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Insulin and diabetes management

Insulin and diabetes management

Cobry E, McFann K, Messer L, Insulin and diabetes management manageement. Insulin is a hormone Insuiln by the pancreas to help the body use and store glucose sugar. This is called insulin resistance. Griffith, MD — By Jessica DiGiacinto and Valencia Higuera — Updated on April 20,

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Your Inssulin care provider can work with you to determine what your goal should be. The frequency of testing and blood sugar goals can change over time, so it's important to see your health care provider regularly.

See 'How often to see your provider' below. Blood sugar control can also be measured with a blood test called A1C, also called HbA1c.

The A1C blood test is an indicator of your average blood sugar level over the past two to three months. Knowing your average level can be useful as blood sugar levels can fluctuate throughout the day depending on your diet and activity level. The A1C test involves having a blood sample taken either from a vein or through a finger prick in a doctor's office for testing.

However, different people have different goals for their A1C level. For example, people who are older or have several other medical conditions might have a slightly higher goal. Your health care provider will work with you to understand your A1C goal.

The A1C measures the amount of blood sugar that is stuck to hemoglobin, a molecule in red blood cells. Sometimes, the A1C cannot accurately measure average blood sugar; this can be due to conditions that affect red blood cells or normal variations in how long the red blood cells last in the body.

If your health care provider suspects that your A1C results are inaccurate, they may use other methods to measure your blood sugar level.

How often to see your provider — Most people with type 2 diabetes meet with their health care provider every three to four months. At these visits, you will discuss your blood sugar and other care goals and how you are managing your diabetes, including your medications.

This allows you and your provider to work together to fine-tune your care plan and keep you as healthy as possible. STARTING INSULIN. Most people who are newly diagnosed with type 2 diabetes begin initial treatment with a combination of diet, exercise, and an oral pill or tablet medication.

Over time, some people will need to add insulin or another injectable medication because their blood sugar levels are not well managed with oral medication.

In some cases, insulin or another injectable medication is recommended first, as initial treatment. Your health care provider will talk to you about your options and goals, and work with you to make a treatment plan.

Types of insulin — There are several types of insulin. These types are classified according to how quickly the insulin begins to work and how long it remains active in the body:.

One form of inhaled insulin brand name: Afrezza is available in the United States. Inhaled insulin has not been shown to lower A1C levels to the usual target level of less than 7 percent in most studies. In addition, lung function testing is required before starting it and periodically during therapy.

For these reasons, inhaled insulin has not been used widely. Initial insulin dose — When insulin is started for type 2 diabetes, health care providers usually recommend "basal" insulin; this means taking intermediate-acting or long-acting forms of insulin to keep blood sugar controlled overnight and throughout the day.

Basal insulin is usually given once per day, either in the morning or at bedtime. Basal insulin is usually started at a low dose 10 to 20 units and then increased gradually to determine the right dose for an individual.

Using a combination of treatments ie, an oral medication plus insulin generally lowers the dose of insulin compared with taking insulin only. Since insulin can cause weight gain, combination therapy may reduce the risk of weight gain. Your health care provider will work with you to monitor your body's response and adjust the dose over time.

Adjusting insulin dose over time — To determine how and when to adjust your once-daily insulin dose, you will need to check your blood sugar levels. This is usually done with a home glucose meter in the morning before eating. If the value is consistently higher than your fasting blood sugar goal, and you do not have episodes of low blood sugar especially overnightyour provider may recommend increasing your insulin dose.

If the basal once-daily insulin regimen is still not adequately controlling your blood sugar levels, your health care provider might recommend giving two or more insulin injections each day.

Being diagnosed with a new medical problem or starting a new medication can also change the body's needs for insulin, sometimes requiring a change in diabetes treatment. For example, when a person with type 2 diabetes takes steroids eg, prednisone for an asthma attack or other reasons, the blood sugar levels increase.

This usually requires temporarily increasing the dose of insulin. Type 2 diabetes typically progresses over time, causing the body to produce less insulin. Some people will need a more complex insulin regimen.

In this situation, a pre-meal prandial dose of rapid-acting or short-acting insulin is added to the basal insulin. As a first step, prandial insulin may be started as a single injection before the largest meal of the day, but your health care provider might suggest another approach.

The dose of short-acting or rapid-acting insulin is adjusted immediately prior to a meal; the dose needed depends on many different factors, including your current and goal blood sugar levels, the carbohydrate content of the meal, and your activity level.

People with type 2 diabetes are occasionally treated with "intensive" insulin regimens. Intensive insulin treatment requires multiple injections of insulin per day or the use of an insulin pump.

It also requires measuring blood sugar levels several times a day, with adjustment of pre-meal insulin dosing based on the size and carbohydrate content of the meal. This approach is more commonly used in people with type 1 diabetes, and it is discussed in greater detail in a separate topic review.

See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ", section on 'Intensive insulin treatment'. INJECTING INSULIN. Insulin cannot be taken in pill form. It is usually injected into the layer of fat under the skin called "subcutaneous" injection with a device called a "pen injector" or a needle and syringe.

Insulin can be injected into different areas of the body figure 1. You will need to learn how to use an insulin pen injector or, if you use a needle and syringe, draw up and inject your insulin.

You may also want to have your partner or a family member learn how to give insulin shots. The site and the insulin dose determine how quickly the insulin is absorbed. See 'Site of injection' below. Insulin pen injectors — Insulin pen injectors may be more convenient to carry and use, particularly when you are away from home.

Most are approximately the size of a large writing pen and contain a cartridge that contains the insulin, a dial to set the dose, and a button to deliver the injection figure 2.

A new needle must be attached to the pen prior to each injection. The needles are sold separately from the pens. Insulin pen cartridges should never be shared, even if the needle is changed. The injection technique is similar to using a needle and syringe. See 'Injection technique' below.

Pens are especially useful for accurately injecting very small doses of insulin and may be easier to use for people with vision or dexterity problems. Pens are more expensive than traditional syringes and needles. A number of different insulin pens are available; each comes with specific instructions for use, and video tutorials are available online.

Needle and syringe — Some people use a needle and syringe rather than a pen injector to give themselves insulin. This involves drawing up insulin from a bottle using the syringe, then injecting it with the needle.

: Insulin and diabetes management

Diabetes - insulin therapy Antiemetic Medicines: OTC Relief for Nausea and Vomiting. However, a few types of insulin can be used for up to 42 days, so check with your pharmacist or health care provider. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. Hypoglycemia has been associated with poor outcomes and higher rates of death, especially in older patients. Alternatively, a puncture-proof container such as an old liquid laundry detergent bottle, which can be closed with a screw cap, can be used.
Diabetes - insulin therapy: MedlinePlus Medical Encyclopedia

If insulin injection therapy is used, the pre-meal blood sugar and anticipated food intake are also used to help calculate the mealtime insulin dose injected.

Some insulin pumps communicate with CGMs, receiving glucose readings every five minutes. They can automatically adjust the basal rate of insulin delivery and deliver extra insulin to help correct for high blood sugars depending on the CGM results called a partial "artificial pancreas," "automated insulin delivery" [AID], or "hybrid closed-loop" system figure 5.

These devices can improve or maintain glucose control with less risk of hypoglycemia low blood sugar. The following devices, combining an insulin pump with CGM, are available or will become available in the future:.

The insulin pump can be programmed to stop insulin delivery for up to two hours at a preset glucose value "low glucose suspend" feature or to reduce or stop insulin infusion if the system "predicts" that your blood sugar will soon go too low "predictive low glucose suspend" feature.

These features reduce the frequency and duration of hypoglycemia that may occur while you are sleeping. Some systems will also deliver extra insulin to help correct for hyperglycemia high blood sugar when there is insufficient insulin on board.

You need to manually direct delivery of insulin doses prior to meals. Use of these systems has been associated with less hypoglycemia low blood sugar and more blood sugar readings in the target range.

An investigational bihormonal system uses two commercially available pumps, with one delivering insulin and the other glucagon.

These systems are also fully automated, in that the delivery of the insulin and glucagon is determined completely automatically by an algorithm that is, in turn, dependent on CGM results.

These devices have not yet been approved and are not commercially available. The insulin pump has advantages and disadvantages; it may be helpful to talk with a person who uses a pump before deciding to try it.

Most pump manufacturers have a list of people willing to speak with prospective pump users. It may also be possible to use a trial pump for a few days before committing to it. Advantages — Insulin pumps have the advantage of increasing flexibility in the timing of meals and other day-to-day events.

This can be of great benefit for children or adults whose schedule varies from one day to the next. People who use an insulin pump do not require multiple daily injections; most people who use the pump change their injection insulin infusion site every 48 to 72 hours.

Another major advantage of an insulin pump is that there is less variation in the amount of insulin absorbed compared with when insulin is given with a needle and syringe or pen.

This can help reduce day-to-day variations in blood sugar levels. Insulin pumps can deliver smaller amounts of insulin at a time than injection therapy. The greatest advantage is for people with type 1 diabetes having blood glucose readings that are too low hypoglycemia and too high hyperglycemia.

The use of an insulin pump with CGM in an automated system can help reduce hypoglycemia and increase time in the target range.

Disadvantages — The cost of an insulin pump and supplies is greater than the cost of insulin syringes and needles or pens, although most insurance carriers cover some portion of the expenses. Some people develop pump-associated problems, including skin irritation or infection at the infusion site or pump malfunction.

You must take care to monitor your blood sugar levels carefully; stopping insulin, even for a short time, can lead to a significant increase in blood sugar.

Some people find the pump awkward, unpleasant, or embarrassing although others find that they are able to adjust to it fairly easily. However, you can disconnect the pump for brief periods, if desired. FACTORS AFFECTING INSULIN ACTION.

Dose of insulin injected — The dose of insulin injected affects the rate at which your body absorbs it. For example, larger doses of insulin may be absorbed more slowly than a small dose.

With larger doses of insulin, the insulin may peak later or last longer than with small doses. This could mean that your blood sugar level is higher than expected within a few hours after eating but then becomes low. Injection technique — In general, we recommend the use of short insulin needles 4 or 5 mm to minimize tissue damage and reduce the likelihood of inadvertently injecting into muscle.

The angle and depth of an insulin injection are important, as mentioned above. See 'Needle and syringe' above. Site of injection — Clinicians usually recommend changing your injection site to minimize tissue irritation.

However, it is important to keep in mind that insulin is absorbed at different rates in different areas of the body. For some types of insulin, the insulin is absorbed fastest from the abdominal area, slowest from the leg and buttock, and at an intermediate rate from the arm.

This may vary with the amount of fat under the skin; the more fat, the more slowly insulin is absorbed figure 2. Because of variations in absorption, it is reasonable to use the same general area for injections at a particular time of the day.

Pre-meal insulin injections are absorbed fastest from the abdominal area, allowing for optimal coverage of carbohydrates consumed in a meal.

Injection into the thigh or buttock may be best for the evening dose because the insulin will be absorbed more slowly during the night. Subcutaneous blood flow — Any factor that alters the rate of blood flow to the body's tissues will alter insulin absorption. Smoking decreases blood flow to the tissues and decreases absorption of injected insulin, whereas running increases blood flow to the lower body, speeding up absorption of insulin injected into a leg.

Factors that increase the skin temperature such as exercise, saunas, hot baths, and massage of the injection site will also increase insulin absorption.

Time since opening the insulin bottle or pen — In general, insulin bottles vials , pens, and pen cartridges are good until their expirations date, if left unopened in a refrigerator. Insulin should never be allowed to freeze or get hot.

Once an insulin bottle vial is opened, it should be kept at room temperature or in the refrigerator for 28 to 30 days and then discarded. After a month, the potency begins to decrease.

This can be a problem for people who require very small doses of insulin, for whom a bottle might last two months or more. In general, it is advisable to open a new bottle at least every 30 days, even if there is insulin left in the old bottle.

However, a few types of insulin can be used for up to 42 days, so check with your pharmacist or health care provider.

For insulin pen devices, it is acceptable to keep the pen injector unrefrigerated in a bag or jacket pocket for varying amounts of time, depending upon the type of pen.

Most opened insulin pens can be used for either 10, 14, or 28 days, but there are some pens that can be used for 42 or 56 days, depending upon the type of insulin in the pen.

Be sure you know how long your type of insulin pen is safe to use after opening. Individual factors — The same dose of the same type of insulin may have different effects in different people with diabetes.

Some trial and error is usually necessary to find the ideal type s and dose of insulin and schedule for each person. Several special situations can complicate insulin treatment. With advance planning and close monitoring, these situations are less likely to cause serious difficulties.

A health care provider can help to handle these situations. Eating out — Eating out can be challenging since ingredients used, calorie and fat content, and portion sizes are usually different from meals prepared at home. You can estimate the carbohydrate content of meals to calculate insulin dose; nutrition information is often available from restaurants, a handheld or online reference book, or mobile phone app.

Low or high blood sugar levels can occur more easily in situations where new or different foods are eaten; a fast-acting source of carbohydrates eg, candy, glucose tablets and, if not using CGM, a blood glucose monitor should be kept on hand at all times.

See "Patient education: Type 1 diabetes and diet Beyond the Basics ". Surgery — If you are planning to have surgery, you may be instructed not to eat for 8 to 12 hours before the procedure.

A health care provider can help to determine the dose and timing of insulin to use before and after the procedure. This is particularly important if you will be unable to eat a normal diet for a time afterwards.

Infections — Infections such as a cold, sore throat, urinary tract infection, or any infection that causes fever can cause blood sugar levels to rise and can even lead to a serious problem called diabetic ketoacidosis DKA. DKA happens when the body's lack of insulin makes it unable to use glucose sugar for energy.

The body then burns fat as an energy source, which causes the buildup of acids in the blood called "ketones. If you get sick, it's a good idea to talk with your health care provider, as you will need to carefully monitor your blood sugar levels and possibly increase your insulin dose.

It is also important to drink plenty of fluids in order to avoid dehydration. If you have nausea or vomiting, you may need medication to control your symptoms and avoid dehydration and ketoacidosis.

Your provider can also talk to you about how and when to check for ketones the acids produced in the body when the body needs more insulin. Travel — Managing blood sugar levels and insulin treatment while traveling can be difficult, especially when traveling across multiple time zones.

In addition, activity levels and diet are often different while traveling, making careful blood sugar monitoring essential. Speak with your health care provider before traveling to develop a treatment plan.

See "Patient education: General travel advice Beyond the Basics ", section on 'Traveling with medical conditions'. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Type 1 diabetes The Basics Patient education: Using insulin The Basics Patient education: Should I switch to an insulin pump? The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Care during pregnancy for people with type 1 or type 2 diabetes The Basics Patient education: My child has diabetes: How will we manage?

The Basics Patient education: Managing blood sugar in children with diabetes The Basics Patient education: Managing diabetes in school The Basics Patient education: Giving your child insulin The Basics Patient education: Checking your child's blood sugar level The Basics Patient education: Carb counting for children with diabetes The Basics Patient education: Diabetic ketoacidosis The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Type 1 diabetes and diet Beyond the Basics Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics Patient education: General travel advice Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.

Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Exercise guidance in adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus General principles of insulin therapy in diabetes mellitus Glycemic control and vascular complications in type 1 diabetes mellitus Pregestational preexisting diabetes mellitus: Antenatal glycemic control Inhaled insulin therapy in diabetes mellitus Management of blood glucose in adults with type 1 diabetes mellitus Hypoglycemia in adults with diabetes mellitus Nutritional considerations in type 1 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus Pancreas and islet transplantation in diabetes mellitus Perioperative management of blood glucose in adults with diabetes mellitus Type 1 diabetes mellitus: Prevention and disease-modifying therapy Approach to the adult with brittle diabetes or high glucose variability.

Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics. Formulary drug information for this topic.

No drug references linked in this topic. Find in topic Formulary Print Share. Author: Ruth S Weinstock, MD, PhD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jan This topic last updated: Aug 11, DIABETES CARE DURING THE COVID PANDEMIC COVID stands for "coronavirus disease STARTING INSULIN The pancreas produces very little or no insulin at all in people with type 1 diabetes.

INSULIN REGIMENS Intensive insulin treatment plans are designed to imitate how the nondiabetic pancreas works. INJECTING INSULIN Insulin is given as a shot under the skin this is called a subcutaneous injection using an insulin "pen" injector or a needle and syringe.

Insulin pump General principles — Insulin can be continuously administered by an insulin pump, rather than through multiple daily injections with a pen injector or needle and syringe. FACTORS AFFECTING INSULIN ACTION Several factors can affect how insulin is absorbed.

The Basics Patient education: Managing blood sugar in children with diabetes The Basics Patient education: Managing diabetes in school The Basics Patient education: Giving your child insulin The Basics Patient education: Checking your child's blood sugar level The Basics Patient education: Carb counting for children with diabetes The Basics Patient education: Diabetic ketoacidosis The Basics Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Type 1 diabetes and diet Beyond the Basics Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics Patient education: General travel advice Beyond the Basics Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

Exercise guidance in adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus General principles of insulin therapy in diabetes mellitus Glycemic control and vascular complications in type 1 diabetes mellitus Pregestational preexisting diabetes mellitus: Antenatal glycemic control Inhaled insulin therapy in diabetes mellitus Management of blood glucose in adults with type 1 diabetes mellitus Hypoglycemia in adults with diabetes mellitus Nutritional considerations in type 1 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus Pancreas and islet transplantation in diabetes mellitus Perioperative management of blood glucose in adults with diabetes mellitus Type 1 diabetes mellitus: Prevention and disease-modifying therapy Approach to the adult with brittle diabetes or high glucose variability The following organizations also provide reliable health information.

It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances.

Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.

UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. All rights reserved. Topic Feedback. Technique for drawing up insulin. How and when you take insulin is unique to you and can change over time. Bolus Insulin. Short- or rapid-acting insulin taken at or before mealtimes to control blood sugar levels.

Basal Insulin background insulin. Basal-Bolus Regimen. Rapid-acting insulin taken at mealtimes and long-acting insulin taken once or twice a day. Syringe or Pen Syringes and insulin pens deliver insulin through a needle. Syringe Your doctor will tell you how much insulin you need per dose. If you need doses in half units, choose a syringe with half-unit markings.

Insulin pen Some pens use cartridges that are inserted into the pen. Insulin Pump An insulin pump is about the size of a small cell phone. Advantages of insulin pumps Have been shown to improve A1C.

Deliver insulin more accurately. Deliver bolus insulin easier. Eliminate unpredictable effects of intermediate- or long-acting insulin. Provide greater flexibility with meals, exercise, and daily schedule.

Can improve physical and psychological well-being. Disadvantages of insulin pumps May cause weight gain. Can be expensive.

May cause infection. May cause diabetic ketoacidosis very high blood sugar if the system is stopped or stops working correctly. Can be a constant reminder of having diabetes. Training is necessary. Insulin Inhaler Inhaled insulin is taken using an oral inhaler to deliver ultra-rapid-acting insulin at the beginning of meals.

Advantages of insulin inhalers Is not an injection. Acts very fast and is as effective as injectable rapid-acting insulins. Can be taken at the beginning of meals. Could lower risk of low blood sugar. Could cause less weight gain.

Inhaler device is small. Disadvantages of insulin inhalers Might cause mild or severe coughing. May be more expensive. Still requires injections or a pump for basal insulin. Types of Insulin Diabetes Self-Management Education and Support Managing Insulin in an Emergency Managing Diabetes at School.

Last Reviewed: April 18, Source: Centers for Disease Control and Prevention. Facebook Twitter LinkedIn Syndicate.

Syringe or Pen

If you don't get treatment for diabetes, high blood sugar can lead to health problems over time. These conditions include:. Insulin therapy keeps your blood sugar within your target range. It helps prevent serious complications. If you have type 1 diabetes, you need insulin therapy to stay healthy.

It replaces the insulin your body doesn't make. If you have type 2 diabetes, insulin therapy might be part of your treatment. It's needed when healthy-lifestyle changes and other diabetes treatments don't control your blood sugar well enough. Insulin therapy also is sometimes needed to treat a type of diabetes that happens during pregnancy.

This is called gestational diabetes. If you have gestational diabetes, you might need insulin therapy if healthy habits and other diabetes treatments don't help enough.

Any types of insulin help treat diabetes. Each type varies in how quickly and how long it controls blood sugar. You may need to take more than one kind of insulin. Factors that help determine which types of insulin you need and how much you need include:.

Long-acting, ultralong-acting or intermediate-acting insulins. When you're not eating, your liver releases glucose so your body has energy. Long-, ultralong- or intermediate-acting insulin prevents blood sugar levels from rising without eating.

Examples of these insulins are glargine Lantus, Basaglar, others , detemir Levemir , degludec Tresiba and NPH Humulin N, Novolin N, others. Intermediate-acting insulin lasts about 12 to 18 hours.

Long-acting insulin works for about 24 hours. And ultralong-acting insulin lasts about 36 hours or longer. Rapid-acting or short-acting insulins. These insulins are ideal for use before meals.

If taken with a meal, they can help bring blood sugar back down to the baseline. They also blunt the sugar spikes after you eat. They start to work much faster than long-acting or intermediate-acting insulins do.

Sometimes, rapid-acting insulins begin working in as few as 5 to 15 minutes. But they work for a much shorter time. Rapid-acting insulin lasts about 2 to 3 hours. Short-acting insulin lasts about 3 to 6 hours.

Examples of these insulins include ultrafast-acting aspart Fiasp and lispro Lyumjev ; rapid-acting aspart NovoLog , glulisine Apidra and lispro Humalog, Admelog ; and short-acting, regular Humulin R, Novolin R. Sometimes, insulin-makers combine two types of insulin. This is called pre-mixed insulin.

It can be helpful for people who have trouble using more than one type of insulin. Pre-mixed insulin often starts to work in 5 to 60 minutes. It can keep working for 10 to 16 hours. Be aware that different preparations of insulin vary in terms of when they start working and how long they last.

Be sure to read the instructions that come with your insulin. And follow any directions from your health care team. Insulin doesn't come in pill form. The digestive system would break the pill down before it had a chance to work.

But there are other ways to take insulin. Your health care team can help you decide which method fits best for you. Sometimes, using insulin therapy can be a challenge. But it's an effective way to lower blood sugar.

Talk to a member of your health care team if you have any trouble with your insulin routine. Ask for help right away if at-home glucose tests show that you have very low or very high blood sugar. Your insulin or other diabetes medicines may need to be adjusted. With time, you can find an insulin routine that fits your needs and lifestyle.

And that can help you lead an active, healthy life. If you take many doses of insulin a day, ask your health care provider if there's a way to make the routine simpler.

Adding noninsulin medicines to your treatment plan might lower the number of insulin shots you need each day. And if you take fewer insulin shots, you'll need to check your blood sugar less often.

Certain noninsulin medicines have other health benefits too. Some can help control weight and lower the chances of heart attack or stroke, heart failure, and kidney failure. Some people with type 2 diabetes can stop taking insulin completely after they start taking noninsulin medicines.

But it's important to keep taking your insulin as prescribed until your health care provider tells you it's OK to stop. There is a problem with information submitted for this request.

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Advertising revenue supports our not-for-profit mission. Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia B. The shortest needles currently the 4-mm pen and 6-mm syringe needles are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular IM injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them A.

Many patients in East Africa reuse syringes for various reasons, including financial. This is not recommended by the manufacturer and there is an association between needle reuse and lipohypertrophy.

However, patients who reuse needles should not be subjected to alarming claims of excessive morbidity from this practice A. Health care authorities and planners should be alerted to the risks associated with syringe or pen needles 6 mm or longer in children A.

Keywords: Diabetes mellitus; East Africa; Guidelines; Hyperglycemia; Hypoglycemia; Insulin therapy; Type 1 diabetes mellitus T1DM ; Type 2 diabetes mellitus T2DM. Insulin acts like a key to let blood sugar into cells for use as energy. Insulin, Blood Sugar, and Type 2 Diabetes Insulin is a key player in developing type 2 diabetes.

Here are the high points: The food you eat is broken down into blood sugar. Blood sugar enters your bloodstream, which signals the pancreas to release insulin. Insulin also signals the liver to store blood sugar for later use.

Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too. But this finely tuned system can quickly get out of whack, as follows: A lot of blood sugar enters the bloodstream. The pancreas pumps out more insulin to get blood sugar into cells. The pancreas keeps making more insulin to try to make cells respond.

Do You Have Insulin Resistance? What Causes Insulin Resistance? How to Reverse Insulin Resistance If you have insulin resistance, you want to become the opposite—more insulin sensitive cells are more effective at absorbing blood sugar so less insulin is needed.

Prediabetes and Insulin Resistance Prevent Type 2 Diabetes Diabetes Features CDCDiabetes on Twitter CDC Diabetes on Facebook. Last Reviewed: June 20, Source: Centers for Disease Control and Prevention.

Insulin, Blood Sugar, and Type 2 Diabetes Community Health Needs Digestive system benefits. Linking Insulin and diabetes management a non-federal website does not constitute an diabefes by Riabetes Insulin and diabetes management any of its employees of the sponsors or the information and products presented on the website. Thank you for subscribing! Short-acting insulin Short-acting insulin takes longer to start working than the rapid-acting insulins. All Rights Reserved.
Insulin Resistance and Diabetes | CDC

They will know about the latest devices and have tips to make taking insulin and all aspects of diabetes easier to manage. Need help finding a diabetes educator? Find a diabetes education program in your area. Skip directly to site content Skip directly to search.

Español Other Languages. Minus Related Pages. How and when you take insulin is unique to you and can change over time. Bolus Insulin. Short- or rapid-acting insulin taken at or before mealtimes to control blood sugar levels.

Basal Insulin background insulin. Basal-Bolus Regimen. Rapid-acting insulin taken at mealtimes and long-acting insulin taken once or twice a day. Syringe or Pen Syringes and insulin pens deliver insulin through a needle. Syringe Your doctor will tell you how much insulin you need per dose.

If you need doses in half units, choose a syringe with half-unit markings. Insulin pen Some pens use cartridges that are inserted into the pen. Insulin Pump An insulin pump is about the size of a small cell phone. Advantages of insulin pumps Have been shown to improve A1C. Deliver insulin more accurately.

Deliver bolus insulin easier. Eliminate unpredictable effects of intermediate- or long-acting insulin. Provide greater flexibility with meals, exercise, and daily schedule. Can improve physical and psychological well-being.

Disadvantages of insulin pumps May cause weight gain. Can be expensive. May cause infection. May cause diabetic ketoacidosis very high blood sugar if the system is stopped or stops working correctly.

Can be a constant reminder of having diabetes. Training is necessary. Insulin Inhaler Inhaled insulin is taken using an oral inhaler to deliver ultra-rapid-acting insulin at the beginning of meals. Advantages of insulin inhalers Is not an injection.

Acts very fast and is as effective as injectable rapid-acting insulins. Can be taken at the beginning of meals. Could lower risk of low blood sugar. Could cause less weight gain. Inhaler device is small.

Yep, weight gain. You do not have to be overweight to have insulin resistance. If you have insulin resistance, you want to become the opposite—more insulin sensitive cells are more effective at absorbing blood sugar so less insulin is needed.

These lifestyle changes really work. Talk with your health care provider about how to get started. Skip directly to site content Skip directly to search.

Español Other Languages. Insulin Resistance and Diabetes. Spanish Print. Minus Related Pages. Insulin acts like a key to let blood sugar into cells for use as energy.

Insulin, Blood Sugar, and Type 2 Diabetes Insulin is a key player in developing type 2 diabetes. Here are the high points: The food you eat is broken down into blood sugar. Blood sugar enters your bloodstream, which signals the pancreas to release insulin.

Insulin also signals the liver to store blood sugar for later use. Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.

But this finely tuned system can quickly get out of whack, as follows: A lot of blood sugar enters the bloodstream. The pancreas pumps out more insulin to get blood sugar into cells.

The pancreas keeps making more insulin to try to make cells respond. Do You Have Insulin Resistance? What Causes Insulin Resistance?

Insulin and diabetes management -

There are many ways to lower the risk of heart disease, including lifestyle changes such as avoiding smoking, eating a healthy diet, exercising regularly, and maintaining a healthy weight and medications to control blood pressure and cholesterol, if needed.

Specific diabetes drugs also help reduce the risk of cardiovascular disease in people with or at high risk for cardiovascular disease. See "Patient education: Preventing complications from diabetes Beyond the Basics ".

Monitoring — Many people with type 2 diabetes need to check their blood sugar regularly. This is especially important for people who use insulin or other medications that can lower blood sugar levels too much.

That's because while high blood sugar hyper glycemia can lead to complications, having a blood sugar level that is too low hypo glycemia can also cause problems.

See "Patient education: Glucose monitoring in diabetes Beyond the Basics ". Overall blood sugar management is often measured by checking the level before the first meal of the day fasting.

Your health care provider can work with you to determine what your goal should be. The frequency of testing and blood sugar goals can change over time, so it's important to see your health care provider regularly. See 'How often to see your provider' below.

Blood sugar control can also be measured with a blood test called A1C, also called HbA1c. The A1C blood test is an indicator of your average blood sugar level over the past two to three months. Knowing your average level can be useful as blood sugar levels can fluctuate throughout the day depending on your diet and activity level.

The A1C test involves having a blood sample taken either from a vein or through a finger prick in a doctor's office for testing. However, different people have different goals for their A1C level.

For example, people who are older or have several other medical conditions might have a slightly higher goal. Your health care provider will work with you to understand your A1C goal.

The A1C measures the amount of blood sugar that is stuck to hemoglobin, a molecule in red blood cells. Sometimes, the A1C cannot accurately measure average blood sugar; this can be due to conditions that affect red blood cells or normal variations in how long the red blood cells last in the body.

If your health care provider suspects that your A1C results are inaccurate, they may use other methods to measure your blood sugar level.

How often to see your provider — Most people with type 2 diabetes meet with their health care provider every three to four months. At these visits, you will discuss your blood sugar and other care goals and how you are managing your diabetes, including your medications.

This allows you and your provider to work together to fine-tune your care plan and keep you as healthy as possible. STARTING INSULIN.

Most people who are newly diagnosed with type 2 diabetes begin initial treatment with a combination of diet, exercise, and an oral pill or tablet medication. Over time, some people will need to add insulin or another injectable medication because their blood sugar levels are not well managed with oral medication.

In some cases, insulin or another injectable medication is recommended first, as initial treatment. Your health care provider will talk to you about your options and goals, and work with you to make a treatment plan. Types of insulin — There are several types of insulin.

These types are classified according to how quickly the insulin begins to work and how long it remains active in the body:. One form of inhaled insulin brand name: Afrezza is available in the United States. Inhaled insulin has not been shown to lower A1C levels to the usual target level of less than 7 percent in most studies.

In addition, lung function testing is required before starting it and periodically during therapy. For these reasons, inhaled insulin has not been used widely. Initial insulin dose — When insulin is started for type 2 diabetes, health care providers usually recommend "basal" insulin; this means taking intermediate-acting or long-acting forms of insulin to keep blood sugar controlled overnight and throughout the day.

Basal insulin is usually given once per day, either in the morning or at bedtime. Basal insulin is usually started at a low dose 10 to 20 units and then increased gradually to determine the right dose for an individual.

Using a combination of treatments ie, an oral medication plus insulin generally lowers the dose of insulin compared with taking insulin only. Since insulin can cause weight gain, combination therapy may reduce the risk of weight gain.

Your health care provider will work with you to monitor your body's response and adjust the dose over time. Adjusting insulin dose over time — To determine how and when to adjust your once-daily insulin dose, you will need to check your blood sugar levels.

This is usually done with a home glucose meter in the morning before eating. If the value is consistently higher than your fasting blood sugar goal, and you do not have episodes of low blood sugar especially overnight , your provider may recommend increasing your insulin dose.

If the basal once-daily insulin regimen is still not adequately controlling your blood sugar levels, your health care provider might recommend giving two or more insulin injections each day. Being diagnosed with a new medical problem or starting a new medication can also change the body's needs for insulin, sometimes requiring a change in diabetes treatment.

For example, when a person with type 2 diabetes takes steroids eg, prednisone for an asthma attack or other reasons, the blood sugar levels increase. This usually requires temporarily increasing the dose of insulin.

Type 2 diabetes typically progresses over time, causing the body to produce less insulin. Some people will need a more complex insulin regimen. In this situation, a pre-meal prandial dose of rapid-acting or short-acting insulin is added to the basal insulin.

As a first step, prandial insulin may be started as a single injection before the largest meal of the day, but your health care provider might suggest another approach. The dose of short-acting or rapid-acting insulin is adjusted immediately prior to a meal; the dose needed depends on many different factors, including your current and goal blood sugar levels, the carbohydrate content of the meal, and your activity level.

People with type 2 diabetes are occasionally treated with "intensive" insulin regimens. Intensive insulin treatment requires multiple injections of insulin per day or the use of an insulin pump.

It also requires measuring blood sugar levels several times a day, with adjustment of pre-meal insulin dosing based on the size and carbohydrate content of the meal. This approach is more commonly used in people with type 1 diabetes, and it is discussed in greater detail in a separate topic review.

See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ", section on 'Intensive insulin treatment'.

INJECTING INSULIN. Insulin cannot be taken in pill form. It is usually injected into the layer of fat under the skin called "subcutaneous" injection with a device called a "pen injector" or a needle and syringe.

Insulin can be injected into different areas of the body figure 1. You will need to learn how to use an insulin pen injector or, if you use a needle and syringe, draw up and inject your insulin. You may also want to have your partner or a family member learn how to give insulin shots.

The site and the insulin dose determine how quickly the insulin is absorbed. See 'Site of injection' below. Insulin pen injectors — Insulin pen injectors may be more convenient to carry and use, particularly when you are away from home.

Most are approximately the size of a large writing pen and contain a cartridge that contains the insulin, a dial to set the dose, and a button to deliver the injection figure 2. A new needle must be attached to the pen prior to each injection.

The needles are sold separately from the pens. Insulin pen cartridges should never be shared, even if the needle is changed. The injection technique is similar to using a needle and syringe. See 'Injection technique' below. Pens are especially useful for accurately injecting very small doses of insulin and may be easier to use for people with vision or dexterity problems.

Pens are more expensive than traditional syringes and needles. A number of different insulin pens are available; each comes with specific instructions for use, and video tutorials are available online.

Needle and syringe — Some people use a needle and syringe rather than a pen injector to give themselves insulin. This involves drawing up insulin from a bottle using the syringe, then injecting it with the needle.

Drawing up insulin — There are many different types of syringes and needles, so it's best to get specific instructions for drawing up insulin from your health care provider.

The basic steps are listed in the table table 2. See 'Insulin pen injectors' above. Medically reviewed by Michelle L. Griffith, MD — By Jessica DiGiacinto and Valencia Higuera — Updated on April 20, Understanding diabetes Managing diabetes with insulin Types of insulin Administration and dosage Storing insulin Side effects and reactions Treatment Alternative medications Ways to manage blood glucose Takeaway Insulin is a hormone made in your pancreas, a gland located behind your stomach.

Understanding diabetes. Managing diabetes with insulin. Types of insulin treatments. Insulin type Onset When it peaks in your system Duration When taken Ultra-rapid acting 2 to 15 min min 4 hours Taken with meals, usually with the first bite of a meal. Commonly used along with long-acting insulin.

Rapid-acting 15 min 1 hour 2 to 4 hours Taken with meals, typically right before a meal. Commonly used along with longer-acting insulin. Rapid-acting inhaled 10 to 15 min 30 min 3 hours Taken with meals, typically right before a meal. Commonly used with injectable long-acting insulin.

Regular or short-acting 30 min 2 to 3 hours 3 to 6 hours Taken with meals, typically 30 to 60 minutes before a meal. Intermediate acting 2 to 4 hours 4 to 12 hours 12 to 18 hours Taken once or twice a day. Covers your insulin needs for half a day or overnight.

Commonly used with rapid- or short-acting insulin. Can be used with rapid- or short-acting insulin if needed. Premixed 5 to 60 min varied peaks 10 to 16 hours Taken twice a day, commonly 10 to 30 minutes before breakfast and dinner.

This type is a combination of intermediate- and short-acting insulin. Administration and dosage. How should I store my insulin?

Side effects and reactions. Alternative medications for people with type 2 diabetes. Ways to manage blood glucose levels. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.

We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Apr 20, Written By Jessica DiGiacinto, Valencia Higuera.

Oct 1, Medically Reviewed By Michelle L. Griffith, MD. Share this article. Read this next. Type 2 Diabetes and Insulin: 10 Things You Should Know. Medically reviewed by Maria Prelipcean, M.

Insulin Before or After Meals? Here are some do's and don'ts to pay attention to as you learn how to effectively manage your diabetes with… READ MORE. How Do Insulin Pumps Work? Medically reviewed by Kelly Wood, MD.

Is Type 1 Diabetes Genetic? Skip directly to site content Skip directly to search. Español Other Languages. Insulin Resistance and Diabetes. Spanish Print. Minus Related Pages. Insulin acts like a key to let blood sugar into cells for use as energy.

Insulin, Blood Sugar, and Type 2 Diabetes Insulin is a key player in developing type 2 diabetes. Here are the high points: The food you eat is broken down into blood sugar. Blood sugar enters your bloodstream, which signals the pancreas to release insulin.

Insulin also signals the liver to store blood sugar for later use. Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too. But this finely tuned system can quickly get out of whack, as follows: A lot of blood sugar enters the bloodstream.

The pancreas pumps out more insulin to get blood sugar into cells. The pancreas keeps making more insulin to try to make cells respond.

Diabetss Disclosures. Please Insupin the Disclaimer at the end of this page. Type 1 diabetes mellitus is dabetes chronic medical condition that Fat burners for rapid weight loss when the pancreas, an organ in the Insulin and diabetes management, produces very little or no insulin figure 1. Insulin is a hormone that helps the body to use glucose for energy. Glucose is a sugar that comes, in large part, from foods we eat. Insulin allows glucose to enter cells in the body where it is needed and stores excess glucose for later use. It has other important actions as well. Insulin and diabetes management

Insulin and diabetes management -

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International Patients. Financial Services. Community Health Needs Assessment. Financial Assistance Documents — Arizona. In the U. Prospective Diabetes Study, patients with type 2 diabetes who were taking insulin gained an average of 8 lb, 13 oz 4 kg , which was associated with a 0.

Hypoglycemia may occur from a mismatch between insulin and carbohydrate intake, exercise, or alcohol consumption. Hypoglycemia has been associated with an increased risk of dementia and may have implications in cardiac arrhythmia.

American Diabetes Association ADA guidelines recommend that the blood glucose level be checked if hypoglycemia is suspected glucose level lower than 70 mg per dL [3. The blood glucose level should be rechecked after 15 minutes to make sure it has normalized.

An epidemiologic study has raised concern about cancer risk with glargine Lantus and other insulin therapies. A consensus statement by the ADA indicates that this possible risk needs further research but should not be a limiting factor in treatment choice.

The American College of Endocrinology and the American Association of Clinical Endocrinologists recommend initiation of insulin therapy in patients with type 2 diabetes and an initial A1C level greater than 9 percent, or if the diabetes is uncontrolled despite optimal oral glycemic therapy.

This recommendation is based on expert opinion, and not on the results of randomized controlled trials comparing different approaches in patients with an initial A1C level greater than 9 percent. Prospective Diabetes Study, early intensive glucose control starting with a sulfonylurea, then metformin, then insulin was associated with a 25 percent reduction in microvascular complications and a 12 percent risk reduction in any diabetes-related end point, but was not associated with a reduction in all-cause mortality.

Recent trials have shown that intensive glucose control i. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing a type of insulin.

In general, analogue insulin is similar to human insulin in controlling diabetes, although some trials have found higher mean A1C levels in patients taking analogue insulin compared with human insulin.

An industry-funded cost-effectiveness analysis found that the increased cost of medication is more than off set by the reduction in hypoglycemic events. Insulin regimens should be tailored to the patient's needs and lifestyle. One of the most important considerations is the pharmacokinetics of different insulin preparations 26 Table 1 26 and Figure 2 Table 2 defines commonly used terms in insulin therapy.

In one study, patients who had uncontrolled type 2 diabetes and were taking a sulfonylurea and metformin were randomized to receive premixed, bolus, or basal analogue insulin.

Median A1C levels were similar among the groups, but hypoglycemia was more common in the premixed and bolus groups, and weight gain was more common in the bolus group.

The goal of basal insulin is to suppress hepatic glucose production and improve fasting hyperglycemia Figure 3 2. If basal insulin is titrated too high, it will also partially cover meals and lead to hypoglycemia during the night or if a meal is missed.

Long-acting analogue insulin may be administered once or twice daily, depending on the dose. Lower doses may not last 24 hours, whereas higher doses may impede insulin absorption. NPH may be administered one to three times daily. NPH is often used during pregnancy and in patients who are unable to afford the up-front cost of analogue insulin.

Bolus insulin may also be used for augmentation Figure 4 2. Short-acting insulin is administered before meals to cover the carbohydrate load. Short-acting analogue insulin is given up to 15 minutes before a meal to maintain two-hour postprandial glucose levels.

Taking insulin after meals increases the risk of early postprandial hyperglycemia followed by delayed hypoglycemia. Replacement therapy includes basal-bolus insulin and correction or premixed insulin; an insulin pump may be used, but is beyond the scope of this article.

Replacement should be considered for patients with type 2 diabetes that is uncontrolled with augmentation therapy and who are able to comply with such a regimen or who desire tighter control. Bolus insulin should be added to basal insulin if fasting glucose goals are met but postprandial goals are not.

When blood glucose levels are above predefined targets, additional short-acting insulin may be added to the bolus dose before meals. For example, a patient takes 40 units of glargine daily and 12 units of lispro Humalog before each meal, and has a correction factor of 1 unit for every 20 mg per dL 1.

If the blood glucose level at breakfast is mg per dL 8. Premixed insulin similarly reduces A1C compared with basal-bolus insulin.

Fewer injections are needed, but patients are more restricted in their eating habits and schedule. Patients must eat breakfast, lunch, dinner, and possibly midmorning and bedtime snacks to prevent hypoglycemia. If used, correction insulin must be administered separately with a short-acting insulin.

This may increase the number of injections compared with basal-bolus therapy Figure 5 2. The initial dosage of insulin is individualized based on the patient's insulin sensitivity. Insulin therapy may be started with a set dosage, such as 10 units of glargine daily, or by using weight-based equations.

Equations to estimate augmentation, replacement, carbohydrate ratio, and correction therapy are listed in Table 2. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal and 50 percent as bolus, divided up before breakfast, lunch, and dinner.

For example, a kg lb patient requiring basal-bolus and correction insulin would need 36 units of basal insulin 0. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications.

Some physicians have adopted the Treat-to-Target Trial's titration schedule for basal insulin Table 4. Patients should go to the physician's office for follow-up at least every three to four months.

The frequency of communicating insulin titration via clinical contact, telephone, e-mail, or fax is highly correlated with improvement of A1C levels. Insulin is effective only if administered appropriately. The needle should be placed at a degree angle to the skin and held in place for five to 10 seconds after injection to prevent insulin leakage.

Rotation of injection sites is important to prevent lipohypertrophy i. Insulin is available in pens and vials. Benefits of insulin pens include the convenience of storing at room temperature for 28 days after opening and ease of use for patients with visual or dexterity problems.

Patients should be instructed to prime the insulin pen before every use. Priming consists of drawing up 1 or 2 units of insulin and injecting into the air to allow the insulin to fill the needle. Many oral medications are safe and effective when combined with insulin therapy. To maximize benefit without causing significant adverse effects, it is important to consider the mechanism of action for different therapies.

Insulin sensitizers have been proven safe and effective when combined with insulin therapy. Alpha-glucosidase inhibitors delay absorption of carbohydrates in the gastrointestinal tract to decrease postprandial hyperglycemia. These medications are safe and effective when combined with insulin. Insulin secretagogues sulfonylureas and glitinides can be combined with insulin, especially when only basal augmentation is being used.

However, there is a possible increased risk of hypoglycemia that needs to be monitored closely. Usually by the time insulin is required for meals, insulin secretagogues are not effective or necessary. However, it is recommended to continue oral medications while starting insulin to prevent rebound hyperglycemia.

Incretin therapies include dipeptidyl-peptidase IV inhibitors sitagliptin [Januvia] and saxagliptin [Onglyza] and glucagon-like peptide-1 agonists exenatide [Byetta] and liraglutide [Victoza]. Sitagliptin is currently the only one of these medications that is approved by the U.

Food and Drug Administration for combination therapy with insulin. This combination is associated with improved fasting and postprandial glucose control.

Data Sources : A PubMed search was completed in Clinical Queries using the key terms intensive insulin therapy, insulin and cancer, insulin and weight gain, UKPDS, self-titration insulin, human and analog insulin, metformin and insulin, sulfonylurea and insulin, and incretin and insulin.

The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Search dates: August 24, , and November 29, Ritzel RA, Bulter PC. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin.

Two or three premixed insulin injections per day may be used A. The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications B.

For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose SMBG B. Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus T2DM include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy B.

If the desired glucose targets are not met, rapid-acting or short-acting bolus or prandial insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels C.

Mayo Clinic offers Insjlin Insulin and diabetes management Arizona, Florida and Minnesota and at Mayo Clinic Diabeets System locations. Diabetes Insulin and diabetes management diabetds awareness. Know what makes your blood xiabetes level rise and Nutrition education programs — and how to control these day-to-day factors. When you have diabetes, it's important to keep your blood sugar levels within the range recommended by your healthcare professional. But many things can make your blood sugar levels change, sometimes quickly. Find out some of the factors that can affect blood sugar. Then learn what you can do to manage them.

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