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Treatment

MEDICATION

Diet Control, Oral Medication and Insulin Injections are the treatment options in diabetes mellitus.

Drugs that are taken orally work in two ways. One group of drugs stimulates (sulfonylureas) the pancreas to secrete more insulin. The other group of drugs reduce blood sugar levels in other ways. The biguanide family of medicines reduces blood sugar levels by possibly slowing down the gastrointestinal absorption of glucose and by increasing the uptake of glucose by the skeletal muscle.

For Insulin Users

When insulin is injected into the tissue beneath the skin (subcutaneous tissue) it remains there until it has all been absorbed into the blood. Different types of insulin preparations are distinguished by the speed at which the injected insulin is absorbed into the blood (onset of action) and by the time it takes for all the injected insulin to be absorbed (duration of action).

Rapid-acting insulin

This form of insulin has a quick onset and a short duration of action. Unlike some other types of insulin, it is clear. Rapid-acting insulins such as Actrapid® reach the blood and begin to lower blood sugar approximately 1/2 hour after injection. Since nutrients from food are absorbed quickly from the intestine into the blood stream, insulin should be injected 1/2 hour before a meal.

Intermediate-acting insulin

This insulin is combined with a substance which slows absorption into the blood. The combination of insulin and a slowing substance usually results in the formation of crystals, which give the liquid a cloudy look. The insulin crystals must be mixed evenly in the liquid before each injection. Intermediate-acting insulins such as Insulatard® take approximately 1 1/2 hours before the first insulin molecules reach the blood. The largest amount arrives between 4 and 12 hours after the injection. It takes about 24 hours for the whole dose to be absorbed.

Premixed insulins

There are also ready-made mixtures of rapid-acting and intermediate-acting insulins. The Mixtard® series, for example, provides several different premixed combinations containing from 10-50% rapid-acting insulin and 90-50% intermediate-acting insulin.

Sometimes it is beneficial to use a combination of insulins with different absorption and duration times. Ready-made mixtures of rapid-acting and intermediate-acting insulins are available. Mixtard®30, for example, combines 30% rapid-acting with 70% intermediate-acting insulin.

Where and how to inject insulin

The figure to the right shows the various areas recommended for insulin injection. To ensure regular absorption of insulin, it's important to vary the location of your injections and not to inject repeatedly in the same spot.

When injecting insulin, the needle should go deep enough to reach the subcutaneous tissue but not so deep that you hit a muscle. It is not dangerous to inject insulin into a muscle, but it is not advised because the insulin's absorption and duration times will be affected. Your doctor will instruct you precisely as to how to inject yourself.

Injection devices

The development of injection devices like NovoLet® and NovoPen®3 has made injecting insulin much more convenient. Designed as a single compact unit, they eliminate the mixing and measuring required by traditional syringes and vials. Injection devices of this type are often referred to as insulin "pens" because they are designed to resemble an ordinary fountain pen and appear more discreet.

NovoLet® is the simplest insulin injection device available. It is completely disposable and prefilled with insulin for several days' use. Once emptied, the entire unit can be disposed of.

With insulin pen systems such as NovoPen®3, you simply insert a replaceable insulin cartridge called a Penfill® cartridge. Each cartridge contains enough insulin for several days' use. Another advance has been the development of ultra-thin, silicone coated needles such as NovoFine®. These needles are so thin they cause virtually no discomfort during injection.

How to store insulin

The best place to store insulin is in the refrigerator. If that is not possible, keep it in the coolest place available. The important factors to avoid are extremes of temperature, sunlight and shaking. Insulin is relatively stable and if stored correctly will maintain its full potency until the expiration date. Here are a few tips for storing your insulin - An opened vial of insulin will remain at room temperature for about six weeks without refrigeration. So once you start a vial of insulin you may not need to refrigerate it after each use. In very hot climates insulin will lose its potency more quickly if not refrigerated.

You can keep Penfill® cartridges or NovoLet® syringes at room temperature during use.

Except for a brief exposure (a few moments) always keep insulin out of direct sunlight. Sunlight gradually degrades insulin and gives it a yellow-brown colour. Never store insulin in a freezer or in a very cold place. Insulin that has been frozen should never be used. When travelling by plane, always carry insulin with you in your cabin baggage since the temperature in the hold of an airplane can be well below freezing during flight.

Do not keep insulin in places that may become very hot, like the glove compartment of a car or on top of a TV set.

Hours of constant shaking - during long car trips, for example - may cause the insulin to clump or form a white layer on the inside of the glass container. Do not use insulin if this has happened.


Hypoglycaemia

Many diabetics using tablets or insulin occasionally experience some form of hypoglycaemic reaction when their blood sugar drops too low. It may occur at any time. Quite often it occurs before a meal or after an exercise, sometimes up to 10 hours after an exercise.

Symptoms vary from person to person, but typical early signals are:

  • Sweating
  • Shaking
Other symptoms include feeling:
  1. Faint
  2. Cold
  3. Irritable
  4. Hungry
  5. Tired
  6. Confused
  • Headache and blurred vision are other possible symptoms.

Managing Hypoglycaemia

As soon as early symptoms occur, eat 15-20 grams of sugar or drink 200 ml of fruit juice or milk. If the symptoms don't disappear within 10 minutes, eat an additional 15-20 grams and, if possible, measure your blood sugar. Follow this with some slowly digested carbohydrates like bread. If you experience such symptoms and do not eat sugar tablets (or some similar source of sugar like fruit juice or milk) you could lose consciousness.

In general, there is little risk involved in hypoglycaemia. Even if you do become unconscious, your body will mobilise a number of hormones to help your liver release glucose into your blood. In severe cases of hypoglycaemia, it may be necessary for a friend or relative to call a doctor, who will inject either glucagon (one of the hormones that helps the liver release sugar) or a solution of sugar into your blood.

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