There are several situations in which Insulin is prescribed for diabetics. This is mainly done when the blood glucose levels remain very high in spite of best efforts at diet, exercise and oral anti-diabetic medications. Insulin is also given during hospitalizations, around surgeries, myocardial infarction (heart attacks), and serious medical illnesses in the intensive care unit and during pregnancy.
Insulin is the only therapy for type 1 diabetics. Insulin is not a last resort medication and can be prescribed at any duration of diabetes. Indeed, there are some situations when the symptoms of high blood sugar such as excessive urination, weight loss, blurred vision may necessitate early initiation of insulin.
Insulin injections are self-administered through thin needles in disposable insulin pen devices. These are taken just underneath the skin form where it is absorbed into the bloodstream.
There are different types of insulins. The basal insulins are usually prescribed once daily at bedtime. These insulins have a relatively flat profile, meaning they are peakless, and therefore in the correctly prescribed doses have a lesser risk of having low blood sugars (hypoglycemia). These insulins are very good for control of blood glucose in fasting state and in between meals.
Another variety of Insulin is the rapid acting insulin. These have a fast onset of action, usually in a few minutes and peak in a couple of hours. Therefore they are taken just before or after a meal. They help to cancel the increases in blood glucose that happen due to meal intake. They are used to keep the after meal glucose under control.
Your physician may prescribed a basal insulin once daily or various combinations of basal and fast acting insulin, called the Basal –bolus regimen.
Pre-mixed insulins have fixed dose combination of fast acting insulins and intermediate acting insulins. These are usually prescribed twice daily.
When you are on insulin you must be educated on the symptoms of low blood sugar or hypoglycemia which include dizziness, fatigue, extreme hunger, sweating, palpitations and confusion. At such times you will have to take two spoons of sugar directly in mouth or in juice and reach a health care facility as soon as possible. Very rarely, you may experience skin allergies due to the injection.
Nevertheless, when prescribed in right doses and situation insulin helps in smooth blood glucose control.
Dr Sunil J Rao
Internal Medicine Specialist
Bahrain Specialist Hospital