Understanding INSULIN

In the early morning, a warm smile greeted me as an enthusiastic lady accompanied her father-in-law, who is a diabetic patient under my care. Her curiosity was evident, sparked by the multitude of posts on social media networks about insulin.

With a genuine eagerness to learn more, she had a plethora of questions about this vital hormone. Insulin is an essential hormone produced by the pancreas, playing a crucial role in regulating blood sugar levels in the body.

In the field of diabetes management, the treatment landscape has evolved significantly over the years. While insulin therapy remains a critical tool for many patients, the advent of novel antidiabetic medications has opened new avenues for tailored and comprehensive care.

These advanced medications not only aid in blood sugar control but also offer invaluable protection for vital organs like the kidneys and heart and help in weight loss. Now have a diverse range of options to effectively manage diabetes, providing patients with improved quality of life and better long-term health outcomes.

Insulin remains the cornerstone for type 1 diabetes; however, today for type 2 diabetics, newer antidiabetic medications have emerged as powerful allies, effectively targeting various aspects of diabetes management.

These novel drugs, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), DPP IV inhibitor (Gliptins) and sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors), work in innovative ways to achieve comprehensive diabetes control.

For those who don’t attain normal blood sugars on the highest doses of oral antidiabetics, or who have contraindication for these medicines, insulin therapy becomes a lifesaving treatment to manage their condition effectively.

The commonly used insulins are:

Fast-Acting Insulin: Is designed to work quickly, mirroring the body’s natural insulin response after a meal. It is usually taken just before or after meals and helps control the sharp rise in blood sugar levels. The benefit of fast-acting insulin lies in its ability to provide quick relief and flexibility in dosing, especially for seniors who may need to adjust their insulin intake based on varying dietary choices.

Long-Acting Insulin: Is formulated to provide a steady release of insulin over an extended period, typically covering the body’s basal insulin needs throughout the day. This type of insulin is taken once or twice daily and offers a consistent effect, ensuring blood sugar levels remain stable between meals and during sleep. For seniors who prefer a less frequent dosing regimen, long-acting insulin can be advantageous in promoting adherence to treatment plans.

Mixed Insulin: Mixed insulin combines both fast-acting and intermediate- or long-acting insulin in one preparation. It is commonly prescribed to individuals who require both rapid-acting insulin to cover mealtime needs and a basal insulin to maintain sugar levels in between. This type of insulin can simplify the insulin regimen for seniors, as they only need to manage a single injection (Twice or once) rather than multiple ones throughout the day.

Some people even ask about insulin syringes or insulin pens. The insulin pen is very user-friendly and is particularly beneficial for the elderly as the dose titration is more accurate and easy.

Now, let’s explore the pros and cons of insulin therapy for seniors:

Pros of Insulin

Effective Blood Sugar Control: For those who don’t get normal sugar levels on oral antidiabetics, Insulin therapy offers precise control over blood sugar levels, reducing the risk of diabetes-related complications, such as kidney damage, nerve problems, and vision issues.

Improved Quality of Life: With well-managed blood sugar levels, seniors can experience increased energy levels, better mood, and enhanced overall well-being, allowing them to enjoy life to the fullest.

Flexibility: The different types of insulin provide flexibility in dosing and timing, enabling seniors to tailor their treatment plans to suit their unique lifestyle and dietary preferences.

Cons of Insulin

Injection-Related Anxiety: Some seniors may feel apprehensive about administering insulin injections, leading to anxiety or discomfort. However, proper education and support from caregivers can alleviate these concerns.

Lifestyle Adjustments: Seniors may need to make dietary and lifestyle adjustments to optimise insulin therapy’s benefits. Adapting to new routines can be challenging, but with support and encouragement, seniors can successfully incorporate these changes into their daily lives.

Unwanted effects of Insulin

Hypoglycemia: One of the most significant concerns with insulin use is the risk of hypoglycemia, also known as low blood sugar. This can occur if too much insulin is taken or if the dose is not adjusted appropriately. Hypoglycemia can cause symptoms such as shakiness, sweating, confusion, dizziness, and in severe cases, loss of consciousness. Prompt treatment is essential to raise blood sugar levels back to normal.

Weight gain: Some individuals may experience weight gain while using insulin. Insulin helps the body use glucose for energy, which can lead to increased fat storage and weight gain in some people. It is crucial to maintain a balanced diet and engage in regular physical activity to manage weight effectively.

Injection site reactions: Insulin is typically administered through injections, and some people may experience redness, swelling, or itching at the injection site. Rotating injection sites and proper injection techniques can help reduce these reactions.

Lipodystrophy: Long-term use of insulin at the same injection site can lead to lipodystrophy, which is the loss of fat tissue or the formation of lumps at the injection site. Rotating injection sites can help prevent this condition.

Hypokalemia: In some cases, insulin can cause a decrease in blood potassium levels (hypokalemia). This is more common in individuals with kidney problems or when high doses of insulin are used.

Proper way of insulin administration and site rotation

Injection Technique: When administering insulin, it’s essential to use a clean syringe or pen needle for each injection. Make sure to follow your doctor’s instructions for drawing up the correct dose of insulin.

Site Rotation: To prevent lipodystrophy and ensure proper insulin absorption, it’s crucial to rotate injection sites. Common injection sites include the abdomen (around the belly button), thighs, upper arms, and buttocks. Avoid injecting in the same spot repeatedly.

Rotation Pattern: Develop a rotation pattern to ensure you are using different sites for each injection. For example, you can inject in a clockwise or counterclockwise pattern, or switch between the left and right sides of the body.

Keep a Record: Maintain a record of the injection sites used to help you keep track of the rotation pattern. This can be especially helpful if multiple injections are required each day.

Avoid Scarred or Tender Areas: Avoid injecting in areas with visible scars, bruises, or tender spots. Choose healthy, fatty tissue for injection to ensure proper insulin absorption.

Use the Right Technique: Follow the recommended injection technique for the specific type of insulin pen or syringe you are using. Your doctor or diabetes educator can demonstrate the proper technique.

Storage: Store insulin vials and pens according to the manufacturer’s instructions. Maintaining recommended temperatures ensures the insulin remains effective and safe to use.

It’s essential to work closely with your doctor to develop a personalised insulin regimen that suits your specific needs. They can provide guidance on proper injection techniques, site rotation, and help you achieve optimal diabetes management.

Dr Zubair Saleem is a Senior Geriatric

Consultant and Gerontologist