Diabetes Diabetes Solutions

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  • Insulin for Diabetes 1 and 2

    ßeta-cells in the pancreas are the focus of attention in the study of diabetes. They produce insulin, a hormone that is essential for normal utilization of glucose. Insulin is a signal to muscle and liver cells to uptake glucose. ß-cells are located in the pancreas in the islets of Langerhans in the company of other sensor cells that respond to blood levels of glucose, amino acids, and fatty acids. The islets have a rich blood supply are innervated by the autonomic nervous system. The brain is an important controller of all metabolic activities. Insulin is secreted in regular pulses continuously, providing basal concentrations in the blood. On demand insulin is secreted when blood glucose levels rise.

    Insulin dependent diabetes (DB1) tends to appear in children and is caused by death of the beta cells in the pancreas that secrete insulin. Insulin must be replaced by injection and therefore the disorder is referred to as insulin dependent. DB1 is one of the most common chronic disorders in children. The World Health Organization's Multinational Project for Childhood Diabetes shows that DB1 rare in most Asian, African, and Native American populations. Northern European countries, including Finland and Sweden, have high rates of DB1.

    DB1 is a T-lymphocyte disease in which cytotoxic T-cells recognize antigens on ß-cells. Because of evidence that cow's milk intake can trigger diabetes in rodents, a study of diabetic children showed that antibodies to cow serum albumin and a 17-amino-acid bovine serum albumin peptide appear in some children. These antibodies would bind to a pancreatic beta-cell surface antigen. Marked cells can be destroyed by killer T-lymphocytes.

    Insulin Treatment of DB2

    Eventually, many people with type 2 diabetes lose beta cells and become insulin dependent, They have to take insulin to utilize blood glucose properly.

    Beta-cell function declines progressively creating insulin dependency. In other words type 2 diabetics tend to become type 1, insulin-dependent, diabetics. The rules we have established for non-insulin dependent people still apply. Your food intake and amount of exercise determine your success or failure. The biggest mistake is to eat carelessly and to rely on increasing insulin doses when blood glucose is too high. Success depends on maintaining a stable insulin intake, adjusting food and exercise to keep blood glucose levels within the normal range.

    Hirsch suggested: “Treatment goals for glycemic control in patients with type 2 diabetes are often not achieved or are difficult to maintain as the disease progresses. Too often, insulin therapy is either delayed or is less than optimal. New insulin analogs may help overcome some of the barriers to insulin use. If combination therapy with oral agents does not achieve glycemic control, the addition of a once-daily intermediate- or long-acting insulin is a simple strategy for initiating insulin. The combination of basal insulin with short acting insulin with breakfast and dinner is a better choice. Fixed-ratio, premixed insulin allows 1-2 fewer injections than pre meal insulin but there is increased risk for hypoglycemia if adherence to mealtime and activity schedules is not maintained.” (Irl B. Hirsch. Optimal Initiation of Insulin in Type 2 Diabetes. Medscape General Medicine 7(4):49, 2005.)

    The kind and amount of food you eat interacts with exercise, interacts with the insulin that is injected. You respond to higher blood glucose with corrections in your food, your timing and duration of exercise, and then if necessary, increase the dose of insulin.

    My first choice for starting insulin therapy is Novlin Insulin Mix 50/50, available in 3 mL cartridges and used in a pen delivery system developed by Novo Nordisk. The Novo pen is a marvelous invention that is easy to use and painless. The premixed insulin contains soluble, short-acting insulin and intermediate-acting insulin. One injection per day may suffice, but two injections – one before breakfast and one before dinner is often a better strategy.

    The onset of the short-acting insulin is about 30 minutes and the peak occurs within the next 2 hours. The intermediate-acting insulin has a slower onset and lasts 24 hours; the peak is variable – between 6 to 12 hours. Adjusting insulin doses is a more demanding task than taking pills. A routine of twice a day mixed insulin provides baseline control. Many variables are at play that might require adjusting the dose. The goal is to achieve a normal and stable relationship between insulin doses, eating food and exercise.

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    Managing Diabetes byStephen Gislason MD is a self-help book explains how to manage diabetes. The book offers the good news that the impending disasters are optional if eating and living conditions are changed correctly. Newly diagnosed diabetics should act to design a new diet with increased physical activity.  2018 Edition 170 Pages

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