What is it?
Hyperglycemia often known as diabetes is a metabolic disorder that is characterized for the long term by high blood sugar levels. A hormone that regulates high blood sugar levels is insulin. Normally, insulin ensures that cells get enough sugar from the blood.
There are medicines that improve the sensitivity of the cells to the action of insulin. With an adapted lifestyle and medication, most people with type 2 diabetes can be helped, sometimes for life. There are also people in whom diabetes gradually worsens and the medication is no longer sufficient. Then insulin is needed.
Usually, type 2 diabetes starts with a diet and lifestyle changes. If that is not enough, the doctor will prescribe medication. If medication is no longer sufficient to control blood sugar levels, insulin injections will be started. Sometimes, when the blood sugar level drops sufficiently, it is possible to switch back to treatment with medication.
Read What is insulin resistance
When you have to undergo surgery or go through a serious illness (such as serious infection or a heart attack), your body needs more insulin. Even then it is sometimes necessary to temporarily add insulin to your treatment.
Insulin
There are different types of insulin depending on how they work. The fast-acting insulin works after 5 to 15 minutes, peaks after 1 hour, and then works for another 2 to 5 hours. The long-acting insulin peaks after about 2 hours and can last for up to 24 hours. There are also mixtures, which have both a fast and a slow and long-lasting effect.
How does it work?
Usually, you put one shot of long-acting insulin after dinner. The insulin you inject does the same job as the insulin that the pancreas normally produces. Administration takes place between 9 pm and 11 pm.
The number of units of insulin needed varies from person to person (8 to 200 units). Usually, you start by injecting 10 units of insulin in the evening. You can then raise the dose yourself, for example, every three days, in conjunction with your doctor.
Read Treatment for insulin resistance
A healthy diet and eating at fixed times remain important. If you already have a healthy diet, you don't have to adjust your eating habits when starting insulin.
You usually continue to go through the sugar-lowering medicines that you were already taking before starting insulin. If you are not allowed to take sugar-lowering medicines, for example, because you have poorly functioning kidneys, one injection in the evening with long-acting insulin is usually insufficient for good sugar control. A schedule with 2 injections of insulin is then a possibility. This is usually a mixture of fast-acting and long-acting insulin. The first injection is taken before breakfast and the second before dinner.
Administer insulin
Insulin is administered by subcutaneous injections using an insulin pen or an insulin pump. Correct use is extremely important.
The needle's length is determined by the patient's weight and the quantity of subcutaneous fat. The abdomen, alternating right and left, is the best place for injections. You can also inject in the upper arms and thighs, where it is recommended to switch to the symmetrical place, so from right to the left arm and from right to the left thigh, and not from arm to thigh or abdomen.
Pen needles are preferably used once. With multiple injections per day, pen needles can be used for a maximum of 24 hours, provided they are not visibly bone, dirty, and/or misshapen. Never use someone else's pen.
The skin must not be damaged. So do not spray into an abrasion, scar or place with eczema.
In addition, the injection site must be dry. However, it is not necessary to disinfect the skin or the filling.
Practical
- Mix the insulin well by gently tilting the pen 10 to 20 times.
- Vent the syringe before injecting the insulin. To do this, set 2 units of insulin and press the injection button of the pen until you see a drop appear at the tip of the needle. This also ensures that the needle is not clogged.
- Only then do you set the correct dose and make the injection.
- Do not withdraw the needle immediately, but wait 10 seconds.
- Do not massage the skin after the insulin injection.
Storage
- Unopened insulin packs can be stored in a cool place (between 2 and 8°C) until the expiry date.
- Once the cartridge has been inserted into an insulin pen, you can use it for another four weeks.
- To avoid temperature fluctuations, an insulin preparation that is in use is not kept in the refrigerator every time.
- All insulins must not be frozen. Do not put them in the refrigerator against the freezer compartment.
- When traveling by plane, but the insulin in your hand luggage. After all, the temperature in the cargo hold of aircraft drops below zero.
- Insulin should not get too hot either. Above 30° it starts to lose its effect. So make sure that the packaging is not exposed to the sun or use special cooling bags.
Why check your sugar level with a finger prick?
For a successful and safe treatment with insulin, you have to check the sugar level in your blood yourself via a finger prick. Usually, one measurement per day is sufficient. You measure your sugar level in the morning before breakfast. You also take extra measurements if you have complaints of a blood sugar level that is too low (hypoglycemia).
How to adjust your insulin dose?
Because the dose of insulin your body needs can fluctuate, your doctor or nurse will teach you how to adjust the dose of your evening insulin yourself. You base this on the sugar values that you measured with a finger prick. You may also have to adjust your insulin dose yourself according to your daily schedule. For example, if you go out to eat, you may need to inject a few more units of insulin.
If only your doctor adjusts the dose, you will not achieve good sugar control. Both you and your doctor can become frustrated because of this. Good sugar control is not achieved in one day, it usually takes 6 to 12 months before your sugar is perfectly regulated.
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