Understanding Basal And Bolus Insulin
Pumps are designed to operate similarly to the human pancreas, but it is still important to check your blood sugar while using a pump. Some pumps communicate directly with continuous glucose monitors or you can use a traditional glucose monitor with test-strips and finger pricks.
- Basal: The basal rate in your pump is programmed to be given through a gradual drip each hour. These relatively small, continuous doses of insulin manage your bodys background insulin needs. The human body needs insulin 24 hours a day in order to use the glucose in your bloodstream for fuel.
- Bolus: A bolus is a larger dose of insulin given for meals and to correct high blood sugars. Every time you eat or drink any calories, your body turns some of that meal into glucose that enters your bloodstream. The bolus of insulin helps your body use that glucose for fuel and store extra glucose in your muscles or as body fat.
It is important to understand the differences between MDI and pumps in order to optimize your personal treatment plan for diabetes.
Different Types Of Insulin Pens
There are two different types of insulin pens:
- Disposable pens contain prefilled insulin supply. Depending on the type of insulin they use, disposable pens are designed to be thrown away either when theyre empty or when the pen has been used for 2832 days.
- With reusable pens, you can dispose of an insulin cartridge the container that holds the insulin once its empty and replace it with a new one.
Note that, with regard to dosage, certain pens measure in half-unit increments for each dose, while others measure in whole units.
Individuals who use insulin pens must also select pen tip needles, which screw onto the top of the pen and are changed with each injection. When choosing pen tip needles for your insulin pen, the American Diabetes Association recommends that you consider both length and gauge , noting that shorter needles are more effective for all body types, and that needles with a higher gauge are typically thinner and less painful.
Be sure to consult your healthcare professional if you need more information about why you have been prescribed a specific type of insulin or pen, or if you need more information about pen tip needle choices.
How Does An Insulin Pump Work
The American Diabetes Association states that insulin pumps are small, computerized devices. They deliver insulin in a steady and continuous dose, or basal rate, which the user programs. They also deliver insulin as a surge dose, or bolus, under the users direction.
The insulin enters the body through a thin tube that attaches to a needle, which goes under the skin. People refer to the tube and needle together as an infusion set.
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When To Stop Oral Hypoglycaemic Agents
Sometimes patients develop frequent daytime hypoglycaemia on combined treatment. When this happens, the sulfonylurea dosage should be reduced or ceased if necessary. Apart from this and in the absence of contraindications , there is no good evidence that oral hypoglycaemic drugs must be stopped at any stage and our policy is to continue them while glycaemic control remains satisfactory. Most diabetes specialists would support the continuation of metformin indefinitely, because it increases insulin sensitivity. Others advocate stopping the sulfonylurea after insulin treatment is established, an attitude based more on philosophy than real need. Some patients may wish to reduce the number of tablets they take especially when they are already on multiple medications for blood pressure and lipid control. There is nothing wrong with reducing one or more of the oral hypoglycaemic drugs once they are established on insulin therapy, as long as it is recognised that the dose of insulin needs to go up, by an average of 20-30 units per day for each withdrawn drug, to maintain the same degree of glycaemic control.
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Effects On Oxidative Stress
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Metformin has antioxidant properties which are not fully characterized. It reduces reactive oxygen species by inhibiting mitochondrial respiration and decreases advanced glycosylation end product indirectly through reduction of hyperglycemia and directly through an insulin-dependent mechanism .
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What Type 2 Diabetes Medication Has The Least Side Effects
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How Should Insulin Therapy Be Intensified
The available options for additional insulin injections include a second injection of basal insulin, prandial insulin before one or more meals, or a switch to biphasic insulin. The choice between intensification of basal insulin versus the introduction of prandial or biphasic insulin should be individualized based on patients’ diurnal blood glucose profiles. When considering the profiles obtained with NPH insulin or long-acting insulin analog once daily, the effect appears to wane during the day, even in patients starting insulin therapy, i.e., with remaining endogenous insulin secretion . These patients could benefit from adding a second injection of basal insulin . However, in the context of declining endogenous insulin secretion, daytime hyperglycemia is usually related to elevated postprandial glucose levels, favoring the initiation of prandial or biphasic insulin.
Metformin Indications For Management Of Obesity Insulin Resistance And Non
Insulin resistance in obese children and adolescents should be appropriately and aggressively addressed once it is linked to known cardiovascular risks such as IGT, T2DM, dyslipidemia, and hypertension . Non-alcoholic fatty disease, a frequent cause of chronic liver disease in obese adults, is also associated with a higher risk of developing diabetes and of progression to fibrosis and cirrhosis with an increased relative risk of cardiovascular events or death . The true prevalence of NAFLD in children is underestimated. The prevalence of steatosis in obese children was estimated to be 38% in a large retrospective autopsy study .
Currently, the best supported therapy for NAFLD is gradual weight loss through exercise and nutritional support . Metformin is associated with short-term weight loss, improvement of insulin sensitivity, and decreased visceral fat . A reduction in ALT, GGT, and fatty liver incidence and severity has also been described with metformin use .
Metformin may not be as effective as behavioral interventions in reducing BMI and when compared with drugs that are licensed for obesity, its effects are moderate .
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Effects On Blood Pressure
The hypertension associated with diabetes has an unclear pathogenesis that may involve insulin resistance. Insulin resistance is related to hypertension in both diabetic and non-diabetic individuals and may contribute to hypertension by increasing sympathetic activity, peripheral vascular resistance, renal sodium retention , and vascular smooth muscle tone and proliferation .
Data of the effects of metformin on BP are variable, with neutral effects or small decreases in SBP and DBP . In the BIGPRO1 trial carried out in upper-body obese non-diabetic subjects with no cardiovascular diseases or contraindications to metformin, blood pressure decreased significantly more in the IFG/IGT subgroup treated with metformin compared to the placebo group .
New Oral Drugs Or Insulin
Traditionally metformin plus a sulfonylurea has been the mainstay of oral treatment. Patients understandably often want to know whether they should try adding a third drug or begin insulin. The addition of acarbose can usually only decrease the HbA1c by 0.5% at best, so one would only consider its use if a slight improvement in control is needed. Repaglinide and sulfonylureas should not be used in combination, as they are both insulin secretagogues. The response to therapy with a thiazolidinedione can be more profound with improvements in HbA1c of 1-2%.The decision whether to start insulin or to add a thiazolidinedione would depend on factors such as patient acceptance, coexisting conditions and access to medicines. At this stage it matters less which drug or ‘pathway’ is used, but more that the patient’s glycaemic target is reached.
Sometimes it is necessary to let patients try triple oral drug therapy. If nothing else, it serves to convince them that insulin is indeed necessary. In this situation, it is important not to delay insulin therapy for more than a few months. A trial of triple therapy for two months should be sufficient to assess whether it is likely to be effective or not.
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Why Is This Medication Prescribed
Human insulin is used to control blood sugar in people who have type 1 diabetes or in people who have type 2 diabetes that cannot be controlled with oral medications alone. Human insulin is in a class of medications called hormones. Human insulin is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar.
Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Using medication, making lifestyle changes , and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage , eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.
Risks Of Taking Insulin For Type 2
There are side effects that can occur when taking insulin for type 2:
- Lowers blood sugar too much
- Can cause discomfort of injections
- Weight gain is possible
- Risk of infection
If insulin isnt appropriate to treat your diabetes, your doctor might recommend other ways of treating your high blood sugar.
Alternatives to taking insulin can include:
- Eating a very low-carb diet
- Taking oral diabetes medications
- Undergoing weight loss surgery
If your doctor does tell you that you need to take insulin, dont think of it as a failure. It just means that you might need to take it in order to control your diabetes for a time. Know that by managing your diet and exercise you may be able to get your diabetes better under control and stop taking insulin.
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What Are The Different Types Of Insulin
The key to transitioning to insulin is knowing your options. Some people taking insulin need to use both a basal and a prandial insulin each day, while others may only need to use basal insulin. Learn about your options here.
Basal insulins are designed to be injected once or twice daily to provide a constant background level of insulin throughout the day. Basal insulins help keep blood sugars at a consistent level when you are not eating and through the night but cannot cover carbohydrates eaten for meals or snacks or glucose spikes after meals.
Some people use other medications, like GLP-1 agonists, to help cover mealtimes. GLP-1/basal combination treatments for people with type 2 diabetes combine basal insulin with GLP-1 agonist medication in one daily injection. This combination can effectively lower glucose levels while reducing weight gain and risk of hypoglycemia . Learn more here.
Prandial insulins are taken before mealtime and act quickly to cover carbohydrates eaten and bring down high sugar levels following meals. Ultra-rapid-acting prandial insulins can act even more rapidly in the body to bring down glucose levels. Rapid and ultra-rapid insulins are also taken to correct high glucose levels when they occur or are still persistent a few hours after a meal.