Disease, Medication and Healthy Lifestyle

Posts Tagged ‘insulin’

Article by Mark Anastasi

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Article by Lynn Woods

The use of insulin as a treatment for diabetes may become more common as the American Diabetes Association’s new treatment algorithm places basal insulin as a possible second-line treatment strategy after lifestyle modification and Metformin. Beginning insulin as a form of treatment requires proper education regarding injection technique. However, even with proper education by a certified diabetes educator problems can still occur. Here are some of the most common problems I encounter at the diabetes care center where I serve as the diabetologist and medical director.
 
Painful injections:

Review your technique with your nurse educator.
Try injecting at a 45° angle; you may be hitting muscle.
 Be sure the alcohol has dried.
Inject quickly.
Check to be sure you have not bent the needle when removing the cap.
Change to a smaller needle length and/or diameter (gauge).
Be sure the insulin is not too cold.
Try injecting in a different site.
 Do not use needles more than once.
Try to relax the muscle below the injection site.
Larger doses just hurt more-sorry.

Bubbles in your insulin syringe: They won’t harm you if they are injected into the subcutaneous space; however, they obviously take up space in the syringe and will cause an inaccurate dose.

Here are suggestions for avoiding bubbles: 
 Draw up your insulin slowly and steadily from the vial.
 Draw up two or three more units of insulin into the syringe than you need.  If bubbles are present, flick the syringe with one of your fingers to make the bubbles rise to the top and once the bubbles are at the top or you can find no bubbles then push the extra units of insulin back into the vial.
If bubble do appear you can inject all the insulin back into the vial and redraw the dose.

 Bleeding at the site of injection:

 Do not rub the injection site.
 Apply light pressure with your finger to prevent bruising.
If a bruise appears, then do not use that injection site again until the bruise resolves.
Frequent bleeding may indicate poor technique or another medical problem; contact your healthcare provider and/or nurse educator.

Insulin is dripping from the pen needle after injection:

Wait at least five seconds after you inject before removing the needle.
For doses of 25 units or more, wait 10 seconds before needle removal.
When using a needle with a larger bore than 29-gauge, i.e., 28 or lower, wait 10 seconds before removing the needle.
Do not carry a pen with the needle attached.  This causes air to enter the cartridge, thus slowing the time it will take to get the insulin dose.

 Insulin is leaking from the injection site:

 Try using a longer needle.
 Try a different injection site.
Be sure you release the pinch before you remove the needle from the skin.

 The injection device is clogged:

Small amounts of insulin may be caught in the needle from a previous use:  Never re-use needles.
There may be a clump in the insulin:  If you use cloudy insulin, be sure to properly mix your insulin before drawing it up.
Cloudy insulin can dry inside the needle or syringe if drawn up too far before the time of injection:  Fill your syringe closer to the time of your injection.

If these solutions do not solve your problem you need to contact your diabetes educator or provider for further assistance.

There’s good news for insulin dependent diabetics who rely on fast-acting mealtime insulin injections to keep their blood sugar under control. MannKind Corporation has the go-ahead to continue clinical testing of its investigational inhaled insulin, AFREZZA. The drug maker and the FDA met to confirm the protocols for two new studies, one in type 1 diabetics, and one in type 2 diabetics.

AFREZZA is an ultra-rapid acting inhaled insulin which uses patented technology to deliver powdered insulin from a thumb-sized device into the lungs. The lungs are an effective option for delivering diabetes medication, largely because of their huge surface area (about the size of a tennis court).

MannKind focuses on the discovery, development and commercialization of therapeutic products for patients with diseases such as diabetes and cancer.

Now in late stage clinical investigation, AFREEZA is its lead product candidate. Shares of the company jumped 20% at the news that the design of the follow-up clinical trials had been confirmed.

MannKind has been seeking approval for its new generation diabetes medication since March of 2009, but was asked twice to run additional clinical trials in order to provide the FDA with more information. One of the approval delays was due to the drug maker updating the design of its insulin inhaler after applying for approval of the earlier design. The FDA was concerned that there was not enough data to support a switch to the new generation device, and asked that both models be tested together.

Clinical trials of the initial design of the insulin inhaler were promising. Participants reported being pleased with the innovative insulin delivery device, and experienced less hypoglycemia and weight gain than did controls using a standard combination of long-acting insulin glargine and twice a day 70 30 insulin injections.

Insulin can’t be taken orally, as digestive juices break it down before it can be used by the body. Currently, the only means of delivering insulin are subcutaneous insulin injections or intravenously. Because AFREEZA is a short-acting mealtime insulin, type 1 diabetics will need to combine it with long-acting insulin injections for complete diabetes control.

Dr. Larry Deeb, a pediatric endocrinologist from the University of Florida College of Medicine, says that failure to comply with regular insulin dosing is one of the major issues in diabetes, often because of the discomfort and inconvenience of insulin injections. Deeb says that finding an alternative insulin delivery method is crucial, especially for children and the needle-phobic.

Should it be approved, AFREEZA would be the second inhaled insulin to hit the market. Pfizer received approval to market a similar product, Exubera, several years ago, but, surprisingly, the product never caught on with diabetics, and was withdrawn from the market a year later.

AFREZZA is easier to use, faster acting and boasts better bioavailability than Exubera, enabling diabetics to achieve more satisfactory insulin levels using smaller amounts. Despite Exubera’s unexpected failure, AFREEZA is expected to be a blockbuster diabetes drug when it becomes available.

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Article by Diana Walker

Article by Dr Guin Van Niekerk

RESISTING INSULIN RESISTANCE

By Dr Guin Van Niekerk

It seems that almost every day a new association between diet and health is discovered. Certain food groups have been shown in reliable studies to decrease the risk of various conditions; for example, the high lycopene content of tomatoes helps to prevent prostate cancer, and calcium-containing foods such as yoghurt and broccoli delay the onset of osteoporosis.

Other foods have been shown to cause, or aggravate, particular conditions. People with high blood pressure are routinely advised to cut down on salt intake. Gout sufferers are all too aware of the impact that some foods, especially drinks like beer (even alcohol-free beer!) have on their joints.

The problem with these food-health relationships, is that they are not very specific, or predictable. How many tomatoes must you eat, and for how long, for it to have a protective effect on your prostate? Assuming, of course, that you are a man and therefore would have one of these. And how much yoghurt and broccoli should you eat to help delay the onset of osteoporosis? Nobody seems to know the answers to these problems, and so it is generally recommended that we eat as much of the protective food types as we can, while avoiding the less favourable things like salt and saturated fats.

Recommendations like these seem to be a bit too vague for my liking. In this era of precise measurements and percentages, it could be expected that someone would be able to prescribe a daily or weekly portion of the particular food group required to decrease the risk of having a condition by a precise percentage. But this is just not possible. Confounding factors such as genetics need to be taken into account; if you have a family history of an illness you may have a genetic predisposition to having the condition yourself, no matter what you do. And genetics is generally too complex a subject to be able to make very accurate predictions. So any recommendations regarding eating certain foods to prevent disease should read something like this: ” Eat such-and-such food, and you may be able to make a slight difference to your overall risk of developing the condition, unless your genes say otherwise, and who can tell if this is the case?” Some prediction!

However, there is one condition where lifestyle and diet will always have a predictable impact on its severity and course, and that is insulin resistance.

“What?” you say. “Never heard of it.” And most people haven’t heard of it, despite the fact that it is one of the most prevalent conditions in the world today. It is more common than diabetes; in fact, insulin resistance is the cause of type 2 diabetes, and has been estimated to affect about one in four people.

So what is insulin resistance?

The answer is not a simple one: insulin resistance is a complex entity, which involves a spectrum of conditions ranging from excess weight around the waist, to type 2 diabetes mellitus. It is the single cause of conditions such as metabolic syndrome, polycystic ovarian syndrome and type 2 diabetes, and is strongly associated with high blood pressure, cholesterol abnormalities, gout, and most frighteningly, sudden death, especially in middle-aged women. In short, it is a medical time bomb.

Its origins are not always clear-cut either. Insulin resistance tends to run in families – although not everyone in the same family is necessarily equally affected. A brother may never show any symptoms of the illness, while his sister may have significant weight problems and go on to develop type 2 diabetes at the age of forty. Or vice versa. Why this happens is not always apparent, although diet and lifestyle do play very significant roles in the progression of the condition.

Insulin resistance may also be “acquired”; in other words it develops in an individual with no family background of insulin resistance and its associated conditions. This usually occurs in people who are overweight for whatever reasons. It has been estimated that half of all people who are significantly overweight have insulin resistance!

It may be because of this very obvious association between insulin resistance and excess weight that, despite the fact that insulin resistance is largely a genetic disorder, it is very responsive to dietary and lifestyle changes, especially those that result in significant (i.e. more than 2-5 kilograms) weight loss. Fantastic news for those who are not very fond of taking tablets!In fact, exercise and diet were shown by the Diabetes Prevention Program to be almost twice as effective as metformin (a drug that is known to reduce insulin resistance) at reducing the risk of progressing to type 2 diabetes, which is more or less the end result of insulin resistance. And these benefits occur whether the person affected was overweight or not at the beginning of the lifestyle modification program. Strangely enough, some people with insulin resistance do not have a weight problem by ordinary standards. Instead, they may have a completely normal body mass index, and the only sign of underlying insulin resistance may be a slight thickening around the waist area.

Nevertheless, the end result of the appropriate dietary modification is the same… an improvement in symptoms, and a longer, healthier life. In a world where people are becoming more interested and involved in taking control of their bodies and their health, this is excellent news. A do-it-yourself cure that really works!

Having said all this, just a word of caution. Weight loss should be approached carefully. Conventional low calorie, low fat and high carbohydrate diets do not work very well for people with insulin resistance, and crash diets work well for nobody. An appropriate diet, a bit of mild exercise, and a slow, gentle loss of weight are all that is needed to make a huge difference to your health. And to the health of those around you. Please remember that family members of people with diabetes are likely to have insulin resistance too, and need to be made aware of this possibility. With insulin resistance and diabetes, prevention is always better than cure!

Dr Guin Van Niekerk is the author of “Why Fat Sticks : An Introduction to Insulin Resistance” For more information go to http://www.insulinresistancesite.com

Article by Arif Rahim

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If you have experience with feline diabetes you know how hard it can be to watch your furry family member suffer through weakness, vet appointments, diet changes and, possibly the most challenging of all, insulin injections. Knowledge of proper cat insulin injection techniques can make your life and your cat’s life easier. If you have any questions or concerns talk to your vet.

Prepare the Insulin

Start by filling the insulin syringe slightly more than your cat’s dose
Tap the insulin syringe to remove air bubbles
Slowly push the plunger until you have the correct dosage of insulin in the syringe

Prepare Your Cat

Create a routine to make your cat comfortable. At first he will likely try to get away, but eventually he should become familiar with the process, and you may even be able to train him to come when it is time for his insulin injection. Start by giving him lots of attention and affection, and maybe even a small treat. It is probably best to keep the insulin syringe out of your hands at first, so that he does not get scared. When you are ready to give your cat insulin, get on his level – don’t come at him from above or he will feel threatened. Now it is time to find the injection site.

Injection sites

The scruff (top of the neck) is the most commonly used injection site for insulin for cats, however it may not be the best. The amount of skin and muscle in this area can slow absorption of the insulin, and can be more painful for the cat.

Other options for injection are the flank (between the ribs and the legs), the side or underside of the belly, and the side of the chest. Absorption tends to be quickest when given in the side or underside of the belly.

Insulin Injection

Each cat is different, and the proper type, dose and frequency of insulin for cats need to be determined by a veterinarian. Once you know the proper insulin dosing and have determined the best place for injection, place your thumb and index finger approximately an inch apart and pinch the skin to create a “tent”. Make sure you are not grabbing any muscle.

The insulin injection should go into the hollow space under the “tent” of skin. It should not go into the skin itself, or into the muscle. If your cat is long-haired make sure that you can see the skin and that you are not giving him a “fur shot”.

When you are giving the insulin injection be confident, smooth and fast. It is the puncture part that hurts, so go quickly through that part; you can slow down a bit while you inject the fluid.

Above all, be gentle and kind when giving your cat insulin, especially at first, and praise him when it is all done.

Hypoglycemia can occur because of an imbalance between food intake and physical exercise and drugs that are used. The best treatment of hypoglycemia is to prevent the occurrence of hypoglycemia.

Causes of Hypoglycemia

You may have hypoglycemia if you use insulin injections or blood glucose-lowering drugs of the sulfonylurea group and do one or more of the following:

* Eating too little carbohydrate
* Late eating or not eating
* Physical exercise is too hard and too long than usual
* The dose of insulin is too much or drink too much diabetes medicine
* In case of illness
* Drinking alcohol on an empty stomach

Symptoms

1. In Light Hypoglycemia (blood glucose 50-60 mg / dL)
Symptoms of nausea, hunger, anxiety, a lot of sweat, wet skin, numbness in the fingertips and lips, trembling.

2. In Hypoglycemia moderate (blood glucose <50 mg / dL)
Will arise a feeling anxious, weak, angry, confused, difficulty thinking, blurred eyes, headache, difficulty speaking and drowsiness.

3. In severe hypoglycemia (blood glucose 70 mg / dL and the meal is still more than 1 hour, eat a snack that contains carbohydrates and proteins for example: 5 pieces of low-fat crackers with cheese.
b. When blood glucose is still <70 mg / dL immediately to the doctor / hospital to receive further treatment.

2. If you can not conduct its own examination of blood glucose:
i. Eat and drink something that contains at least 15 grams of carbohydrates.
ii. When the meal is still more than 1 hour longer, eat a snack that contains carbohydrates and proteins, for example, 2 pieces of bread and low fat cheese.
iii. You can get a 15gram carbohydrate intake by eating:

You can get a 15gram carbohydrate intake by eating:

* 4-5 dextrose tablets
* 2 tablespoons granulated sugar
* 3 pieces of crackers
* ½ cup fruit juice without sugar
* 3-4 pieces of candy (made from sugar)

If hypoglycemia occurs, discontinue temporarily the use of insulin or blood glucose-lowering drugs, then consult your doctor.

If you use insulin or glibenclamide medication needs to keep his eating schedule 15-30 minutes after injecting insulin or taking medication, if not yet had time to eat, look for a meal replacement or snack.

The elderly are more susceptible to hypoglycemia if they do not eat or when disturbed liver function and kidney.

In patients who use insulin injections, if blood glucose levels rather low and not doing physical activity, avoid injecting in the abdomen (stomach) due to more rapid absorption of insulin hypoglycemia so easily happen.

When sports

It is important for diabetesein to be able to check blood sugar levels independently. Blood glucose levels should be checked before and after exercise. When symptoms of hypoglycemia during exercise, stop the exercise and report physician or sports supervisor.

Travel far

Travel quite a long time to change the diet drugs or insulin injections and diet. This situation would facilitate the occurrence of hypoglycemia. To prevent this, you should check blood glucose and general health prior to travel. Also you should take medicines and snacks that contain carbohydrates such as biscuits and bread.