Insulin Therapy
By Catherine Murphy, RN

Not every diabetic has to take insulin as part of his or her treatment plan. Those people who have been diagnosed with Type I Diabetes must take insulin each day because their body is not manufacturing the needed insulin necessary to live.

How does the doctor select the type of insulin you will need? Well, the selection process takes several things into account. They include information about your body such as weight, and build. The degree of physical activity you normally have and your usual daily food intake is also considered. In addition to your current state of health, both emotional and physical the doctor will need to look at other factors like what medications you may be taking. All of these factors will play a large part in determining the correct type of insulin for you.

Often people who require insulin must take two shots a day, and careful monitoring of blood sugar levels is important to ensuring the correct amount of insulin is administered. It is not unusual for people to require more than one type of insulin to control their blood levels.

There are various types of insulin available and just as many delivery options for the diabetic today. The doctor based on the different actions of each type and its duration carefully evaluates types and delivery methods. Because not everyone responds in the same way, it may be necessary to try several types of insulin before the right one you for is determined.

Types of Insulin

The different types of insulin are classified by how long they take to act. There is fast acting, slow acting prolonged duration or very slow acting and rapid acting or very fast acting.

Here is a list of the types of insulin commonly used:

  • Ultra Short-Acting Insulin: HUMALOG

  • Short-Acting Insulin: Regular (R) and Semilente (r) (S). These preparations start and stop working more quickly than other types of insulin.

  • Intermediate-Acting Insulin: NPH (N) and Lente(r) (L). These insulins take longer to start working and work longer than short-acting insulins.

  • Long-Acting Insulin: Ultralente(r) (U). This insulin starts acting slowly and last the longest.

  • Combination Insulins: 70/30 insulin contains 70 percent NPH and 30 percent Regular insulin, so the Regular begins working quickly, and the NPH takes over when the Regular is stopping. 50/50 insulin has equal parts of the two preparations.

When you are ready to give an injection it is important to select the right location for the shot. There are a wide variety of site on your body that you can use including your abdomen, thighs, buttocks, and upper arms. Some of these sites will get the insulin into your body faster than others, and this can affect your blood sugar. That is why it is important to talk with your doctor about which are the best sites for you to use. How fast your body absorbs the insulin is important because it helps to reliably predict the effect of each dose of insulin. It is best to keep a consistent site for each time of day and the type of insulin you are using. Here is a breakdown of the common sites and how the absorption time is for each site.

·        Thighs – Slow absorption

·        Upper Arms – Medium absorption

·        Abdomen – Fast absorption

·        Buttocks – Slow absorption

 It is a good idea to rotate the sites where you are injecting insulin. Rotating helps prevent the skin from toughening and affecting absorption. It is best to have a set plan for rotating the sites. You may find it easiest to always use only the abdomen and rotate sites within the area of the abdomen. If you think of the area of your abdomen as a clock, you could rotate from 1 o’clock to 11 o’clock, starting farthest out from the navel and moving progressively closer in toward the navel. If you want to include arms and thighs in the rotation, you should be sure to inject in the same area at the same time each day. For example, take your morning injection in the abdomen, your afternoon injection in the thigh or arm, and your evening injection in the buttocks. When rotating injection sites on a limb or the abdomen, make the first injection within the appropriate area and then separate subsequent injection sites by about a finger's width.

Always be sure to discuss any plan of care with your doctor, or health care manager. When you work together, you will be able to formulate a plan of care that works best for your individual needs.

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