It is hard to understand how our body reacts to certain medications, foods, and exercise routines. For diabetics it is especially hard to predict which medications work which way, since more often then not they have to take more than one medication in order to keep the blood sugars under control.
Most people are unaware of the side effects of mixing medications. Although educating patients with prescription medications is done by the pharmacists,most patients could also benefit from getting detailed explanation about the medications they are prescribed and possible side effects by the doctors' offices. Insulin is one such medication if not taken properly could result in adverse affects. Insulin injections and their effects on patients with type1 or type2 diabetes are not discussed to the extent by most doctors, especially if they are not endocrinologists. Most patients rely on their primary care physicians for their diabetic care and management but do not get proper education regarding their insulin intake by them. A one-on-one session about the medications that are prescribed by the doctor could help the patients tremendously at their homes.
Insulin is prescribed for patients who have type 1 diabetes since their pancreas cannot produce it in the body. It is given to patients with type 2 diabetes when they cannot produce enough or even if produced in enough quantities it is not supplied in the right time for controlling blood sugar. Depending on a person's needs, insulin is given in different strengths and forms.
Different kinds of insulin injections are:
1. Short-acting injections that are given before the breakfast in order to control the blood sugars right after the morning meals and also as a result of high levels of fasting blood sugars. Patients who are on this dose have to take their food within 15 minutes after taking the injection. Usually the afternoon meals are recommended to be taken on time in order to avoid hypoglycemia since this kind of insulin is given to control sugars for the short period of time.
2. Bolus doses: are given at lunch or dinner time in order to control peak levels of sugars so as not to go into hyperglycemia. These doses are usually higher than short acting doses.
3. Long-acting insulin injections are given to control the blood sugar levels for a period of 20 hours or more. These are taken commonly at dinner time in order to control blood sugars all through the night and part of the day.
4. Insulin pumps are machines that are similar to a cell phone in size. They contain three parts: one to hold the medication, another is battery-operated to program different doses at different times according to food intake, and the third part consists of a tube and needle that is inserted into the subcutaneous tissue in the abdominal area. The needle is changed every three days. The whole machine could be mounted at the waist with a strap to hold in place. Bolus doses are given at meal times and every five minutes throughout the day a small amount of insulin is released mimicking the function of pancreas in order to control the sugars all day. Insulin pumps are usually prescribed for patients with type 1 diabetes or patients with type 2 who over time become chronic diabetes in order to prevent complications.
5. Some patients are prescribed insulin injections all through the day, maybe three to five times, in small doses. These patients usually take short-acting and long-acting insulin injections along with the oral medications.
Even though insulin injections are given to prevent high levels of blood sugar, over a period of time they result in weight gain. Short acting insulin injections tend to cause a person to gain weight rapidly as opposed to long acting ones. It could be because of the need for taking food in order to avoid hypoglycemia or patients develop hunger with increased doses. Either way one should be careful in avoiding foods that are high in fats or carbohydrates while taking these injections.
Hypoglycemia is very common in patients who take insulin injections. Some forms of insulin drops the sugars very rapidly so that the patients don't even realize what is happening to them until it is too late. Common signs of hypoglycemia include, shaking, shivers, cold sweats, dizziness, rapid heart beat, and confusion among others. Patients taking insulin injections are recommended to keep sugar tablets or candy with them all the time. Even though orange juice is recommended to be taken when going through hypoglycemia, I found it raises blood sugar levels too rapidly. A glass of milk is better than orange juice as the amount of sugar in it is less and it takes time for the sugars to mix in the blood stream. A piece of cheese, fruit or crackers could be helpful if any meals are not possible to be taken on time in order to avoid low blood sugars. Patients who exercise while on insulin should be aware of hypoglycemia and take proper precautions. A small snack half an hour before doing exercise is helpful in avoiding low sugars.
Diabetic educators can be reached for elderly patients or parents of young children with insulin needs to answer questions and help determine how to handle certain emergency situations like insulin overdose. Caretakers of elderly patients should be educated or trained to handle the injections properly. Hand washing and personal hygiene are important when handling a patient's insulin injections as they might cause infections. Caregivers should be instructed on the proper dietary needs of elderly diabetic patients. Temperature control is extremely important in storing insulin as it loses effect with extreme hot temperatures. Insulin can be kept outside while traveling for a twenty four hour period providing that the temperatures are moderate. When insulin in the bottle is milky or cloudy instead of clear liquid it is time to discard and start another new bottle. Alcohol swabs are important to be used to clean the area of injection before and after to avoid infections.
Common sites for insulin injections are the upper outer arm, upper thigh, or two inches from navel on the lower abdomen. Alternating the sites could help prevent forming painful nodules. In order to inject the syringe one should raise the tissue of the intended area between the thumb and index finger. The needle should be inserted straight down rather than slanted. Slanted needles tends to cut through the muscle causing pain with difficulty in going in. After injecting the insulin, the needle should be left in place for a matter of two to three seconds so small amounts of insulin is not leaked when taking it out. The abdominal area is considered the best place to inject insulin as it is closer to the small intestine where the blood is processed. The abdominal area consists of more fat tissue that absorbs the insulin fast and supplies it to the blood stream faster. Since fat is softer than tissue or muscle it is less painful injecting the insulin. Injecting around the navel with a circular pattern can prevent the chances of doing it twice in the same area.
Monitoring blood sugars before or after meals for several days and averaging them out will give an idea on how much the blood sugars are running at different times and insulin doses could be increased or decreased in order to avoid hypoglycemia or hyperglycemia. The patient's physician should be monitoring the levels and adjusting the doses in a timely manner. Appointments should be given to patients who get their lab work done every three months on average, and these appointments should be given on a priority basis in order to avoid delays in adjusting doses and further complications. Copies of the detailed consultation report should be given to patient at the end of each visit that explains adjusted doses, new medications, side effects, and functions of specific medications in laymen's terms. Most doctors now charge a fee for the medical records to be released to the patients or the concerning doctors. It is the patients' responsibility to keep up with the medical care that they are getting. Patients should keep copies of all the medical procedures, medicines, and doctors' contact numbers in case of emergencies or if doctors are changed. Questions should be asked if any concerns regarding medications and possible side affects arise. Most patients follow a specific dosage their doctors order for years without consulting the doctors to see if any change should be made to adjust to the new levels. Most doctors just tell the patients to keep continuing the same doses even though sometimes the reports show numbers differently. A tight control over the overall health of the patient is not only important but is essential because, OUR LIFE MATTERS.