Diabetes Treatment

 

What are the symptoms of diabetes?

People with type 2 diabetes often do not have any symptoms. When symptoms do occur, they are often ignored because they may not seem serious. Symptoms in type 1 diabetes usually come on much more suddenly and are often severe.

Common symptoms of diabetes include:

  • Excessive thirst and appetite
  • Increased urination (sometimes as often as every hour)
  • Unusual weight loss or gain
  • Fatigue
  • Nausea, perhaps vomiting
  • Blurred vision
  • In women, frequent vaginal infections
  • In men and women, yeast infections
  • Dry mouth
  • Slow-healing sores or cuts
  • Itching skin, especially in the groin or vaginal area

 

Call your doctor about diabetes if:

  • You feel nauseated, weak, and excessively thirsty; are urinating very frequently; have abdominal pain.
  • You are breathing more deeply and rapidly than normal — perhaps with sweet breath that smells like nail polish remover — you need immediate medical attention for ketoacidosis — a potentially deadly complication of type 1 diabetes.
  • If you are having weakness or fainting spells; are experiencing a rapid heartbeat, trembling, and excessive sweating; and feel irritable, hungry, or suddenly drowsy. You could be developing hypoglycemia — low blood sugar that can occur with diabetes treatment. Follow your treatment plan for what to do if you develop hypoglycemia.

 

Types of Insulin for Diabetes Treatment

There are many forms of insulin to treat diabetes. They are classified by how fast they start to work and how long their effects last.

The types of insulin include:

  • Rapid-acting
  • Short-acting
  • Intermediate-acting
  • Long-acting
  • Pre-mixed

 

What type of Insulin is best for my Diabetes?

Your doctor will work with you to prescribe the type of insulin that is best for you and your diabetes. Deciding what type of insulin might be best for you will depend on many factors, including:

  • Your body’s individualized response to insulin (how long it takes insulin to be absorbed in the body and remain active in the body varies slightly from person to person).
  • Your own lifestyle choices — for instance, the type of food you eat, if/how much alcohol you drink, or how much exercise you get — are all factors that influence your body’s processing of insulin.
  • How willing you are to give yourself multiple injections per day.
  • How frequently you are willing to check your blood sugar level.
  • Your age.
  • Your blood sugar management goals.

 

The following chart lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when the insulin is the most effective in lowering blood sugar) and duration (how long insulin continues to lower blood sugar). These three factors may vary, depending on your body’s response. The final column provides some insight into the “coverage” provided by the different insulin types in relation to mealtime.

Type of Insulin & Brand NamesOnsetPeakDurationRole in Blood Sugar Management
Rapid-Acting
Humalog or lispro15-30 min.30-90 min3-5 hoursRapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with longer-acting insulin.
Novolog or aspart10-20 min.40-50 min.3-5 hours
Apidra or glulisine20-30 min.30-90 min.1-2½ hours
Short-Acting
Regular (R) humulin or novolin30 min. -1 hour2-5 hours5-8 hoursShort-acting insulin covers insulin needs for meals eaten within 30-60 minutes
Intermediate-Acting
NPH (N)1-2 hours4-12 hours18-24 hoursIntermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapid- or short-acting insulin.
Long-Acting
Long-acting insulin covers insulin needs for about one full day. This type of insulin is often combined, when needed, with rapid- or short-acting insulin.
Lantus (insulin glargine)1-1½ hourNo peak time; insulin is delivered at a steady level20-24 hours
Levemir (insulin detemir)1-2 hours6-8 hoursUp to 24 hours
Pre-Mixed*
Humulin 70/3030 min.2-4 hours14-24 hoursThese products are generally taken two or three times a day before mealtime.
Humulin 50/5030 min.2-5 hours18-24 hours
Humalog mix 75/2515 min.30 min.-2½ hours16-20 hours
*Premixed insulins are a combination of specific proportions of intermediate-acting and short-acting insulin in one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin).

 

Insulin Dosing Schedule for Diabetes

Follow your health care provider’s guidelines on when to take your insulin for your diabetes. The time span between your insulin shot and meals may vary depending on the type of insulin you are taking.

In general, however, you should coordinate your insulin injection with when you want to eat. From the chart above, the “onset” column provides useful information. Again, the “onset” refers to when the insulin will begin to work in your body. You want the insulin to begin working in your body at the same time your food is being absorbed. This timing will help avoid low blood sugar levels.

  • Rapid acting insulins. If you take Novolog or another rapid-acting injectable insulin, you should self inject about 15 minutes before mealtime.
  • Short-acting insulins. Such as regular insulin, should be taken 30 to 60 minutes before a meal. Intermediate-acting insulins should be taken up to 1 hour prior to a meal.
  • Pre-mixed insulins. Depending on the product used, premixed solutions should be taken 10 minutes or 30 to 45 minutes before mealtime.

Exceptions to Insulin Dosing & Timing

Injections of long-acting insulins are not “timed” to mealtime because of their long duration of action. Levemir is taken once or twice a day irrespective of mealtime. Lantus is only administered once a day (and should be administered at the same time each day). Keep in mind that these long-acting insulins may need to be given with shorter-acting insulin products –depending on your individual situation — that will likely need to be “timed” with mealtime. Some people with type 2 diabetes may be given long acting insulin to be used in combination with an oral drug as well.

Finally, the rapid-acting products can also be taken immediately after a meal (rather than 15 minutes before mealtime). Some products can also be administered at bedtime.

For more information about when to take insulin, read the “dosing and administration” section of the insulin product package insert that came with your insulin product or call your doctor.