Let’s Talk About Insulin Pt. 2: Supplemental Insulin

An overview of the five types of supplemental insulin

In the previous post, I discussed the role of insulin and glucagon, as well as the two main types of insulin, basal and bolus. In this post, I will discuss supplemental insulin, how each type works and insulin brands.

There are more than 20 brands of supplemental insulin available in the United States. There are five types of brands: rapid acting, short acting, intermediate-acting, long-acting, and ultra long-acting. In addition to these categories, you can get premixed insulin or inhaled insulin as well.

Rapid-acting Insulin & Short-acting Insulin

To replace the natural bolus insulin produced by the pancreas, rapid-acting and short-acting insulins are used. These types of insulin are administered just before a meal or snack to counteract sugar spikes that are caused by eating.

In the medical world, short acting insulin is known as regular bolus insulin. Short-acting insulin begins to work within 30 minutes, reaches its peak between 2 and 3 hours, and lasts for 3 to 6 hours.

Examples of short-acting insulin:

Humulin R
Novolin R
Velsulin R

Rapid-acting insulin, however, works the fastest of all types of supplemental insulin. In the case of rapid-acting insulin, onset occurs after 15 minutes, peak within an hour, and then lasts 2-4 hours.

Examples of rapid-acting insulin:

Apidra (glulisine)
Admelog
Humalog (lispro)
Fiasp (insulin aspart)
Novolog (insulin aspart)

Intermediate-acting Insulin

Intermittent-acting insulin replaces basal insulin. Only one type of intermediate insulin exists, Hagedorn or NPH. Within 2-4 hours, the onset occurs. Peak hours are between 4 and 12 hours and the duration varies from 12 to 18 hours. As a result, some people use short-acting or rapid-acting insulin to cover meals.

Examples of intermediate-acting insulin:

Humulin N
Novolin N
ReliOn (NPH)

Long-acting Insulin & Ultra Long-acting Insulin

The long-acting and ultra-long-acting insulins are used to replace basal insulin by maintaining glucose levels throughout the day and night. They begin around four to six hours apart, but the duration is at least 24 hours. This type of insulin doesn’t have any peak points as it is designed to remain in the system for longer.

Examples of long-acting insulin:

Toujeo (glargine u-300)
Levemir (detemir)
Basaglar
Lantus (glarine)

Example of ultra long-acting insulin:

Tresiba (degludec)

Premixed Insulin

In a premixed insulin injection, varying amounts of intermediate-acting insulin are combined with short-acting or rapid acting insulin. Depending on the mix, onset can take between 15 minutes and an hour. It peaks at varying times and lasts for up to 24 hours.

Examples of premixed insulin:

Humulin 70/30, Novolin 70/30 and Humulin 50/50 are mixtures of intermediate and short acting insulin.

Humalog Mix 75/25 and Novolog Mix 70/30 are mixtures of intermediate and rapid-acting insulin.

Inhaled Insulin

As far as we know, Afrezza is the only rapid-acting insulin that is inhaled. As soon as Afrezza is inhaled, it begins to take effect within 12 to 15 minutes, peaks in around 30 minutes, and dissipates around 3 hours after taking it.

SOUND OFF: What type of insulin are you currently using? Let’s have a conversation and comment below!

Until Next Time,

The Genetic Diabetic

References:

American Diabetes Association: Insulin Basics

https://www.diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics

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Let’s Talk About Insulin

The role of insulin and the two basic types

You just returned from your follow up doctor’s appointment, and it didn’t go quite as well as expected. While you’ve followed the recommended diet, exercised, improved your sleep and implemented some stress management strategies, your A1C has increased. Your doctor is strongly considering adding insulin therapy to your treatment plan.

The stigma attached to injecting insulin has caused you to try very hard to avoid using it. However, it seems that there is no alternative for you.

Feelings of guilt and failure begin to creep in. As a result of the failure of your current treatment, you feel that you failed.

Taking insulin is not a sign of failure, my friend.

When insulin therapy is used properly, you can still live a long and healthy life. There is a good deal of planning, organizing and a lot of math skills required (no kidding!), but once you understand the role insulin plays in our bodies, you will discover that insulin therapy is a life-saving tool for managing diabetes.

The Role of Insulin

Insulin is a hormone that aids in lowering the level of glucose in the blood. In response to a rise in glucose level, such as when eating, this hormone is released into the bloodstream. In the body, glucose enters cells where it can be used for energy or stored to use later.

Any excess sugar is stored in the liver, muscles, and fat cells. In the cells, glucose reaches its normal level once it enters the cells.

The presence of low blood glucose stimulates the release of another hormone called glucagon by cells of the pancreas. Glucagon activates the liver to release the stored glucose known as glycogen from the liver into your bloodstream. Throughout the day, insulin and glucagon alternate their release in order to keep blood glucose levels stable.

A person with type 1 diabetes needs insulin therapy to replace the insulin that is not produced by the body.

The insulin therapy is sometimes necessary for people with type 2 diabetes or gestational diabetes when other treatments have not controlled blood glucose levels. Maintaining a target blood glucose level prevents complications.

Basal & Bolus

Insulin comes in two basic forms: basal and bolus.

Basal insulin is a long-acting type of insulin, also known as a “background”. Basal insulin boosts activity for about 24 hours at a time. High resting blood glucose levels can be brought down with basal insulin by providing a continuous supply of throughout the day. Basal insulin is usually taken once or twice a day to maintain consistent levels. By using basal insulin, glucose levels can remain steady even when individuals are not eating, allowing the cells to use energy more efficiently.

Bolus insulin is a more powerful, but shorter-lasting type of insulin. It is commonly taken before meals and during periods of higher blood sugar. Bolus insulin is taken at mealtimes to maintain a healthy level after eating. It is also known as “rapid-acting” insulin because it needs to work fast. Bolus insulin usually works around 15 minutes, peaks after an hour, and lasts for 2-4 hours. Bolus insulin is affected by the amount of food a person eats during a meal; therefore, it’s necessary that a person with diabetes knows how many carbohydrates they consume so that they can adjust how much insulin they need. Many people using bolus insulin use carb counting and carb-to-insulin ratios as tools.

Basal-bolus insulin therapy is an intensive insulin treatment that involves taking basal and bolus insulin simultaneously. This means that some people takes basal insulin once or twice a day and use bolus insulin at mealtime. In addition to insulin, people with type 2 diabetes may need to take oral, non-insulin medications.

Did you know that there are over 20 different types of insulin on the market in the United States? Tomorrow, I will share the five types of supplemental insulin and how each of them work.

Until Next Time,

The Genetic Diabetic

Pause and Rest

When it’s time to take a break from it all

Today, I’ve battled extreme exhaustion in the middle of the day. One minute, I was watching TV with my sons. The next minute, I’m having trouble keeping my eyes open while sitting on the bed. My sons’ caught me dozing off and they tried to keep me up.

Even though I did manage to stay up and not go to sleep, I’ve felt completely drained and it was hard for me to focus on any tasks. With my annual community event quickly approaching, starting my new positions, completing my children’s book while taking care of my household, I knew that I have a lot on my plate. I’ve felt like I had to do it all.

And my body realized it, too, and decided to give me a reality check in the form of sheer exhaustion and debilitating headaches. Instead of trying to meet my deadlines and complete the tasks that I’ve intended to accomplish, I’ve decided to complete what I could and then pause everything else and rest.

Recognize the signs that our bodies are telling us to slow down:

– Feeling frazzled and overwhelmed with all that you have to do.

– Feeling less motivated to complete your tasks.

– Being short-tempered, annoyed and irritable around others.

– Experiencing short-term memory issues. You’re forgetting appointments, tasks and events.

– Lacking sleep because you’re too focused on completing your tasks.

– Experiencing a change of dietary habits. You’re either skipping meals, not eating a lot, eating too much or eating less nutritious meals. This could also happen when you’re drinking more caffeinated drinks to stay focused or just not drinking any liquids at all.

– Experiencing headaches, muscle tension, skin issues due to stress and anxiety.

If you’re currently experiencing any of these symptoms, then your body is telling you to pause what you’re doing and rest.

As spoonies, it’s especially important that we listen to our body cues, because ignoring the signs will greatly affect our health. From a diabetic standpoint, we risk experiencing hyperglycemic episodes from being stressed, forgetting to take medicine or lack of sleep. We could also experience hypoglycemic episodes issues from skipping meals, not eating enough and feeling fatigued.

What does it mean to pause and rest?

You stop doing everything that you’re doing and rest. You’re taking a nap. You’re eating a nutritious meal. You’re spending time with family and friends. You’re taking a walk or going to the gym. You’re going on a vacation. You’re focusing on a hobby. You’re delegating tasks to others, whether it’s chores or work assignments. You’re giving up control and letting things be.

Then when you’re ready, return to your task with a sound mind and renewed focus.

Don’t wait until you’re exhausted to pause and rest. Listen for your body cues. When you notice the signs, act accordingly. Don’t ignore the signs. Pause and rest!

Until Next Time,

The Genetic Diabetic

To the Mom-to-Be Diagnosed with Gestational Diabetes

A heart to heart from a mom diagnosed with gestational diabetes

I see that you’ve just left your doctor’s appointment with the news that you’ve failed your glucose test and you’re now diagnosed with gestational diabetes and you’re understandably emotional.

Until this point, your pregnancy has been perfect- the classic textbook pregnancy. The baby has grown well. You haven’t experienced any unusual symptoms. You and your family are over the moon, excited about this new life forming inside you. Suddenly, you’re hit with this unexpected news.

As a result, major changes are about to occur. You’re now considered a high-risk pregnancy. Therefore, there’s a chance that you’ll lose your doctor because he/she doesn’t specialize in high-risk pregnancies. In addition, you will have to meet with a dietician because you will have to change your current diet to a diabetes-based diet. You might have to take medication like Metformin, Glyburide or Insulin in addition to diet. You now have to go to two appointments a week—a normal appointment and a weekly non-stress test (NST) and an ultrasound appointment up until delivery. In an instant, your pregnancy journey turned from peaceful to stressful and chaotic. You’re overwhelmed and scared for the baby.

You’re wondering, “How could this be? I’ve never had issues with diabetes.”

“I’ve been eating healthy and taking my prenatal vitamins. I’ve been following the doctor’s orders.”

You’re confused, angry and disappointed.

Take a deep breath.

Take another one.

I understand what you’re going through, because long ago this was me. I’ve been exactly where you are and how you’re feeling.

Know that this is not your fault. You did nothing to cause gestational diabetes. Our pregnancy causes our bodies to make more hormones, making our cells to use insulin less effectively, which is also known as insulin resistance. Some women might have insulin resistance before conceiving and with the extra hormones we make, this is a possible cause of gestational diabetes.

I know that this is hard to digest, but let me assure you that you’re going to be able to overcome this. In my experience, these tips helped me keep my blood sugar numbers normal while still making sure that my baby was still growing and healthy:

– Take prescribed medicine when directed

It’s vital to take any prescribed medicine as directed unless your doctor says otherwise. The medicine prescribed to you is usually temporary until delivery.

– Avoid ultra-processed and refined foods

Ultra-processed foods contain ingredients that cause inflammation and other issues, such as heart issues and high blood sugar numbers. Eat whole foods and limit the amount the starchy foods (white flour, rice, potatoes and corn) at each meal. Avoid sugary foods, drinks to prevent insulin resistance and high blood sugar numbers.

– Exercise

Try to incorporate a simple exercise routine like walking, swimming or water aerobics for healthy blood sugar and overall health.

– Get plenty of sleep

Make sure you get adequate sleep. Poor sleep is correlated to higher blood sugars. Snoring and sleep apnea are also possible signs of poor blood sugar control.

– Stay stress free

Protect your peace and mental health. Gestational diabetes can be a challenge to handle. Any additional stress will cause an increase in blood sugar. Therefore, only do what you can. Stay away from people and situations that cause you stress.

There’s one more thing that you must know and it’s probably the most important…

When your beautiful baby enters into the world, I know that a lot of your focus will be on your baby- and rightfully so. However, Mama, you have to prioritize your health, especially after delivery. It’s going to take awhile for your body to properly heal. It’s especially true when you have a high-risk condition like gestational diabetes.

Please follow up with your doctor after delivery.

I wish I could tell you that all cases of gestational diabetes would go away after delivery. For many, it does happen. However, there’s a small number of women who end up with diabetes postpartum. Sometimes it’s immediate, but for others it could take months or years. It’s very important to schedule your 6-12 week follow-up appointment to get screened for diabetes. If you’re tested negative, then continue to schedule a yearly A1c check every one to three years for the rest of your life. These tips will help build a solid foundation, turning them into a new lifestyle for yourself and your family.

Speaking of your family, you will also have to protect your growing child/children to make sure that they are taught healthy habits and nutrition so that their chances of being diagnosed with diabetes later in life are lowered.

I know that this is not something that you want to hear right now, but I would never forgive myself if I didn’t mention everything about my experience, because I am one of those women who’s now a full-blown diabetic five years postpartum. This is why I’m reaching out to you, even though I don’t know you. I want to see you and your family thrive. I want to see you and your family healthy. I don’t want anyone to go through what I went through during my pregnancies.

Unfortunately, gestational diabetes is not a one-and-done deal. It’s more like an alarm clock, a reminder from this day forward to take care of your health and the health of your family. I’ve learned this concept the hard way, but you have a chance to change the narrative, shift your thinking and battle this hurdle with grace, knowing that you have the tools you need.

Mama,

You are stronger than you realize.

You’ve made it this far.

Don’t lose faith now.

You can still have a healthy pregnancy.

You and your baby will make it.

You will get through this.

Until Next Time,

The Genetic Diabetic