How to get off insulin?

Insulin Shock: Warning Signs and Treatment Options

What is insulin shock?

After taking an insulin shot, a person with diabetes might on occasion forget to eat (or eat less than they normally do). If this happens, they may end up with too much insulin in their blood. This, in turn, can lead to hypoglycemia, also called low blood sugar.

A serious condition called insulin shock may occur if a person:

  • ignores mild hypoglycemia
  • takes too much insulin by mistake
  • misses a meal completely
  • does excessive unusual exercise without changing their carbohydrate intake

Insulin shock is a diabetic emergency. It involves symptoms that, if left untreated, can lead to diabetic coma, brain damage, and even death.

How insulin works

When we consume food or beverages that contain carbohydrates, the body converts them into glucose. Glucose is a type of sugar that fuels the body, giving it the energy it needs to perform everyday functions. Insulin is a hormone that works like a key. It opens the door in the body’s cells so they can absorb glucose and use it as fuel.

People with diabetes may lack enough insulin or have cells that aren’t able to use insulin as they should. If the cells of the body aren’t able to absorb the glucose properly, it causes excess glucose in blood. This is called high blood glucose, which is linked with a number of health issues. High blood glucose can cause eye and foot problems, heart disease, stroke, kidney problems, and nerve damage.

Insulin shots help people with diabetes use glucose more efficiently. Taking an insulin shot before eating helps the body absorb and use glucose from the food. The result is a more balanced and healthy blood sugar level. Usually, it works great. Sometimes, however, things go wrong.

What causes insulin shock?

Having too much insulin in your blood can lead to having too little glucose. If your blood sugar falls too low, your body no longer has enough fuel to carry out its regular functions. In insulin shock, your body becomes so starved for fuel that it begins to shut down.

If you have diabetes and use insulin to help control your blood sugar, you can end up with excess amounts in your blood if you inject too much insulin or miss a meal after injecting insulin. This can throw your system out of balance.

Other possible causes include:

  • not eating enough
  • exercising more than usual
  • drinking alcohol without eating any or enough food

How does insulin shock affect the body?

If your blood sugar drops a bit below normal, you may experience mild to moderate symptoms, including:

  • dizziness
  • shaking
  • sweating/clamminess
  • hunger
  • nervousness or anxiety
  • irritability
  • rapid pulse

At this stage, you can usually take immediate steps to recover. You might eat 15 grams of a quick-acting carbohydrate, such as some glucose tablets or high-sugar options like fruit juice, raisins, honey, or candy. The idea is to give insulin something to work with, which will help stabilize your blood sugar and reduce symptoms. After 15 minutes or so, test again. If your blood sugar has improved you’re likely on your way to a full recovery. You would want to then make sure to eat a small snack if your mealtime isn’t coming up soon.

If your blood sugar isn’t increasing, you would continue to treat again with 15 grams of carbohydrate until your blood sugar is up, and then be sure to eat a meal. If you blood sugar is not increasing after three treatments, contact your doctor or head to the emergency room.

If you’re experiencing insulin shock, you may have some of the above symptoms, but they will progress more quickly. Plummeting blood sugar can also cause:

  • headaches
  • confusion
  • fainting
  • poor coordination, tripping, and falling
  • muscle tremors
  • seizures
  • coma

Insulin shock can also happen in the middle of the night. In that case, the symptoms may include:

  • nightmares
  • crying out in your sleep
  • waking up confused or very irritable
  • very heavy sweating
  • aggressive behavior

Treating insulin shock

Mild to moderate hypoglycemia can normally be treated as described above. If you start experiencing the symptoms of severe hypoglycemia, however, it’s time for more aggressive treatments. If you or someone near you begins to experience insulin shock, take these steps:

  1. Call 911, particularly if the person is unconscious.
  2. Treat as outlined above unless the person is unconscious. Don’t give an unconscious person something to swallow as they may choke on it.
  3. Administer an injection of glucagon if the person is unconscious, if you have it. If you don’t have glucagon, emergency personnel will have some.

How to prevent insulin shock

Insulin shock is not a pleasant experience. But there are things you can do to prevent it from happening.

Follow these tips to reduce your risk of experiencing severe hypoglycemia and related problems:

  • Always keep glucose tablets with you or get in the habit of carrying hard candy for times when your blood sugar dips too low.
  • Always eat after taking your insulin shot.
  • Make sure you always ask your doctor how to use a new medication.
  • Eat a snack if your blood sugar is under 100 milligrams per deciliter before exercise or if you’re planning on doing more or more intense exercise than normal. Take a carbohydrate snack with you when exercising. Talk to your dietitian about the best things to eat before exercise.
  • Be cautious when drinking alcohol. Talk to your doctor about what’s best.
  • Be cautious after vigorous exercise, as it can lower blood sugar for hours after the workout.
  • Test your blood sugar often.
  • If you experience symptoms while driving, pull over immediately.
  • Inform family and friends of the symptoms of hypoglycemia so they can help you if you start experiencing it.
  • Ask your doctor for glucagon, since all people on insulin should always have glucagon available.
  • Wear a medical ID so emergency technicians can treat you quickly.

With the proper precautions, you can manage your diabetes and your insulin medications to keep your blood sugar levels steady.

Can You Ever Stop Insulin?

Q1. Once you begin using insulin to treat type 2 diabetes, can you ever get off it and go back to medications?

— Anne, Minnesota

For someone to go back to oral diabetes medicines after starting insulin, the pancreas must be able to produce enough insulin to maintain normal sugar levels. That being said, there are several instances in which insulin injections may be stopped. Here are a few:

1. In some individuals who have had untreated or poorly controlled diabetes for several weeks to months, glucose levels are high enough to be directly toxic to the pancreas. This means that the pancreas has not completely lost its ability to produce the critical level of insulin, but it does not work properly as a result of high glucose levels. In this instance, injected insulin can be used for several days or weeks to reduce glucose and help the pancreas to revert back to its usual level of functioning — a level that can control glucose supported by oral medicines. Once this occurs, insulin can be stopped. Remember, oral diabetes medicines work well only if the pancreas can still produce and release insulin.

2. Sometimes insulin is given during an acute illness such as an infection, when glucose levels can be high and the demand for insulin is greater than the pancreas can handle. After the illness is treated adequately, oral medicines can be started again.

3. Many obese individuals with diabetes who require insulin can reduce their dose or control their diabetes by taking oral medicines if they lose weight.

However, the choice of insulin to manage diabetes does not always come after exhausting all oral or non-insulin options. Insulin has several advantages and is now more frequently introduced early in the management of type 2 diabetes.

Q2. I have gestational diabetes. I am 34 weeks pregnant and I am on approximately 108 units of insulin per day. My OB has expressed concern that I am on very high doses and that I could “cap out” on insulin, meaning that I could reach the maximum dose possible. Is this true? I thought that there was no max as long as my sugar is being controlled.

— Karen, Massachusetts

Your doctor might be referring to the balance that you should have between good glucose control and low nighttime glucose levels. Having said this, higher than 140 units per day of total insulin dose is not usually necessary to achieve this balance.

I will first explain why insulin requirements increase during pregnancy. In normal pregnancy, there is a 50 percent decline in glucose metabolism due to the secretion of specific hormones from the placenta and the fetus. This translates into a higher insulin requirement, making the body produce 200 to 300 percent more insulin. The increase in fat cells, insulin resistance, and increased fat metabolism are all factors in the increase in insulin requirement. The insulin requirement is greater among diabetic women in general, and it is also larger in those whose glucose has not been well-controlled or who are obese, regardless of glucose control. Insulin dosage during pregnancy takes into account these factors as well as your weight, the amount of carbohydrates in your diet, and how much physical activity you are getting.

While it is true that you can take higher insulin doses, there is a downside to taking large amounts of insulin during pregnancy. During the long fasting state that occurs each night during sleep, the baby in the uterus will continue to require glucose, as does the mother, so higher insulin doses increases the risk of hypoglycemia (low sugar level) during sleep. Instead of continuously increasing insulin, working on your diet and physical activity to reduce your glucose is a safer alternative.

Q3. Is it okay to use two different insulin pens? My doctor has me taking Lantus Solostar at night and Humalog at every meal. The Lantus Solostar has a warning on the pen that says not to use with other insulins. What should I do?

— David, Texas

You should continue to take both types of insulin as recommended by your doctor — that is, injecting Lantus at night and Humalog before your meals. Using a Lantus-type basal insulin and a mealtime Humalog-type insulin is not only safe, it will give you the best control of high blood glucose. That’s because this regimen approximates the body’s natural pattern of insulin release from the pancreas.

The warning on the Lantus package insert is not to dilute or mix Lantus with any other insulin. Mixing Lantus insulin in the same pen or syringe might change the onset of the insulin’s action and result in erratic glucose control.

Q4. What can you tell me about the use of alpha-lipoic acid for type 2 diabetes? I’ve read that it has an effect on insulin resistance. Is that true?

— Carol, Michigan

In animal studies, alpha-lipoic acid (ALA) has been shown to reduce insulin resistance, which is the main mechanism for type 2 diabetes. But studies in humans have not confirmed that taking the oral form of ALA reduces or improves diabetes control.

However, there is limited evidence to suggest that ALA given intravenously enhances insulin sensitivity and reduces nerve damage due to diabetes. The rationale for its use is follows:

  • Having high blood sugar levels causes increased oxidative stress. This means that the body has a high concentration of free radicals — substances that can damage cells — and low capacity to clear these free radicals.
  • Oxidative stress, in turn, causes insulin resistance and neuropathy (nerve damage).
  • ALA is an antioxidant and helps eliminate free radicals, thus reducing insulin resistance and nerve damage.

Bottom line: ALA has not been approved for use in the United States. But it is an area of research interest, so stay tuned for further updates.

Q5. I take insulin and it’s very hard for me to lose weight. I’ve read that this can happen — that insulin can contribute to weight gain. What can I do? I try to watch what I eat and have recently joined a fitness club, but I haven’t had much success yet. Any advice?

Insulin can, in fact, lead to weight gain. Here’s how it works:

Insulin is a potent hormone that regulates glucose, fat, and protein metabolism. In many cases, people with type 2 diabetes start insulin therapy when oral medicines cannot or no longer control their glucose levels. This means that blood glucose levels in the body have been elevated for an extended period of time. In this state, the body does not metabolize glucose, fat, or protein in a well-regulated or efficient way. Cells that require glucose to function properly begin starving because of inadequate amounts of circulating insulin. Fat metabolism becomes abnormal, which can lead to high triglyceride levels. The body’s metabolic rate then increases as it tries to convert this fat into a source of energy.

These abnormalities are usually corrected when you begin insulin therapy. The body begins using glucose better, and the metabolic rate declines by about five percent. Insulin also helps the body gain fat-free mass, but on the flip side, it also helps it store fat more efficiently. Therefore, efficient glucose and fat metabolism and the reduction in metabolic rate cause most people to gain four to six pounds during the first two to three years of insulin therapy. Individuals who had poor glucose control, or who lost significant amounts of weight before beginning insulin treatment, usually experience the most weight gain.

Losing weight in general requires persistent attention to energy balance — that is, the number of calories you take in versus the number you burn. During insulin therapy, the body does not need as much food to get the energy it requires, so reducing your caloric intake is quite important. This should be accompanied by an exercise regimen, as you have begun, to expend at least 200 to 300 calories a day.

In addition, you should consult with your doctor to consider other kinds of diabetes treatments that could mitigate the weight gain. These include metformin, an oral medication that prevents weight gain; an insulin analogue called detemir, which has been shown to cause less weight gain than NPH insulin; and exenatide, an antidiabetes injection that can lead to weight loss.

Q6. I was diagnosed with type 2 diabetes in 1979. I take two pills twice a day, but I’m having a hard time controlling my blood sugar with medication and diet. Will I eventually have to take insulin shots?

— Donna, Ohio

Congratulations on having good control of your diabetes for almost three decades! This is remarkable, and you should be proud.

Diabetes is a progressive disease that eventually results in inadequate production of insulin by the pancreas. Medication has to be intensified periodically to overcome this progressive decline in insulin. Oral medicines are effective as long as the pancreas responds to therapy. However, when the underlying disease has affected a certain number of the pancreatic cells, oral medicines won’t work as well.

If adding a third oral long-acting agent or pre-meal oral medicines does not control your sugar level, you will need to take insulin. Many diabetes experts today are prescribing insulin even before exhausting all the oral medicine options. Insulin is the natural hormone the body absolutely needs to metabolize sugar and perform other anabolic tasks.

But don’t worry too much. Insulin has very few side effects, among them small amounts of weight gain and irritation at the injection site. Hypoglycemia (low blood sugar) can also occur if the insulin dose exceeds your body requirement or if you skip meals. If you are squeamish about needles, there are many options today that have made injecting insulin much easier, including insulin pens and thinner needles.

Q7. I’m so tired of all the monitoring and measuring — is there a pump on the market that checks your blood sugar and then gives you insulin according to need?

— Danna, Alabama

You’re not alone in your frustration. Many of my patients would passionately agree that monitoring glucose using meters is tedious and inconvenient. However, at present there isn’t a system that makes finger stick-based glucose measurements completely unnecessary. The good news is that in light of current advances, I am hopeful there will be such a device in the near future. In fact, in April 2006 the Food and Drug Administration approved a continuous glucose monitoring system (CGMS) that transmits glucose readings in real time to an insulin pump. This is the first in a series of developments toward a system that will lead not only to fewer finger sticks but also to better glucose control.

However, the currently available system has three major drawbacks.

  • First, individuals must ensure the accuracy of the CGMS using glucose values from their own finger-stick measurements. This calibration must be performed every 12 hours. In other words, the CGMS does not replace finger-stick measurements but does allow you to do them less frequently (if you were checking your glucose more than twice a day).
  • Second, any insulin dose adjustment must also be preceded by a finger-stick glucose check using a meter. This means that if the CGMS transmits a high glucose value, a finger-stick measurement has to confirm it before the right insulin dose is programmed into the pump.
  • Third, the insulin pump does not automatically adjust the insulin dose according to the transmitted glucose values. You must program the pump to inject a predetermined amount of insulin based on your current glucose reading.

Even with these drawbacks, many patients who meet the criteria for using an insulin pump report high satisfaction rates. So try to be patient: Within the next few months to two years, a closed-loop system that delivers insulin automatically as a response to your glucose reading — mimicking the action of the normal pancreas — will be brought to market. And you may well be a good candidate for it.

Learn more in the Everyday Health Diabetes Center.

Taking insulin for type 2 diabetes could expose patients to greater risk of health complications, study suggests

Examining the UK Clinical Practice Research Datalink (CPRD) ― data that characterises about 10% of the UK population ― a team of researchers from the University’s School of Medicine looked at the risk of death for patients taking insulin compared with other treatments designed to lower blood glucose levels in people with type 2 diabetes.

The team’s epidemiological study found people have greater risk of individual complications associated with diabetes such as heart attack, stroke, eye complications and renal disease when compared with patients treated with alternative glucose-lowering treatments.

“Insulin treatment remains the most longstanding blood-glucose-lowering therapies for people with type 2 diabetes, with its use growing markedly in recent years,” according to Professor Craig Currie from the School of Medicine, who led the research.

“However, with new diabetes therapies and treatments emerging there has been a new spotlight on treatments to ensure what the best and safest form of diabetes treatment is.

“By reviewing data from CPRD between 1999 and 2011 we’ve confirmed there are increased health risks for patients with type 2 diabetes who take insulin to manage their condition,” he added.

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The study adds to previous findings which identified potential health risks of insulin in this specific group of people.

Initial concerns were first raised regarding the use of insulin in type 2 diabetes from a population-based study in Canada, which reported a three-fold increase in mortality.

A similar study of people in UK primary care with type 2 diabetes treated with insulin also reported a 50% risk of increased mortality compared with another common treatment regimen.

Professor Currie adds: “Patients currently being treated with insulin should not, under any circumstances, stop taking their medications, and it is important to emphasise that this report related to only type 2 diabetes which typically starts in older people who are overweight.

“Each patient’s individual circumstances are different and treatment decisions are managed by their clinician with all of their medical history fully considered.

“The vast majority of people who take insulin will experience no adverse effects and it remains a reliable and common form of treatment worldwide but this study shows that we need to investigate this matter urgently and the drug regulatory authorities should take interest in this issue.

“Anyone who is concerned should speak to their GP first before taking any action on managing their condition.”

Diabetes Forecast

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Insulin is life—without it, the body can’t convert the food we eat into the energy that’s needed to survive. Type 1 diabetes targets for destruction the cells that make insulin, and so the disease absolutely requires that insulin be taken as a medication. The relationship between insulin and type 2 diabetes is more complicated. People with type 2 can make some of their own insulin, but it’s not enough to maintain normal blood glucose levels.

Type 2 diabetes can be treated with medication in several ways: encourage beta cells in the pancreas to make more insulin, help the body be more responsive to the insulin that’s there, or deliver more insulin by injection or pump. Without question, the last option is the right call for certain people with type 2 diabetes. Are you one of them? There are a lot of myths about insulin, leading some to view the medication with suspicion. It’s time to clear up what’s insulin fact, what’s fiction, and what’s not necessarily so.

1. Once you start, you can’t stop (FICTION)

Insulin has gotten a reputation for being an “end of the line” medication for type 2 that once started, can’t be stopped. “Patients ask if this is the rest of your life,” says Luigi Meneghini, MD, MBA, director of the Kosow Diabetes Treatment Center at the University of Miami Health System. Once glucose levels are controlled and lifestyle changes are in place, people may be able to use oral meds instead of insulin or reduce multiple daily injections to once daily.

2. Insulin means you failed at caring for your diabetes (FICTION)

In a large study that explored people’s beliefs about insulin, “some patients saw insulin use, or the need to start insulin, as a personal failure,” according to Andrew Karter, PhD, a researcher at Kaiser Permanente. It’s not. Type 2 diabetes is a progressive illness, which means that over time the body makes less and less insulin. Even people without diabetes produce less insulin as they age.

3. Insulin causes diabetes complications (FICTION)

While it may be true that people with type 2 diabetes who use insulin tend to have more diabetes-related complications—such as heart, eye, and kidney disease—this is a good example of an association that has nothing to do with cause and effect. The link exists, says Karter, because insulin users have had diabetes longer on average than those who take other medications. Having diabetes for a long time, even when it is controlled, makes some types of complications more likely. Plus, doctors may tend to prescribe insulin for people who are having trouble getting blood glucose under control. Uncontrolled blood glucose levels can raise the risk for complications. Insulin helps bring blood glucose to target, which can prevent complications, not cause them.

4. Insulin is only for people who’ve had diabetes a long time (FICTION)

Sometimes insulin is the right choice for a person newly diagnosed with type 2 diabetes, says Meneghini, particularly if blood glucose levels are very high at diagnosis. “There are studies that show an intensive insulin approach for six months or a year tends to be more successful at preserving than oral medications,” he says. After blood glucose levels are under control, he adds, it may be possible to reduce or stop insulin and use another type of diabetes medication.

5. Oral medications are safer (NOT NECESSARILY)

It’s true that too much insulin can cause blood sugar to go too low (hypoglycemia), but it is otherwise quite safe and has no adverse effects on the heart, kidneys, pancreas, or liver, as do some other diabetes medications. “Insulin can be thought of as a clean medicine,” says Meneghini. That’s good news for people with liver or kidney problems, who may not be able to take diabetes medications that are processed through these organs.

6. Injections hurt (NOT NECESSARILY)

Insulin has to make its way under the skin to work, and for that you need a needle. Some people may experience discomfort when injecting insulin. However, today’s insulin needles are short and very thin—about the same thickness as three hairs laid side by side—making injections less painful than they once were. To help put his patients with new insulin prescriptions at ease, Meneghini injects himself with an insulin syringe containing saline a few times in the office before his patients leave. “They either think I’m completely crazy or that it doesn’t hurt so much,” he says. If concerns about pain are keeping you from trying insulin, talk to your doctor about testing a needle during a visit. You may be pleasantly surprised.

7. Insulin will lead to weight gain (NOT NECESSARILY)

Insulin helps the body absorb the calories from the foods you eat, so weight gain is a risk. When starting insulin, you can take steps to avoid packing on pounds. The obvious strategy is to eat less and exercise more. Yet there are other approaches to preventing weight gain. For example, “there is evidence that if you take insulin with metformin, then there is less weight gain,” says John Buse, MD, PhD, of the University of North Carolina–Chapel Hill School of Medicine. Some studies have also shown that using an injectable incretin mimetic, such as exenatide (Byetta) or liraglutide (Victoza), and insulin may also prevent weight gain.

8. Insulin can cause hypoglycemia (FACT)

The occasional low may be hard to avoid when taking insulin, but people with type 2 diabetes who take only long-acting insulin are less likely to have hypoglycemia than those taking multiple daily shots of mealtime insulin. “That first episode may be scary,” says Meneghini, but he tries to get patients to come around to the idea that the unpleasant symptoms are actually a good thing. “That’s your body telling you that your blood glucose is too low and you need to eat something,” he says. Before you start a new exercise routine or change your eating plan or if you experience lows, talk to your doctor about a dose adjustment.

9. Taking insulin is hard (NOT NECESSARILY)

You may associate insulin with testing blood glucose, carbohydrate counting, and other tasks. Some insulin users do benefit from these activities, but not everyone will need to do the extra work. For example, most people with type 2 diabetes who take insulin use a fixed dose of long-acting insulin, so they may not need to count carbohydrate grams, which is a strategy for adjusting mealtime insulin doses. Whether blood glucose testing is needed is more complicated. The jury is still out on who benefits from blood glucose monitoring, says Meneghini, though he encourages self-checks by people changing or adjusting medications, food, or exercise. Blood glucose measurements tend to be useless, however, without instructions on how to use the information, he says: “The frequency of testing and when you test are dependent on what you are going to do with that result.”

Types of Insulin

The body makes just one type of insulin, but scientists have developed a variety of insulins that can be taken as medication. The goal with insulin given as medication is to mimic how the body adjusts insulin levels automatically. In the absence of diabetes, the body produces low, steady insulin levels between meals and produces rapid, high peaks of insulin at meals to “match” how much food is eaten.

Long-acting insulin

begins to work several hours after injection and lowers blood glucose levels somewhat evenly over a 24-hour period.
Types: Insulin detemir (Levemir) and insulin glargine (Lantus)

Rapid-acting insulin

begins to work 15 minutes after injection, peaks in one hour, and is effective for two to four hours. It’s used in insulin pumps and for mealtime injections.
Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog)
Other insulins
include regular or short-acting insulin (Humulin R, Novolin R); intermediate-acting insulin, or NPH (Humulin N, Novolin N); and premixed insulins, which combine fast-acting and longer-acting insulin.

Human Insulin Injection

Human insulin comes as a solution (liquid) and a suspension (liquid with particles that will settle on standing). to be injected subcutaneously (under the skin). Human insulin is usually injected subcutaneously several times a day, and more than one type of insulin may be needed. Your doctor will tell you which type(s) of insulin to use, how much insulin to use, and how often to inject insulin. Follow these directions carefully. Do not use more or less insulin or use it more often than prescribed by your doctor.

Human insulin (Myxredlin, Humulin R U-100, Novolin R) solution may also be injected intravenously (into a vein) by a doctor or nurse in a healthcare setting. A doctor or nurse will carefully monitor you for side effects.

Human insulin controls high blood sugar but does not cure diabetes. Continue to use human insulin even if you feel well. Do not stop using insulin without talking to your doctor. Do not switch to another brand or type of insulin or change the dose of any type of insulin you use without talking to your doctor.

Human insulin comes in vials, prefilled disposable dosing devices, and cartridges. The cartridges are designed to be placed in dosing pens. Be sure you know what type of container your insulin comes in and what other supplies, such as needles, syringes, or pens, you will need to inject your medication. Make sure that the name and letter on your insulin are exactly what your doctor prescribed.

If your human insulin comes in vials, you will need to use syringes to inject your dose. Be sure that you know whether your human insulin is U-100 or U-500 and always use a syringe marked for that type of insulin. Always use the same brand and model of needle and syringe. Ask your doctor or pharmacist if you have questions about the type of syringe you should use. Carefully read the manufacturer’s instructions to learn how to draw insulin into a syringe and inject your dose. Ask your doctor or pharmacist if you have questions about how to inject your dose.

If your human insulin comes in cartridges, you may need to buy an insulin pen separately. Talk to your doctor or pharmacist about the type of pen you should use. Carefully read the instructions that come with your pen, and ask your doctor or pharmacist to show you how to use it.

If your human insulin comes in a disposable dosing device, read the instructions that come with the device carefully. Ask your doctor or pharmacist to show you how to use the device.

Never reuse needles or syringes and never share needles, syringes, cartridges, or pens. If you are using an insulin pen, always remove the needle right after you inject your dose. Dispose of needles and syringes in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.

Your doctor may tell you to mix two types of insulin in the same syringe. Your doctor will tell you exactly how to draw both types of insulin into the syringe. Follow these directions carefully. Always draw the same type of insulin into the syringe first, and always use the same brand of needles. Never mix more than one type of insulin in a syringe unless you are told to do so by your doctor.

Always look at your human insulin before you inject. If you are using a regular human insulin (Humulin R, Novolin R), the insulin should be as clear, colorless, and fluid as water. Do not use this type of insulin if it appears cloudy, thickened, or colored, or if it has solid particles. If you are using an NPH human insulin (Humulin N, Novolin N) or a premixed insulin that contains NPH (Humulin 70/30, Novolin 70/30), the insulin should appear cloudy or milky after you mix it. Do not use these types of insulin if there are clumps in the liquid or if there are solid white particles sticking to the bottom or walls of the bottle. Do not use any type of insulin after the expiration date printed on the bottle has passed.

Some types of human insulin must be shaken or rotated to mix before use. Ask your doctor or pharmacist if the type of insulin you are using should be mixed and how you should mix it if necessary.

Talk to your doctor or pharmacist about where on your body you should inject human insulin. You can inject your human insulin in the stomach , upper arm, upper leg, or buttocks. Do not inject human insulin into muscles, scars, or moles. Use a different site for each injection, at least 1/2 inch (1.25 centimeters) away from the previous injection site but in the same general area (for example, the thigh). Use all available sites in the same general area before switching to a different area (for example, the upper arm).

Regular exercise got me off insulin

When 64-year-old Eddie was told three years ago by his GP that if he didn’t stop smoking he risked amputation, he went home and had a think.

Diabetes doesn’t stop you working out

I’d had a series of mini strokes and problems with walking turned out to be peripheral vascular disease. I had smoked all my life. Some time earlier, I was showing all the symptoms of Type 2 diabetes, but I did not know I had developed the condition at that point.

I gave up smoking and then I went back to my GP and said ‘I know what I can’t do, but what can I do?’

I was offered a gym membership free for three months. At first it was hard but then I loved it. It was a case of lie on the couch all day or do something. I chose to do something.

My brother who is Type 1 did not believe I was off insulin as he thought once on it you were on it for life and to tell the truth so did I.

I had been checking my blood sugars once a week and handing them in to my GP and everything was fine. I was then told I did not need to do this anymore.

Everything was fine for about a year then I was taken ill with some sort of virus. After this cleared I went back to the gym as normal.

Then one Friday I was at the gym, but everything seemed more difficult than usual and one of the staff commented that I looked grey and my wife also commented on this. I went straight to the GP who took some bloods. I got a call about 5pm the doctor said he had handed in a new prescription for me to collect on the next day (Saturday).

By now I was terribly thirsty and was drinking anything I could get my hands including sugary juice – coca cola and lemonade – which I knew I should not do, but did not by this time care. I was so thirsty I didn’t want to swallow. I just wanted to pour it down my throat also at the same time. I lost my voice, my penis had become swollen and cracked and it was painful to pee. (I later found out I had thrush).

However, my GP phoned me at 4:30pm on the Saturday morning saying he had been awake all night and could I go to A&E and he would phone and tell them I was coming down.

At the hospital, when the blood test came back from the lab I had a blood sugar reading of 66. At this point i was admitted and put on an insulin drip and another drip because I was dehydrated. The staff commented they thought I should be in a coma. However after three days I was released and started insulin injections twice a day.

Coming off insulin

As I gradually got better I returned to the gym and resumed my exercises. About a year later I was taken off insulin and reduced the metformin tablets from four a day to one.

My brother who is Type 1 did not believe I was off insulin as he thought once on it you were on it for life and to tell the truth so did I.

The diabetic clinic are over the moon with my progress. I now inject lixisenatide once a day which I’ve been on for about a year and I’m feeling great. I don’t worry too much about what I eat as I am doing regular gym session, sometimes five days a week. I don’t take sugar in my tea or coffee and am not a big sweets/cakes/crisps eater, nor do I like sugary drinks, but the hospital have told me I am doing great due to the regular exercise.

I’ve had high blood pressure for years, but at my last reading about two weeks ago, it was 117 over 73 (normal range).

I can’t run and have trouble walking due to vascular disease, but at the gym there’s plenty of variation in my exercise programme. The gym staff will help you.

I want to let people know you can help yourself and it’s not impossible or expensive to do.

Type 2 Diabetes

What causes type 2 diabetes?

The exact cause of type 2 diabetes is unknown. However, there does appear to be a genetic factor that causes it to run in families.

Type 2 diabetes may be prevented or delayed if you eliminate or reduce risk factors, particularly by losing weight and increasing exercise.

Type 2 diabetes risk factors

Risk factors for type 2 diabetes include:

  • Age – People age 45 or older are at higher risk for diabetes.
  • Family history of diabetes
  • Being overweight
  • Not exercising regularly
  • Race and ethnicity – Being a member of certain racial and ethnic groups increases the risk for type 2 diabetes. African-Americans, Hispanic Americans and American Indians are more prone to develop type 2 diabetes than white Americans.
  • History of gestational diabetes or giving birth to a baby who weighed more than 9 pounds
  • A low level HDL (high-density lipoprotein – the “good cholesterol”)
  • A high triglyceride level

Type 2 diabetes symptoms

Type 2 diabetes primarily occurs in middle age or later, but it can appear at any age. Most of the time patients do not know they have type 2 diabetes and it is diagnosed only by a blood test. Signs and symptoms of very high blood sugar levels include:

  • Frequent urination
  • Excessive thirst
  • Fatigue
  • Blurred vision
  • Weight loss
  • Tingling or loss of feeling in the hands and feet (peripheral neuropathy)
  • Sores that don’t heal well

Often, type 2 diabetes can be controlled through losing weight, improved nutrition and exercise alone. However, in some cases, these measures are not enough and either oral or injected medications and/or insulin must be used.

Dr. Roach: What can be done to get off insulin injections?

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Dear Dr. Roach: My doctor placed me on insulin for diabetes because I wasn’t able to bring my glucose below 100. The bloodwork results are now 120 glucose and 6.6 hemoglobin A1C. I’ve been averaging 6.5 hemoglobin A1C for two years. I’ve been taking glucose readings three times a day, with results between 108 and 147 mg/dl. My blood pressure reads 117/61, and my heart rate averages 55. All my bloodwork is in normal limits. I’m 65 years old and wonder if taking the insulin is needed at this time. I still work, and I’m very active for my age. I take 15 units of insulin injections at night before bed. I also take XIGDUO XR 10 mg/1,000 mg in the morning after breakfast. The other medication I take is 10 mg of simvastatin before bedtime for my cholesterol, which is within the limit when I do my bloodwork. What can I do to get off the insulin?

S.R.

Dear S.R.: I understand why people want to stop taking insulin. Many people do not like giving themselves an injection every day. However, it is hard to argue with the success you have had on your current regimen. Your blood sugars, confirmed by your A1C, are in the near-normal range, and your results are very close to what most experts would recommend.

Another consideration is the insulin you take keeps your own pancreas from having to make insulin. This might help your long-term ability to regulate blood sugar. Your insulin is a long-acting form of human insulin, the most natural way of replacing insulin your body can’t make enough of. You also take a potent mix of oral medicines to help the insulin work better.

I spoke with one expert, who said she would consider looking at your body’s ability to make insulin (through a blood test called a C-peptide level). If that level were low, it would be unlikely that you would have success going off insulin.

If you still feel strongly about trying to get off insulin, talk to the doctor managing your diabetes about trying to slowly taper off insulin, going down one or two units a day every week or so. Don’t try this without talking with your doctor; he or she would need to monitor your sugars carefully during the process.

Dear Dr. Roach: I was diagnosed three months ago with osteoarthritis in my knees, including an itchy rash on my right thigh, which is dormant for some hours during the day; other times, it is almost unbearable. I have started some over-the-counter supplements, including boswellia and turmeric, with good results for the knee pain. But the rash concerns me.

C.P.

Dear C.P.: Osteoarthritis and rash normally don’t go together. There can be several types of skin changes in a different condition, rheumatoid arthritis, which generally don’t affect the knees as much as the hands and wrists. So, I suspect that the joint and skin problems are separate issues.

This time of year, when I hear about itchy rashes, I look for dry skin changes such as eczema. I often tell people to start with some moisturizers, especially applied after bathing. If symptoms continue and I cannot make a diagnosis by exam, I will refer to a dermatologist.

I’m glad you’re having a good response to the supplements. Boswellia and turmeric show evidence they may benefit people with osteoarthritis, and have a generally favorable side effect profile.

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What Happens If I Forget?

Life is busy. No matter how good you usually are at managing your diabetes, there may be times when you may forget to take your insulin. While it may not cause an immediate emergency in most cases, it can cause your blood sugar to increase, especially if you forget often. You should talk with your diabetes care team about what to do if you forget a dose, so you have a plan in place.

When your blood sugar is too high, you may notice some of the following signs and symptoms:

  • Feeling hungry
  • Feeling very thirsty
  • Feeling tired or exhausted
  • Frequent urination
  • Blurred vision

What will happen if I stop taking insulin?

Some days you may feel like you want to skip injections, but you should be aware that skipping insulin can cause serious problems.

Without enough insulin, your blood sugar will increase. High blood sugar (hyperglycemia) can make you feel unwell and can lead to emergencies such as diabetic ketoacidosis (DKA)—a condition where your body is producing an unsafe level of ketones. Ketones are natural substances that are created when fat is being used for energy instead of sugar (since people with diabetes don’t make enough insulin on their own to properly process blood sugar), but too many ketones in your blood can cause unsafe changes in blood chemistry. Skipping insulin can also lead to other issues, like infections and increased risk for long-term health problems.

Lowering the risk of long-term problems

If blood sugar is consistently higher than it should be, it may increase the risk of some diabetes-related problems. That’s why it’s so important to keep your blood sugar at the levels recommended by your health care provider—to help to reduce the risk of these problems.

Your health care providers will look out for signs of these problems during your routine checkups. The tests they perform, such as urine and blood tests, and eye and foot examinations, can give important early warning signs of problems at a stage when they can be treated before they cause major damage.

Taking control of diabetes

It is important to learn how to manage your diabetes and how to balance your food intake, insulin doses, and physical activity. Maintaining good blood sugar control can help reduce the risk of some long-term problems.

Dear Nadia,

I have type 2 diabetes and am overweight. I want to get off my insulin and have decided to fast to lose weight and stop taking my insulin. I bought a cleanse and diet package. I do not want to go to my Doctor because I am scared he will talk me out of it.
Shauna

Dear Shauna:

As a person living with Type 2 diabetes, you certainly can get your blood sugar levels to where you can go off your medication. I cannot emphasize enough, why you must work with a healthcare professional without sharing my personal loss with you.

In 2000, my mother, a type 2 for 13 years with an A1c of 10, passed away from diabetes complications. My Aunt Grace, not a blood relative, a close family member who was at my birth, attended my mother’s memorial. In my grief, I sat next to my Aunt Grace for comfort at my mom’s wake. I could see my Aunt was not feeling well. I asked her about her diabetes and if she had tested her blood sugar. She confessed that she did not have her blood glucose meter with her. My former husband, a type 1 for 45 years with no complications, tested her blood sugar. Her reading was over 600 mg/dl. Grieving the loss of my mother, I did not want to lose my Aunt Grace as I did my mother. I told her she needed to follow her healthcare professionals training on how to take insulin to bring her blood sugar down. She decided to inject injected 12 units of Novolog and waited an hour before taking her blood sugar reading the second time. To our surprise, one hour later, her blood sugar reading was still 600 mg/dl after taking 12 units of Novolog. She decided to inject another 12 units of NovoLog. Shortly after her second insulin injection, she left my mother’s memorial.

In my grief, I neglected to check up on her. I do remember saying Aunt Grace, please speak to your healthcare professional to help you bring your blood sugar is in the normal range.

Four months later, my best friend called me in tears, two days before her birthday to inform me that her mother, my Aunt Grace, passed away. She asked me to come to her mother’s house immediately. I asked my life long friend “what had happened?” She said that her mother decided to go off of her insulin by going on a fast. She did not discuss this with her physician in fear that her Western medical Kaiser Doctor would discourage her from an alternative way of managing her diabetes. As brilliant as my Aunt Grace was, she missed a crucial fact. Going off of insulin requires a gradual life style change. It does not happen over night. Especially, if you are taking insulin.

People that are diagnosed with type 2 diabetes are usually prescribed metformin. Once metformin losses its effectiveness in maintaining normal blood sugars, physicians will prescribe insulin.

Going off of insulin requires a lifestyle change. Working with your healthcare physician, you can start lowering your insulin requirements to the completely going off of insulin. Don’t do this alone. Nothing is more gratifying for a healthcare professional than seeing their patients achieve better blood sugar control. Know that your healthcare professional is invested as you are in helping you achieve better diabetes outcomes.

Nadia

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

AskNadia and receive her unique perspective on your question.

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About Nadia:

Nadia is a diabetes advocate that was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

Nadia has received 14 nominations for her work as a diabetes advocate.
 She has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.

Body can regain the ability to produce insulin

University of Oslo

The University of Oslo is Norway’s leading institution of research and higher education.

Type 1 diabetes is a serious disease that affects many children and adolescents. The disease causes the pancreas to stop producing insulin, a hormone that regulates blood sugar levels.

When blood sugar levels are too high, the smallest blood vessels in the body eventually become damaged. This can lead to serious health problems further down the line, including heart attacks, stroke, blindness, kidney failure and foot amputations.

Professor Knut Dahl-Jørgensen and doctoral student Lars Krogvold are leading a research project, (DiViD), in which they want to ascertain among other things whether a virus in the pancreas might cause type 1 diabetes.

They have previously discovered viruses in hormone-producing cells, the so-called islets of Langerhans, in the pancreas. Now their research has generated some new and surprising results.

Recover the ability to produce insulin

Lars Krogvold, doctoral student at the University of Oslo and paediatrician at Oslo University Hospital. (Photo:Oskar Skog, Uppsala Universitet)

Lars Krogvold explains:

“We found that the insulin-producing cells still have the ability to produce insulin when they are stimulated in the lab. But what’s new is our additional discovery that the cells increased their ability to produce insulin after a few days outside the body. Indeed, some became roughly as good at making insulin as cells from people without diabetes,” he says.

Some of the hormone-producing cells in the pancreas, the beta cells, produce insulin when they are stimulated by sugar.

“Previous work has shown that you do not immediately lose your ability to produce insulin when you are first diagnosed with type 1 diabetes,” he says.

Can improve patients’ daily lives

“Our findings might mean that insulin production can be partially restored if we can find a way of stopping the disease process. The potential for insulin production is greater than previously thought,” says Krogvold.

“The risk of developing health problems later on is lower for those who manage to maintain a certain level of insulin production. Less supplementary insulin means that you will be better off as a patient”.

Stimulated by sugar

The aim of the study was to determine whether beta cells still have the ability to produce insulin after the patient has been diagnosed. The researchers bathed the cells in a solution through which sugar was passed. They then measured the insulin content of this solution.

“The really exciting thing here is that insulin production increases when the cells are removed from the body and placed in an environment that is not diabetes-inducing. That your cells produce a little insulin the day after you have been diagnosed with diabetes is not unusual.”

“What surprised us was that the cells increased their ability to produce insulin over time and that after a few days the level was approaching normal”, says Krogvold.

RNA sequencing

In the study the researchers collected tissue samples from the pancreases of living patients shortly after they had been diagnosed.

A technique called RNA sequencing was performed on cells from six living and two deceased donors. Sequencing is a way of mapping genes. The results were compared with cells from three healthy donors.

“A complete set of DNA is present inside all cells. DNA consists of a long series of genes, and those genes that the cell needs to use in a given process are read off to form an opposite strand called RNA. RNA can act as a recipe for proteins”.

This is a complicated process. When the cell realises that it needs to make a protein, structures called ribosomes read off the RNA. All of the necessary amino acids are then assembled to make a new protein, following the recipe contained within the RNA. Ribosomes are a complex of molecules and proteins that are found inside all cell types, and it is here that protein assembly occurs.

“RNA for all the genes involved in insulin production was found in the tissue samples. We interpret this as meaning that the cellular machinery for producing insulin is still intact. This was confirmed when we saw that the beta cells produced insulin”, says Krogvold.

Read the Norwegian version of this article at forskning.no

Scientific links
  • Lars Krogvold et al: “Function of isolated pancreatic islets from patients at onset of type 1 diabetes; Insulin secretion can be restored after some days in a non-diabetogenic environment in vitro. Results from the DiViD study”, Diabetes, 2015.
  • Lars Krogvold’s profile
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