Insulin

Insulin

All people with Type 1 and many Type 2 diabetes need insulin to control their blood glucose. The most important thing is to live well with diabetes, right? Yes, but people often feel anxious when they know they will have to start taking insulin therapy. This is normal. Some people are afraid of injections, others find it hard to understand the application mechanism.






But when you remember that insulin helps in controlling glucose and can prevent your more severe complications, that can be an incentive, right?

In addition, modern application forms and needles make the use of insulin much simpler and more comfortable and virtually painless today. The needles become smaller and more comfortable, both in the new disposable syringes and, even more, with the use in pens of application of insulin, which makes its application much simpler, more precise and comfortable.

In principle, the use of insulin seems a little complicated, but you should rely on your doctor and multidisciplinary team to get that understanding. It's simpler and easier than it sounds. And remember: insulin is the most effective drug for controlling blood glucose.
Types of insulin

There are several types of insulin available today for the treatment of diabetes and they differ by how long they stay active in the body, how long they take to start acting, and with the situation on the day when they are most effective.

By understanding how insulin works, you can plan your meals, snacks, and exercises. Insulin treatment should fit both your lifestyle and your glucose control needs. Remember, the use is very individual and not always get right at first. It is important to be patient.

There is no 'one size fits all' when it comes to insulin treatment and the diabetes management plan. Their goals, age, overall health, daily risk factors, and activities are considered, so each therapy is individual.

Human insulin (NPH and Regular) used in the treatment of diabetes is currently developed in the laboratory, using recombinant DNA technology. The so-called 'regular' insulin is identical to the human insulin in its structure. NPH is associated with two substances (protamine and zinc) that promote a more prolonged effect.

Insulin can not be taken in pills or capsules because the digestive juices in the stomach interfere with its effectiveness. With the advancement of research in the area, this reality may be feasible in the future. An insulin administered by the inhaled route is to be launched in the United States in the year 2015.

The most modern insulins, called analogs (or analogs of insulin), are produced from human insulin and modified to have a shorter action (Lispro (Humalog®), Aspart (NovoRapid®) or Glulisine (Apidra®)). or more action There are several types of premixtures: NPH insulin + Regular insulin, in the ratio of insulin to insulin, and insulin to insulin. 70/30, long-acting analogs + fast acting analogs (Humalog® Mix 25 and 50, Novomix®30).

Insulins can come in jars and pens. The vials are 10 ml (for use with insulin syringes) and refills, are 3 ml (used in insulin dispensing pens), as well as can come in disposable application pens. Another form of insulin administration is the insulin pump. Regardless of the method, it is important to understand some concepts, check:

Insulin units

Insulin identified with U-100 means that there are 100 units of insulin per milliliter (ml) of liquid in the vial. The patient should always respect the number of units prescribed by the doctor. The specialist's assistance is critical in determining the proper dosage. Currently, in Brazil all the insulins sold are U-100.

Basal Insulin and Bolus

The pancreas secretes insulin in two ways: basal and bolus. As basal is meant a constant secretion of insulin that remains at low levels in the blood the whole time and is produced in the form of 'continuous drops', maintaining the release of glucose to the cells of the body; while the term bolus refers to larger amounts of insulin that are released into the bloodstream at times of greatest need, such as at meals, or when there is an increase in blood sugar.

The fast-acting insulins found in pharmacies are used to provide action similar to these insulin boluses, which occur in physiology, needed primarily at meals. In contrast, injections of intermediate-acting (NPH) and slow-acting insulin (analogs) act similarly to basal delivery and are applied in 1 or 2 daily applications (Glargina, Levemir, and NPH) or up to 3 times a day (NPH). in order to provide the "basal" component of insulinization. This is why, for good, safe and effective insulin treatment, to minimize the risk of hypoglycemia, several daily insulin applications are used in the so-called basal-bolus regimen.

People with Type 1 diabetes most often require a therapeutic program that releases both basal and bolus insulin in their treatment, which is usually done in an intensive manner, ie involving 3 or more daily insulin. Treatment for Type 2 diabetes is variable. Some patients only need the basal, since the pancreas still supplies the insulin needed for meals. In these cases, a daily application before bedtime is usually sufficient. Others need basal insulin and bolus, in order to control blood glucose at different times of the day.

Some people with Type 2 diabetes do not need insulin injections. These are the many cases in which oral medicines combined with healthy eating and regular exercise can provide good glycemic control.

The personalized insulin therapy program can include more than one type of insulin, used at different times of the day, at the same time, or even in the same application. The market offers some pre-mixed insulin options that allow the patient to apply two types of insulin in a single application. In other cases, people with diabetes will make them





own combination by adjusting the doses of the ultra-fast acting insulin according to the diet (amount of carbohydrates) or measured blood glucose.


Characteristics of the types of insulins

The table below describes the characteristics of the types of insulin available. The onset of action is the rate at which the insulin starts working after the injection; the peak is the time at which insulin reaches the maximum in regard to the reduction of glycemia and duration is the time in which insulin acts in the body. Reference to the data below is U-100 human insulin.

How to apply?

When you are taking an insulin treatment, you need to check your glucose levels regularly. This is critical to assessing treatment and verifying that goals are being met. The 'fine tuning' of these goals and doses of insulin and medications takes some time and is affected by lifestyle and eventually by other diseases. Good news is that newer equipment, with smaller needles, is making insulin application easier and easier.

The pens can be reusable, in which you buy the refill of 3 mL of insulin to load the pen. In this case, it is important to note that the pens are specific to each refill manufacturer. There are also disposable pens that are already loaded with insulin and when they are finished they are dispensed and a new pen is picked up, so it does not require the exchange of refills, making the use even simpler.

The pens are easy to carry and use and guarantee the correct prescribed dose since they reduce the chance of dose errors, which is very common in day-to-day insulin therapy (see table in the Insulin Types section). Except for premature insulins, the person should have a separate pen for each type of insulin prescribed. If you have to take two types at the same time, apply the respective dose of each pen separately. Read the instruction manual carefully.

Syringes currently have much smaller needles, up to 6mm. They allow application with minimal pain. If you need to take two types of insulin at the same time and they are available in bottles, for example, NPH and Regular insulin, you can mix both types and apply only one application in the same syringe. When doing this you should be aware of the dose of each insulin component by first aspirating Regular insulin and then insulin N, in that order.

Insulin pumps are a safe and efficient way of supplying insulin to the body. They are used more often by people who need multiple injections throughout the day. The kit includes a small catheter, which is inserted under the skin. The 'Pump' itself is used externally. It is the size of the old pagers, that is, it is smaller than a smartphone.

Your doctor will indicate which option is best for you.

Tips for Insulin Application

If you use the pen, be sure to check the insulin flow before applying the dose. Set the unit to two units and, with the tip of the pen facing upright, push the application button, repeating until the insulin appears.

After checking the flow, mark the dose to be applied. Insert the needle into the skin at a 90 ° (perpendicular) angle. Push the button until you see the number 0. Count ten seconds before removing the needle from the skin to ensure the dose has been fully applied. With larger needles, greater than 8 mm, you may need to gently lift the skin prior to injection, the so-called "fold".

It is very important to rotate the sites of the body on which you apply the insulin, to prevent nodules and local changes resulting from the repeated application of insulin, called lipodystrophies. For example, you can apply on one side of the abdomen and then the other side in addition to choosing different parts on each side of the abdomen. Avoid an area of five inches around the navel and also avoid applying over scars.

Local Pros Cons

Abdomen (avoid an area of 5 cm around the navel) Easy access, insulin is absorbed quickly and consistently None

Buttocks and thighs Absorption slower than abdomen and arms Slower absorption and more affected by exercises

Outside of the arm After the abdomen, the arm is the region that provides faster absorption. More difficult access for self-application

Storage

Insulin that has not yet been opened should be stored in the refrigerator between 2 and 8 ° C. Once opened, it can be left at room temperature (less than 30 ° C) for 30 days, with the exception of detemir (Levemir), which may remain at room temperature for up to 42 days. It is important to keep all types of insulin away from light and heat. Discard the insulin that has been exposed to more than 30 ° C or frozen. Do not use medicines after the expiration date.

To help you keep track of the date, the user can note the day the bottle was opened on the label. Or put a piece of adhesive tape stuck to the date the insulin was first opened. If you are going to spend an extended period outdoors, on very cold or hot days, you should store the insulin in a styrofoam bag, possibly containing ice sheets, as long as it has no direct contact with insulin.

Pencil needles

Pen needles should be used only once because they are very thin and reuse can cause pain. Do not leave the needle in the pen, as this can allow leaks and also the air in the cartridge.




Needle Disposal

Pencil needles and lancets should be discarded in their own packaging, which can be found in pharmacies, for example in a hard plastic bottle, and then taken to the Health Post for proper disposal.

Tips for measuring glucose

There is a wide variety of devices, lancets, and techniques for self-monitoring of glucose. Talk to your doctor and the members of your multidisciplinary team to help you test and choose the best one for you.

Do not use alcohol

It is important to keep your hands clean before taking the test. Small traces of food at the fingertips can contaminate the blood sample, for example. But rubbing alcohol in your hands is unnecessary and can thin the skin, making the exam more painful over time. Wash your hands with soap and water.

Facilitate blood flow

If you often have to squeeze the tip of your finger to get the sample, try some of these tips: use warm water to wash your hands, and then let your arm extend up the body in an upright position for one minute.


Gently massage your finger from base to tip. After using the lancet, use a clean handkerchief to press the tip of your finger firmly for a few seconds until the bleeding stops and bruises are prevented.

Lancets

Ideally, lancets should only be used once. Eventually to reduce costs, one can discuss the reuse considering each case according to the guidance of the doctor or nurse, an educator in diabetes. In addition, there are devices that allow you to regulate the depth at which the lancet penetrates the skin. The greater the number than the gradation, the deeper the lancet.

Talk to your doctor or nurse on your team and choose as little depth as possible without affecting the quality of the sample.

Vary the position

Avoid performing the test in the same place. Pretend the sides of the fingertips, which are less enervated and the picadinha there may be less uncomfortable than in the soft area in the middle of the tip of the finger.

Although some equipment indicates that you can also sample the antrum or thigh, these regions of the body may not be the most indicated when your blood sugar level is rapidly changing, such as after-meal periods, physical activity, insulin application or episodes of hypoglycemia.

Talk to your doctor or multidisciplinary team members about alternative sites appropriate for you.

Use moisturizer

Using hand cream regularly will help keep your fingertips soft and testing will be easier. Remember to wash your hands and remove the cream before doing the test.

Converse, clear the doubts

If you are experiencing any major discomfort or pain, talk to your doctor and the team members accompanying your treatment. Do not be shy and do not think you simply "have to put up with it".

In many cases, something may be done incorrectly or it may be done in a way that fits your style, skin, and ability better.

Insulin is an essential hormone. If it is not produced and used correctly by the body, it can cause problems even in the gym.

Insulin is one of the most important hormones in the body that, along with glucagon, controls the level of blood glucose and the uptake of this molecule by the cells of the whole tissue.

Without insulin, glucose gets trapped in the blood, which causes hyperglycemia and causes the body's cells to "starve" and fail to develop, even into catabolism.

An even more common possibility is that the body even has insulin, but the cells have become resistant to that hormone.

But after all, how can this insulin resistance affect your health and your muscle development? How does this relate to diabetes? What about the metabolic syndrome? How to deal with these conditions?

The doubts are many, so let's stop coaxing and start explaining. Check out!

WHAT IS INSULIN?

Insulin is a hormone produced by the so-called beta cells of the pancreas, a long thin organ behind the stomach.

How does it work in the body?

Upon release into the bloodstream, insulin binds to glucose transport channels in muscle, liver and fat cells.

Thus, it allows the glucose that was in the blood to pass into the cell and be burned to generate energy or stored in the form of glycogen or fat.


As all sugars, carbohydrates, and starches in foods turn into glucose during digestion, you can already understand the importance of insulin to the functioning of the body.

Without insulin, you can not use the glucose present in bread, pasta, fruits, milk, and so on.

How is insulin secretion controlled?

Pancreas cells are sensitive to blood glucose levels and use this parameter to determine whether or not insulin needs to be secreted.

So after a meal, when the intestine absorbs all the nutrients and the blood is full of glucose, the beta cells begin to release insulin.

If you stick your finger on the meter and measure the capillary blood glucose, it is normal to find values up to 200 mg / dL, which would already be considered diabetes in a fasting blood glucose.

But when everything is working well in the body, the pancreas begins to release the insulin which will cause the glucose to be picked up by the cells and the blood glucose level back to normal.

And what happens when the person is fasting?

When you have been fasting for a long time and glucose levels are dropping, the pancreas releases another hormone called glucagon and produced by the alpha cells.

Glucagon has the opposite effect of insulin, acting on glycogen and fat stores in the body to produce substances that can be used by cells as a source of energy.

Thus, insulin and glucagon are always in balance according to the level of blood glucose. If insulin exaggerates and lowers glycemia, glucagon comes into play and if glucagon exaggerates and blood glucose goes up too much, insulin comes into play.

How it works on muscles

Insulin stimulates muscle cells to pick up glucose and burn it to generate energy. Any small excess is converted to glycogen and stored there in the same muscles.

How do you act on adipocytes?

Fat cells (or adipocytes) are stimulated to store fat by insulin. This means either capturing excess glucose and turning it into fat or blocking the breakdown of that fat.

WHAT IS INSULIN RESISTANCE?

At first, there is nothing wrong with the pancreas or the production of insulin. The error is in the cells of the body to which the insulin binds.

Thus, insulin resistance occurs when the recipients of muscle and liver cells fail to recognize insulin well and therefore can not catch the excess glucose in the blood.

To solve the problem the pancreas tries to produce more and more insulin.

Already in fat cells, insulin increases the action of the enzyme lipolipase, which stimulates fat storage and blocks the burning of this substance.

Thus, they end up receiving some of that excess glucose and converting it into fat. As insulin levels remain high, the break does not occur and the loss of this deposit becomes difficult.

Symptoms of Insulin Resistance

Insulin resistance does not generate specific symptoms and so many people spend years having this picture without even imagining.

One change that may indicate insulin resistance, however, is the appearance of acanthosis nigricans at the base of the neck and at folded regions, which makes the skin of these sites darker and thicker.

The Consequences of Insulin Resistance

If the cells are resistant to insulin, the production of insulin by the pancreas has to be increased to generate the same result.

If one insulin unit was able to get five units of glucose removed from the blood, two units of insulin are now needed to remove that same amount of glucose.

Over time, three units of insulin are needed, then four, then five, and the pancreas can no longer supply that demand and the glucose level is high in the blood.

If your cells are not receiving energy, you end up eating more to try to supply the energy cells. But this only increases the blood glucose even more, without solving the problem.

This state of insulin resistance ends up increasing the accumulation of fat in the body, raising cholesterol and triglycerides and inducing the secretion of cortisol - the stress hormone that impairs lean mass gain.

That is, you have already noticed that insulin resistance disrupts the dreams of any marbler.

Does this mean that insulin resistance is the same as diabetes?

More or less.

Insulin resistance is what accounts for the onset of type 2 diabetes mellitus, so everyone who has type 2 diabetes has insulin resistance but not everyone with insulin resistance has type 2 diabetes, since despite the resistance the person may be at a stage where the pancreas still accounts for increased insulin production.

Type 1 diabetes has something to do with a pancreas problem that leads to a drop in insulin production. The sensitivity of muscle, liver and fat cells to this hormone has



remained the same but as the amount of hormone decreased glucose will also be left in the blood.

It is also possible that someone with type 1 diabetes develops type 2 diabetes throughout life, as we will see below.

How to know if you have insulin resistance

For laboratory diagnosis of insulin resistance, it would be necessary to measure the level of insulin in the blood, which would be high in this condition. But this test is not yet performed in medical practice and is reserved for research environments.

Therefore, insulin resistance is ultimately inferred by the physician according to his history and the findings of the physical examination.

HOW THIS CAN AFFECT YOUR PERFORMANCE IN THE ACADEMY

With muscle cells resistant to insulin and failing to capture blood glucose well, the metabolism gets impaired and slowed down.

So your muscles cannot get as high as they could because they can not get enough fuel. This ends up generating a lack of energy absurd in a short time, which makes you the greatest chicken in the academy.

In addition, adipocytes insist on absorbing glucose and keeping it well stored in the form of fat, not allowing weight loss.

Without a good glucose metabolism, it's impossible to lose your belly and grow at the speed you want.

WHAT CAUSES THAT RESISTANCE

Genetic factors contribute a lot to the picture - which means that if your parents or older siblings present resistance to insulin or type 2 diabetes the chance of you also having this condition increases.

It is as if it were part of the program of the cell as you get older also become more resistant to insulin. But the environmental factors are what really make the difference.

Abdominal obesity, for example, causes adipocytes to produce large amounts of inflammatory substances that increase the risk of atherosclerosis, raise cholesterol and blood pressure, and increase peripheral resistance to insulin.

The food rich in simple and processed carbohydrates - white bread, sweets, traditional rice, sugar, etc. - causes the blood sugar to rise rapidly since these foods are digested and absorbed without much difficulty.

With peak glycemia, there is also a peak insulin. When this occurs at one time or another it has no problem, but this constant insulin overload of the body makes the cells less sensitive to insulin and stimulates fat deposition.

A sedentary lifestyle is also another important factor. If the body does not exercise, the muscle cells become lazier and do not know how to get large amounts of glucose from the blood since they never had to do that.

If you exercise often, you train all the molecular machinery of cells to make better use of the available glucose to produce as much energy as possible and to sensitize to insulin to pick up more glucose and go against insulin resistance.

So even if you are prone to insulin resistance or do you already have the chart you can counterbalance it with exercises?

Of course! The good thing is that exercising regularly is the solution to all problems!

As you work out in the gym - and here we are talking about both aerobic and weight training - it burns calories, loses weight, and teaches muscle how to best use glucose.

That is, it solves both obesity and sedentary lifestyle and overrides environmental factors to any gene that wants to spoil its scheme.

WHAT HAPPENS IF YOU DO NOT EXERCISE?

Then you fuck it all, basically. As everything is intertwined, the practice of exercises helps in everything and the lack of it hinders everything. That simple.

Without exercise, muscle cells become even lazier and you gain weight depending on your diet, which further worsens the inflammatory state.


And then insulin resistance gets bigger and bigger and it becomes harder to reverse the whole situation, which leads to the metabolic syndrome.

WHAT IS METABOLIC SYNDROME?

Metabolic syndrome is a term used to describe a combination of factors - increased bad cholesterol, increased triglycerides, increased abdominal obesity, increased blood pressure and diabetes - which result in an increased risk of cardiovascular disease.

Therefore, obesity - or insulin resistance - is considered the tip of the iceberg. A single factor that indicates that many more things can be wrong in the body.

How do I know if I have metabolic syndrome?

Only the doctor can give the diagnosis of metabolic syndrome, but you only have to meet the following criteria:

abdominal circumference> 88cm in women or greater than 102cm in men;

elevated triglyceride levels;

low levels of HDL - good cholesterol;

Systemic arterial hypertension;

high fasting blood glucose.

How to fight against insulin resistance, type 2 diabetes, and metabolic syndrome?

Exercise and healthy eating are the answer to much of today's health problems.

Physical activity trains the muscle cells to pick up and store glucose in the form of glycogen, in addition to promoting the burning of this molecule.

All this ends up contributing to this tissue respond to the exercises of the academy and you gain lean mass.

Eating rich in complex carbohydrates, fibers, and supplements helps reduce insulin spikes.

Without insulin spikes there is less stimulation to fat accumulation by adipocytes and a greater stimulus to fat burning, making weight loss easier. With less fat, the entire inflammatory level of the body reduces and everything works better.

In addition, it is important to follow the medical guidelines and use the specific drugs against each disease.

Can insulin be used to gain lean mass?

Theoretically, this makes sense since this hormone stimulates the burning of glucose by muscle tissue. In practice, however, the use of insulin by non-diabetics is considered to be hazardous to health and is not recommended.

If the person is healthy and the body is able to keep blood glucose in balance with the release of insulin and glucagon, external insulin administration could unbalance the entire system and generate excessive glucose uptake through the muscle.

With little glucose in the blood, who suffers is the brain, generating symptoms such as dizziness, fainting, and malaise.

In severe cases, if the body can not react with the release of glucagon and the release of glucose into the blood or if the person is fasting, it is possible that the brain does not receive enough glucose and the individual enters a coma.