Diabetes practices and regimens can vary between countries, hospitals / clinics, & specialists.  Therefore what may be encouraged in one setting may not be so recommended in another.  This insulin tutorial is not meant to provide a didactic (regimented / fixed) plan for using insulin.  Rather the tutorial intends to show some ways of doing things, and provide some explanations as to why things may be done in a certain way.  Furthermore it is hoped that this tutorial may encourage people to think a bit more about what insulin regimens are possible, & how they might be improved and / or tailored for an individual.  In all this remember that people's mileage may vary - so what works for one person may not be appropriate for someone else.  Therefore, as with all medical information on the Web, it is important that you consult your doctor or diabetes specialist before considering acting on any of the information discussed in this tutorial.


Insulin Tutorial 1-3
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A single daily injection of long-acting insulin


We have learnt that there are two main types of insulin:

Regular insulin & Long-acting insulin
Because of the differences in their duration of action, someone with diabetes can be treated either with 3 daily injections of regular insulin or 1 or 2 daily injections of long-acting insulin.

To give 3 daily injections of regular insulin is admittedly troublesome, but it is more physiological.

To give one daily injection of long-acting insulin is certainly less painful, but it has disadvantages. We shall try to explain these by using an example.

The term: physiological processes means the normal healthy functioning of the organs of the body (heart, liver, kidney, pancreas, etc.).



This chart shows a blood sugar curve and an insulin activity curve. It shows us what happens after a single injection of long-acting insulin given to someone with diabetes taking an ordinary diet divided into three main meals.

Look at the above diagram and read the description below.

Long-acting insulin alone: after meals - hyperglycaemia - before meals - hypoglycaemia

1. After giving an injection of long-acting insulin at 7 a.m. someone with diabetes has breakfast. As the long-acting insulin takes a long time to produce its effect, breakfast is followed by a steep rise in blood sugar.

2. Towards the end of the morning the long-acting insulin is working very strongly. There is some risk of a hypoglycaemic episode as the blood sugar is so low. Nevertheless, the urine still contains a lot of glucose, because of the marked rise in blood sugar earlier in the morning.

3. After lunch the blood sugar level rises steeply once more, but during the late afternoon it falls again to dangerously low levels, since the long-acting insulin is still producing its effect.

4. This means that the urine sample tested before the evening meal shows no sugar.

5. After the evening meal the blood sugar rises steeply again, as the effect of the long-acting insulin is wearing off. A urine sample tested before going to bed therefore contains a lot of sugar.

6. Because the patient has nothing to eat during the night, the blood sugar falls again. The fasting urine sample collected next morning therefore contains no sugar.

From this example it is clear that a single injection of long-acting insulin is highly unsatisfactory for controlling the rises in blood sugar after meals, and yet can produce very low blood sugar levels before meals and during the night.

How can we do better? There are two ways:



1.
Before each of the three main meals we can give regular insulin as a booster rate injection together with a small amount of long-acting insulin as a basal rate injection.

This mode of insulin treatment is termed intensive conventional insulin therapy.

However, for a person taking three main meals, this means four insulin injections a day.

Click here to simulate an example case using this mode of treatment



2. We can give two injections of long-acting insulin and by taking at least 6 or 7 meals a day we can adjust food intake to fit in with the effects of the long-acting insulin, with the aim of lessening the fluctuations in blood sugar.

This mode of insulin treatment is termed conventional insulin therapy.

This reduces the number of injections to two a day, but means that 6 or 7 meals have to be taken.

Click here to simulate an example case using this mode of treatment

Diabetes Insulin Tutorial
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The information presented at this site is for general use only and is not intended to provide personal medical advice or substitute for the advice of your doctor or diabetes specialist. If you have any questions about any of the information presented here, concerns about individual health matters or the management of your diabetes, please consult your doctor or diabetes specialist
The material in this on-line Diabetes / Insulin Tutorial has been drawn from a number of different sources.
However the original Web-based version can be found at the AIDA Website at: http://www.2aida.org/tutorial.

AIDA diabetes software simulator program of glucose-insulin interaction