this medicine. Use a different place each time you give an injection. Do not inject into the same place two times in a row.
Do not inject this medicine into skin that is damaged, tender, bruised, pitted, thickened, scaly, or has a scar or hard lump.
After using regular insulin, you should eat a meal within 30 minutes.
Never share a syringe with another person, even if the needle has been changed. Sharing syringes can allow infections or disease to pass from one person to another.
You may have low blood sugar and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar .
Insulin As Treatment For Diabetes
Injections of insulin can help treat both types of diabetes. The injected insulin acts as a replacement for or supplement to your bodys insulin. People with type 1 diabetes cant make insulin, so they must inject insulin to control their blood glucose levels.
Many people with type 2 diabetes can manage their blood glucose levels with lifestyle changes and oral medication. However, if these treatments dont help to control glucose levels, people with the condition may also need insulin to help control their blood glucose levels.
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How Can Therapeutic Approaches Be Revised
Even when individuals with conditions or circumstances allowing exemption from specific glycemic targets are removed from discussion, a sizable group of people who have no apparent reason not to attain HbA1c in the 5364 mmol/mol range remains. Insulin therapy is often said to be unlimited in its capacity to lower glucose levels, but in practice, even very high prescribed doses sometimes yield results that fall short of expectations . The underlying causes of failure of usual treatments are undoubtedly numerous, and to understand them calls for further effort to identify the personal characteristics of each person that may prove relevant . In many cases, progressive obesity, as a marker for high calorie intake and insulin resistance, identifies a metabolic challenge that resists success even when ample insulin is delivered to tissues. Other medical conditions may be important. Examples include unrecognized Cushing syndrome or a genetic or acquired disorder of extreme insulin resistance.
Dealing with problems when on insulin therapy
Exploring individual factors and their interactions lies at the center of personalized treatment and poses a more difficult challenge in this setting than at the time of starting standard treatments for an unselected population of patients . Personalized use of insulin and other therapies by people who have already demonstrated little success with a more generic approach requires time, expertise, and motivation.
Why Do I Need To Take Insulin
All people who have type 1 diabetes and some people who have type 2 diabetes need to take insulin to help control their blood sugar levels. The goal of taking insulin is to keep your blood sugar level in a normal range as much as possible. Keeping blood sugar in check helps you stay healthy. Insulin cant be taken by mouth. It is usually taken by injection . It can also be taken using an insulin pen or an insulin pump.
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Some Side Effects Can Be Serious If You Experience Any Of The Following Symptoms Call Your Doctor Immediately:
- rash and/or itching over the whole body
- shortness of breath
- large weight gain in a short period of time
- swelling of the arms, hands, feet, ankles, or lower legs
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Regulation And Mechanisms Of Insulin Secretion At The Cellular Level
Synthesis and secretion of insulin is regulated by both nutrient and non-nutrient secretagogues, in the context of environmental stimuli and the interplay of other hormones. Nutrient secretagogues such as glucose appear to trigger insulin secretion from the cell by increasing intracellular ATP and closing of K+-ATP channels as outlined above. Generation of cyclic AMP and other cellular energy intermediates is also augmented, further enhancing insulin release. Glucose does not require insulin action to enter the cell . Non-nutrient secretagogues may act via neural stimuli such as cholinergic and adrenergic pathways, or through peptide hormones and cationic amino acids.
1. Cholinergic Transmission
It has been well recognised that vagus nerve stimulation results in pancreatic insulin secretion. This is thought to mediate the so-called cephalic phase of insulin secretion, occurring when food is seen, smelled or acutely ingested. Islet cell cholinergic muscarinic receptors activate phospholipase C, with subsequent intracellular events activating protein kinase C, phospholipase A2 and mobilizing intracellular calcium. Insulin secretion by these mechanisms does not occur in the fasting state or if blood glucose levels are low, but may augment the anabolic response to feeding.
2. Adrenergic Pathway
Schematic presentation of insulin secretory pathways. Adapted from references: & .
Footnotes: Figure Abbreviations
DAG = diacylglycerol
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What Is Prandial Insulin
Basal-prandial insulin therapy is a physiologic approach to insulin delivery that utilizes multiple daily injections to cover both basal and prandial insulin needs.
Likewise, how is prandial insulin calculated? Calculating the insulin dose:
Herein, when should prandial insulin be given?
Given this, it is reasonable to expect that the optimal time to administer rapid-acting insulin analogues is 1520 min prior to eating, to synchronize insulin action peaks with postprandial glucose excursions, thus minimizing postprandial hyperglycaemia.
What is basal insulin example?
Two types of this insulin currently on the market are detemir and glargine . This basal insulin begins working 90 minutes to 4 hours after injection and remains in your bloodstream for up to 24 hours.
What Will Insulin Be Like In The Future
Pharmaceutical companies are working on very long-acting versions of insulin that could last for a week. There is also an ultra-fast version of insulin under development that will act in less than 15 minutes.
Another group of researchers is looking at glucose responsive insulin , which would react to the needs of your body in real time. It would have nanosensors bound to the insulin so that when insulin is needed, it releases, and when it isnt, it stops, according to Dr. Hirsch.
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Functional Measures Of Insulin Resistance
Another approach is to identify insulin resistant patients, based on functional markers of insulin resistance. McLoughlin et al were able to identify insulin resistant individuals from an overweight-obese cohort by looking at plasma triglyceride concentration, ratio of triglyceride to high-density lipoprotein cholesterol concentrations and insulin concentration. Using cut points of 1.47 mmol/L for triglyceride, 1.8 mmol/L for the triglyceride-high-density lipoprotein cholesterol ratio and 109 pmol/L for insulin, they achieved comparable sensitivity and specificity to the Adult Treatment Panel III to diagnose the metabolic syndrome.
What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
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Throwing Away Your Needles And Lancets
Sharps bins and needle clippers are the safest way of disposing of your insulin needles and your lancets. A needle clipper removes the needle from your insulin pen, and is useful when youre out and about. How you get rid of your sharps bin depends on where you live. Your healthcare team should have information to help you get rid of your bin.
Energy Creation And Distribution
The function of insulin is to help transform glucose into energy and distribute it throughout your body, including the central nervous system and cardiovascular system.
Without insulin, cells are starved for energy and must seek an alternative source. This can lead to life threatening complications.
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Consideration Of Other Options
The decision to start insulin therapy will not usually be taken in isolation. Indeed rather than should insulin be started?, the most appropriate question is usually which of a series of options is most appropriate for this person already on treatment but needing better blood glucose control? In the above discussion, we consider situations in which insulin might be started, but in only a few will insulin be mandatory, although in many cases , it can also be the simplest approach to manage in the medium-term .
Why Insulin Can Become Necessary For A Person With Type 2 Diabetes
Starting insulin treatment should not be seen as a setback.
People with type 2 diabetes may require insulin when their meal plan, weight loss, exercise and antidiabetic drugs do not achieve targeted blood glucose levels.
Diabetes is a progressive disease and the body may require insulin injections to compensate for declining insulin production by the pancreas. That is why starting insulin treatment should never be seen as a failure.
Starting insulin treatment should never be seen as a failure.
Treatment with insulin may be added to an antidiabetic medication or completely replace it. Regardless of the treatment, lifestyle habits are essential to managing diabetes.
Many people are reluctant to inject insulin for various reasons:
- Fear of pain or needles
- Impression that this is the last resort
- Fear of hypoglycemic attacks
- Fear of weight gain
- Memories of loved one who had to take insulin
If this is the case, do not hesitate to discuss your concerns with a health care professional. Some of your fears may be due to false beliefs. Learning more about todays insulin treatment will probably allay your fears. For many people, insulin is an effective way to achieve good blood-sugar control, which can prevent or delay certain diabetes complications over the long term.
Further Optimization And Personalization Of Insulin Therapy
After systematic application of lifestyle, oral agent, and injectable therapies for type 2 diabetes, some patients remain unable to achieve or maintain sufficient glycemic control to avoid the onset or progression of glycemia-related complications. Specifically, even after adoption of initial lifestyle changes, trying adequate courses of oral glucose-lowering agents, starting and optimizing insulin therapy, and consideration of GLP-1RAs, a significant proportion of people have HbA1c levels > 53 mmol/mol . In the population enrolled in the Action to Control Cardiovascular Risk in Diabetes trial, which had both 10 years average duration of diabetes and high cardiovascular risk, about 25% of individuals assigned to intensive glucose-lowering therapy were unable to maintain HbA1c levels < 52 mmol/mol . The further observation that this subgroup, in which insulin therapy was expected to be optimized, had both higher risk of hypoglycemia and higher risk of all-cause mortality has focused attention on the clinical dilemmas posed by such people. A general conclusion is that such people need further consideration of the aims in personalizing their therapy regimens, with the goal of balancing the gains and losses in risk and quality of life from medications. The difficulty in translating this conclusion into practical clinical guidance is well recognized and was reflected by discussions at this expert forum. Several questions were addressed to focus these discussions.
Why Must Insulin Be Administered By Injection
For many of the over 34 million Americans living with diabetes, treatment often requires the use of insulin. While normally made in the pancreas, insulin is a natural hormone that helps the body regulate blood sugar. Those with Type 1 diabetes do not make insulin and need insulin injections in order to survive. As Type 2 progresses, many also find the need for regular insulin injections. For many with a fear of needles, this can often be more frightening than a new diagnosis. So why is it that you must inject insulin with a needle rather than simply take a pill?
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What Happens If I Have Too Little Insulin
People with diabetes have problems either making insulin, how that insulin works or both. The main two types of diabetes are type 1 and type 2 diabetes, although there are other more uncommon types.
People with type 1 diabetes produce very little or no insulin at all. This condition is caused when the beta cells that make insulin have been destroyed by antibodies , hence they are unable to produce insulin. With too little insulin, the body can no longer move glucose from the blood into the cells, causing high blood glucose levels. If the glucose level is high enough, excess glucose spills into the urine. This drags extra water into the urine causing more frequent urination and thirst. This leads to dehydration, which can cause confusion. In addition, with too little insulin, the cells cannot take in glucose for energy and other sources of energy are needed to provide this energy. This makes the body tired and can cause weight loss. If this continues, patients can become very ill. This is because the body attempts to make new energy from fat and causes acids to be produced as waste products. Ultimately, this can lead to coma and death if medical attention is not sought. People with type 1 diabetes will need to inject insulin in order to survive.
Can I Mix Rapid
You can mix a rapid-acting insulin with an intermediate-acting insulin, according to your doctors instructions. Rapid-acting insulin should always be drawn into the syringe first. This will keep the intermediate-acting insulin from getting into the rapid-acting insulin bottle. After mixing rapid-acting insulin in the same syringe with an intermediate-acting insulin, you must inject the mixture under your skin within 15 minutes. Remember to eat within 15 minutes after the injection.
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Amda The Society For Post
Dont use sliding scale insulin for long-term diabetes management for individuals residing in the nursing home. SSI is a reactive way of treating hyperglycemia after it has occurred rather than preventing it. Good evidence exists that SSI is neither effective in meeting the bodys physiologic insulin needs nor is it efficient in the long-term care setting in medically stable individuals. Use of SSI is associated with more frequent glucose checks and insulin injections, leads to greater patient discomfort and increased nursing time and resources. With SSI regiments, patients may be at risk from wide glucose fluctuations or hypoglycemia when insulin is given when food intake is erratic. These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.Continue reading > >
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The Insulin Resistance Syndrome
The insulin resistance syndrome describes the cluster of abnormalities which occur more frequently in insulin resistant individuals. These include glucose intolerance, dyslipidaemia, endothelial dysfunction and elevated procoagulant factors, haemodynamic changes, elevated inflammatory markers, abnormal uric acid metabolism, increased ovarian testosterone secretion and sleep-disordered breathing. Clinical syndromes associated with insulin resistance include type 2 diabetes, cardiovascular disease, essential hypertension, polycystic ovary syndrome, non-alcoholic fatty liver disease, certain forms of cancer and sleep apnoea.
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Faq: Frequently Asked Questions
1. Why is insulin so expensive?
Though reforms are underway in many parts of the US, insulin costs are still prohibitively expensive for many people with diabetes. Reasons include the complexity of the pharmaceutical supply chain and lack of generic substitutes.
2. What is sliding scale insulin?
Sliding scale therapy is a regimen that prescribes a progressive increase in insulin doses before meals and at bedtime, based on your blood sugar levels.
3. What is an insulin index?
The insulin index gives foods a rating based on how much your blood insulin concentration rises in the two hours after consumption.
4. What is an insulin resistance diet?
An insulin resistance diet incorporates foods that will help maintain your bodys balance of insulin and blood sugar. Think nourishing calories from veggies, fruit, lean proteins, and healthy fats.
Insulin And Fat Storage
As well as being involved in the regulation of blood glucose, insulin is also involved in how fat is used by the body. When the liver is has taken up its capacity of glycoge, insulin signals fat cells to take up glucose to be stored as triglycerides.
An additional effect of insulin is in inhibiting the breakdown of fats.
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