The Five Insulin Types

December 5th, 2010

Insulin is divided into 5 types: rapid-acting, short-acting (or fast acting), intermediate-acting, long-acting and pre-mixed insulin. The different types of insulin vary in the amount of time until they begin to work (onset), how long they take to achieve the greatest blood concentration and effectiveness (peak) and how long they continue to control blood sugar (duration). The effects of insulin, including onset, peak and duration times, vary from individual to individual and from day to day.

Depending on the brand, rapid-acting insulin has an average onset of from 5 to 15 minutes, peak of 30 minutes to 3 hours, and duration of 3 to 5 hours. It's normally injected with meals, and used in combination with a longer acting insulin.

Short-acting insulin (also called regular insulin) has an average onset of 30 minutes to an hour, peak of 2 to 4 hours, and duration of 4 to 8 hours, depending on if it's injected or used in an insulin pump. It's taken 30 minutes to an hour before a meal, and may be combined with long-acting insulin.

Intermediate-acting insulin (also called NPH insulin or lente insulin) has an average onset of 2 to 4 hours, a peak of 4 to 10 hours, and duration of 10 to 18 hours. It's often used in combination with rapid or short-acting insulin.

The effects of long-acting insulin (sometimes called background insulin or basal insulin) typically cover a full day. There are two types of long-acting insulin: insulin glargine (Lantus) and insulin detemir (Levemir). Typical onset for Lantus is within 4 to 6 hours. Lantus is delivered steadily and so does not peak, and has an average duration of 24 hours.

Typical onset for Levemir insulin is between 2 to 3 hours. Levemir peaks slightly between 8 to 10 hours, and the duration is dose-dependent, between 6 to 23 hours. Long-acting insulin is often used in combination with rapid or short-acting insulin, or an oral diabetes medication in the case of type 2 diabetics.

Premixed insulin is a combination of short and intermediate-acting insulin in the same vial or insulin pen. It's normally taken twice a day before meals.

Artificial Sweeteners Assist in Diabetes Control

January 24th, 2011

sugar cubes

Historically, diabetics have been warned to avoid eating sugar, an almost impossible challenge for those with a sweet tooth. Nowadays, the emphasis has shifted to eating complex carbohydrates with a low glycemic index, and limiting total carbohydrate intake - known as an insulin resistance diet. Diabetics can indulge in the odd sugary treat, but do need to limit their sugar intake more than non-diabetics (especially those who are struggling with diabetes control). Artificial sweeteners provide a convenient way of doing that.

Natural sugars like fructose, honey, corn syrup, molasses, brown sugar, and cane sugar, are simple carbohydrates that quickly raise your blood sugar levels. Reduced calorie sweeteners like sorbital, lactitol, maltitol, mannitol and xylitol are sugar alcohols often used in sugar-free candy, gum and baked goods. They are also a type of carbohydrate and may raise your blood sugar, although not as much as natural sugars. Low calorie sweeteners are artificial sweeteners created in a lab. They don't contain calories, are low or no carb, and do not affect blood glucose levels.

Artificial sweeteners have gotten a bad rap for being "non-natural" and unpleasant tasting over the years, but today's new and improved sweeteners can be a godsend for diabetics who crave sweets. The FDA and the American Diabetes Association both recommend the following low calorie artificial sweeteners as safe for use by non-insulin dependent and insulin dependent diabetics:

1) Aspartame -sold as NutraSweet and Equal. Aspartame may lose some sweetness at high temperatures. It's 160 to 220 times sweeter than sugar. People with a genetic condition called phenylketonuria can't metabolize aspartame.

2) Acesulfame potassium (acesulfame-K) - also known as Sweet One and Sunett. It's 200 times sweeter than sugar. Ace-K is often mixed with other sweeteners to mask its slightly bitter taste, especially in soft drinks. Can be used for cooking and baking.

3) Saccharin - an old stand by, marketed as Sweet N Low and Sugar Twin. Has a slightly bitter aftertaste. Can be used in both hot and cold foods. It's 200 to 300 times sweeter than sugar. Not recommended for pregnant or breastfeeding mothers.

4) Sucralose - this increasingly popular sweetener is a relative newcomer to the market, sold as Splenda. It's 600 times sweeter than sugar. It can be used in cooking and baking, and is being added to a growing number of processed foods.

5) Neotame - a high intensity sweetener made by Nutrasweet. Chemically similar to aspartame, it's an incredible 7,000 to 13,000 times sweeter than sugar. Unlike aspartame, it can be used for baking. Also unlike aspartame, it's safe for use by people with phenylketonuria. Neotame is popular with food manufacturers because the low quantities needed to add sweetness cut production costs.

In addition, Stevia, an all natural sweetener derived from a South American shrub, is being extoled as the sweetener of choice for diabetics. Stevia has no calories, and a zero glycemic index. It's up to 300 times sweeter than sugar, so a little bit goes a long way. Renowned alternative health guru Dr. Andrew Weil writes, "The only non-caloric sweetener I recommend is stevia. It's safe for diabetics and widely used as a sweetener around the world."

Of particular interest to diabetics, stevia has long been considered a therapeutic herb for hyperglycemia, stimulating the release of insulin and enhancing glucose tolerance. It is used as an inexpensive diabetic medication in South America. Interestingly, although it's been shown to lower blood sugar in diabetics, particularly type 2 diabetics, it does not lower blood sugar in people without the condition. Because of it's affect on blood sugar, it is recommended that diabetics test their blood glucose regularly when they first introduce stevia to their diet. They may need to adjust their diabetes medication - some stevia users insist the herb reduced or eliminated their need for insulin therapy. As an added bonus for diabetics with hypertension, stevia is also known to lower high blood pressure.

Diabesity Epidemic Results in More Insulin Dependent Pets

January 24th, 2011

"Diabesity", the twin and entwined epidemics of obesity and diabetes, is not only striking Americans across the socioeconomic spectrum, it is also impacting our pets. As with humans, the number of domestic cats and dogs diagnosed with diabetes is increasing rapidly. About 1 in 400 domestic dogs and cats are believed to have diabetes, compared to just 1 in 2000 only 40 years ago.

Obesity is a major risk factor for diabetes in both people and animals. Obesity contributes to insulin resistance, a condition in which the body no longer responds effectively to insulin. The body overcompensates for the loss in insulin sensitivity by producing more and more insulin, straining and eventually damaging the insulin producing cells in the pancreas. Most people and animals have type 2 diabetes, the form in which their bodies become insulin resistant, as opposed to Type 1, in which an immune system disorder destroys the insulin-producing cells in the pancreas.

Common symptoms of diabetes in pets are similar to those in humans, and include increased thirst, frequent urination, increased appetite, weight loss, shivering, fatigue and chemical or fruity smelling breath. Diabetes control in pets is also much like that in people - a combination of diet, exercise and the same diabetes medication prescribed to humans. Some diabetic cats can be treated with oral diabetes medications, but most cats and almost all dogs require insulin injections. Diabetic dogs are usually treated with twice daily injections of intermediate-acting insulin, while cats usually require one or two daily injections of long-acting insulin.

Interestingly, scientists have discovered that it's not only people and pampered pets that are becoming increasingly obese. Combing through years of data, they discovered that both wild and domestic animals have been steadily gaining weight for decades. Lab rats and street rats have both gained weight, despite the fact that the lab rats' diet and activity levels remained constant. Monkeys in a primate research centre are actually taking in fewer calories than previous generations, but are gaining weight.

Calculating the odds of so many species randomly gaining weight as only one in 10 million, baffled scientists are proposing a number of causes:

1) Viruses - a common virus that causes colds, adenovirus-36, is known to direct stem cells to turn into fat cells.

2) Global warming - As temperatures rise, living creatures don't have to expend as much energy to keep warm.

3) Chemicals -endocrine disrupters such as the chemical tributyltin, flame retardants and the organic compounds PCBs and BPA have all been linked to obesity.

4) Sleep deprivation - Lack of sleep has been linked to weight gain. A related theory is that changes in the amount of time spent in light or dark environments changes eating habits.

5) Nitrates - Nitrates in processed foods and in dog food have been linked to weight gain.

It's most likely that a variety of environmental factors are driving the obesity epidemic and the related diabetes epidemic. The best way to combat "diabesity" for humans and pets alike remains a low carbohydrate and low glycemic index (dubbed insulin resistance) diet, adequate physical activity, and, if needed, insulin therapy.

Asthma Inhalers Increase Risk of Diabetes and Insulin Resistance

January 25th, 2011


Use of asthma inhalers containing corticosteroids has been linked to a 34% increase of developing type 2 diabetes, and to accelerated diabetes progression in those already diagnosed with the condition. Higher dose inhalers were linked to even higher risks - a 64% increase in type 2 diabetes diagnoses, and a 34% increase in existing diabetes progressing to the point of requiring insulin therapy.

Theses figures came out of a large Canadian study of the records of more than 380,000 asthma and chronic obstructive pulmonary disease (COPD) patients treated with inhaled corticosteroids. "Patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia, and treatment with high doses of inhaled corticosteroids limited to situations where the benefit is clear," warn the researchers, from the Jewish General Hospital and McGill University in Montreal.

More than 30,000 of the asthma/COPD patients included in the study were diagnosed with diabetes over a span of five and a half years -over 14 patients per 1000 inhalers. Nearly 2100 patients who had been previously diagnosed with diabetes experienced a deterioration in their condition, going from controlling blood sugar with oral diabetes medication torelying on insulin injections.

Dr. Stuart Weiss, an endocrinologist at the New York Medical Center makes the point that the issue may be a common underlying cause of both diabetes and asthma/COPD, rather than corticosteroids. "We know that steroids increase insulin resistance, and that people treated with steroids require more aggressive diabetes management," he says, "What may be at the root of this problem is the fact that those who are most at risk for diabetes are the same people who have the worst asthma and COPD that requires steroid treatment in the first place." Weiss believes that "the overconsumption of processed foods and the lack of consumption of green vegetables" lead to pre-inflammatory conditions that raise the risk of both diabetes and asthma/COPD. He warns that if Americans don't improve their diets "the incidence of both these diseases will continue to go up at a dramatic rate."

DR. Rohit Katial, a professor of medicine at National Jewish Health, is concerned that the study contained no information about obesity, a significant risk factor for both diabetes and respiratory problems. "For the people on higher doses of medications, was their BMI (body mass index) higher? We don't know."

What the medical experts do agree upon is the need for doctors to prescribe the lowest possible dose of corticosteroids to asthma and COPD patients, and to educate patients about the risks of insulin resistance, becoming insulin dependent, and the possible need for more intensive insulin therapy.

Diabetes and Depression are a "Double Whammy" That Lower Life Expectancy

January 25th, 2011

A ten-year study of almost 80,000 women conducted by the Harvard School of Public Health established a disturbing link between diabetes, depression and the risk of premature death. Women with diabetes had a 35% increased risk of death; women with depression had a 44% increased risk of dying; and those with both diabetes and depression were at almost double the risk of death as women with neither condition.

The risk of dying from cardiovascular disease (heart disease) were even more startling, especially for women with diabetes. Diabetics were at a 67% greater risk of dying from heart disease; depressed women were at a 35% increased risk, and women with both conditions faced a 270% greater risk of dying from heart disease than the general population. The study's lead researcher, Harvard Medical School professor Dr. Frank Hu, calls the combination of diabetes and depression "double whammies". "People with both conditions are at very high risk of death," he stresses.

Previous studies have shown that diabetics are more than twice as likely as the average population to suffer from depression, especially diabetics who are insulin dependent. Conversely, depression has been discovered to be a risk factor for diabetes. Women with depression are about 17% more likely to develop diabetes than non-depressed women, and those who taking antidepressant medication are at 25% greater risk.

But the link between diabetes and depression remains "chicken and egg". Does having a chronic illness requiring lifestyle restrictions and complicated insulin therapy like diabetes cause depression, or are people with depression more prone to developing diabetes? Do antidepressants have an impact on blood sugar levels? Does diabetes medication set the stage for depression? Do diabetics who are depressed neglect the self care necessary for effective diabetes control? Or do both conditions have an underlying cause or causes in common, such as stress, smoking, poor diet, and a lack of exercise?

"People usually think of these as two isolated conditions, but there is growing evidence that they are linked behaviorally and biologically," says Hu, "This date provides strong evidence that we should not consider these two isolated conditions any longer."

"The combination of diabetes and depression needs to be addressed," agrees Dr. Luigi Meneghini of the University of the Miami Miller School of Medicine Diabetes Research Institute. Meneghini points out that many diabetics with depression go undiagnosed, and stresses the need for more awareness among both doctors and patients.

Whatever the connections between diabetes, depression, and depression and diabetes medication, it's well established that a healthy weight, a healthy diet and regular exercise reduce the risk and treat the symptoms of both conditions.

Warnings about Antipsychotics and Diabetic Hyperglycemia Go Unheeded

January 25th, 2011

In 2003, the FDA warned doctors to screen users of antipsychotic drugs for high blood sugar and cholesterol, and to perform ongoing blood glucose monitoring. The American Diabetes Association and the American Psychiatric Association also issued similar warnings. The warnings were a result of accumulating evidence that some atypical antipsychotics caused impaired glucose regulation and increases in cholesterol and body weight, significantly increasing the risk of developing or worsening diabetes.

But a recent analysis of almost 110,000 Medicaid patients from three different states taking antipsychotics found that the recommended screening and monitoring simply never happened.

"The existing baseline screening and ongoing monitoring of glucose and lipid levels in these patients was already pretty low, and the FDA warning really had no impact in changing that," says Daniel Hartung, an assistant professor in Oregon State University's College of Pharmacy, "The side effects that can be caused by these new types of antipsychotic medications, some of which were approved in the 1990s, are not trivial," warns Hartung, "Increases in blood sugar, cholesterol and body weight can lead to diabetes in some cases, and this patient group already has a problem with diabetes that's almost twice that of the average population."

Canadian researchers who studied the use of antipsychotic drugs in seniors with diabetes are also calling for enhanced glucose monitoring in patients beginning antipsychotic therapy, especially insulin dependent seniors. The researchers found diabetic seniors being treated with antipsychotics were at significantly increased risk of hospitalization for high blood sugar. "The risk of diabetes may be partly related to chronic effects of the weight gain associated with antipsychotic agents," wrote the authors of that study, "However, case reports of acute hyperglycemia [high blood sugar] after the initiation of therapy with these drugs suggest that they may also be associated with acute glycemic changes."

The researchers discovered 11% of their almost 14,000 diabetic study participants taking antipsychotics were hospitalized for acute hyperglycemia. The risk of diabetic hyperglycemia was "strikingly high" among those just starting antipsychotic treatment, while the incidence of hospitalization was lower for those patients who had been off antipsychotic medication for at least six months. "Our study indicates that the initiation of antipsychotic therapy represents a critical period during which seniors with diabetes are particularly vulnerable," wrote the researchers.

The large pharmaceutical company Eli Lilly, which markets both antipsychotics and human insulin, has said that the relationship between atypical antipsychotics and diabetic hyperglycemia is not completely understood. The Canadian researchers theorize that the neurotransmitter dopamine plays a role in regulating blood glucose, and that the use of antipsychotics may disrupt it. Other studies suggest that antipsychotics impair glucose regulation by decreasing insulin action, and possibly insulin secretion.

Eli Lilly reports that diabetic hyperglycemia resolves in some patients when they are taken off antipsychotics, but that others need to continue taking diabetes medication. This underlines the importance for doctors to monitor the need to begin or adjust insulin therapy for those patients who have, or are at risk of developing, diabetes who must take antipsychotics.

Long-Acting Insulin Best at Controlling Blood Sugar

February 3rd, 2011

blood glucose testing

As type 2 diabetes progresses, oral diabetes medication doses typically need to be adjusted upwards over time, and a good many type 2 diabetics can expect to end up insulin dependent. There does not appear to be any clear consensus on how best to introduce insulin injections in addition to oral diabetes medications - three times a day with meals, twice daily injections, or a single daily long-acting insulin injection.

Professor Rury Holman, director of the Diabetes Trial Unit at Oxford University, was the principal investigator of a large scale study conducted to determine how best to introduce insulin to control blood sugar levels as type 2 diabetes progresses. "Type 2 diabetes is a progressive condition with the majority of patients eventually requiring insulin therapy," Holman explains.

Holman and his fellow researchers recruited over 700 type 2 diabetes patients whose current medications were not effectively controlling their blood sugar levels. The patients were divided randomly into three groups to compare the effectiveness of the different insulin dosing regimens, and monitored for three years. After the first year, those patients who were still not achieving the necessary blood glucose control were moved to a more complex insulin therapy.

At the end of the three years, the researchers concluded that once-a-day basal insulin and three-times-a-day mealtimes injections were both more effective at controlling blood sugar levels than twice-daily insulin injections. In addition, those who took the once-daily basal insulin had fewer incidents of low blood sugar than those taking three-times-a-day mealtime insulin.

As a result, the researchers advise those beginning insulin therapy to start with a basal insulin, and add a mealtime insulin if required for what they term "the best combination of effectiveness, safety, and treatment satisfaction". "This large scale study strengthens guidelines recommending adding a basal insulin to oral agents when glycemic targets are not met," says Holman.

Insulin Shock Therapy Once Used to Treat Schizophrenia

February 7th, 2011

electric shock

It's not widely known that large doses of insulin were commonly used in psychiatric institutions in the 1940s and 1950s to treat schizophrenia and other mental illness. Insulin shock therapy was regarded as the treatment of choice for schizophrenia for about twenty years, enjoying uncritical acceptance in Europe and America.

The "treatment" was considered a type of shock therapy. Patients were given regular insulin injections to produce five or six diabetic comas a week for weeks at a time. Insulin therapy continued until the patient improved, or until 50 to 60 comas had been induced.

The originator of insulin shock therapy, also known as insulin coma therapy, was Dr. Manfred Sakel. The Polish doctor stumbled upon the therapy accidentally while working in Vienna, when a patient in whom he'd provoked an insulin coma showed a remarkable improvement in her mental functioning.

Sakel practiced and popularized insulin therapy in Europe, and introduced it to the US after he emigrated from Austria to New York in 1936. The practice of insulin dosing continued into the 1960s in America, and for much longer in countries like China and the former Soviet Union.

Sakel believed that the seizures and unconsciousness experienced by psychiatric patients undergoing an insulin-induced hypoglycemic episode resulted in dramatic change in their mental state. In his own words: "My supposition was that some noxious agent weakened the resilience and the metabolism of the nerve cells-blocking the cell off with insulin will force it to conserve functional energy and store it to be available for the reinforcement of the cell."

Sakel claimed that close to ninety percent of his patients improved with insulin shock therapy, but his methods were later called into question and discredited as unscientific. In particular, Sakel was accused of "cherry picking" the patients most likely to improve using insulin therapy, and providing them with extra attention and support.

Patients were said to have been terrified of the procedure, which is now considered to be inhumane. Severe hypoglycemia such as that induced by Sakel can result in permanent brain damage and even death. Some of his insulin therapy patients did indeed suffer adverse effects, including fatalities. While today's antipsychotic medications are not without their side effects, thankfully they are much safer and more effective than anything available just a couple of decades ago.

Why Have Insulin Jet Injectors Never Really Caught On?

February 18th, 2011

An insulin jet injector sounds like a great idea. Intended to be a less painful way of delivering insulin than the traditional insulin syringes or insulin pens, they deliver a fine jet of insulin under such high pressure that it is able to penetrate the skin without a needle.

The first insulin jet injector, dubbed the "peace gun", was invented by a doctor in the 1940s for mass immunization of American troops. It was used right up until 1997, when it's use was discontinued because of concerns around cross-contamination from multiple users. According to all reports, the peace gun was efficient, but painful.

The jet injector was first offered for individual use in 1979. A modern insulin injector looks similar to an insulin pen, but larger. There are a number of different models, but the typical insulin injector consists of three pieces - a metal pen-like delivery device, a disposable plastic nozzle, and a disposable adapter to connect the injector to an insulin vial. The insulin injector has a dosing dial that allows individual users to select their correct dosage.

The metal injector is designed to last for years, and the detachable nozzle and adapter are intended for multiple uses before disposal. The air pressure is created by either a powerful spring device or a nitrogen or cartridge dioxide cartridge. The devices have adjustable pressure settings so users can select the one that is most effective while causing them the least discomfort.

There are some obvious benefits to a needle free jet injection system, the most apparent being the option for the needle phobic to avoid needles. Other advantages are the speed and ease of use, safety (no bent or broken needles, or "sharps" to dispose of ), less risk of contamination, a better spread of insulin into the subcutaneous tissue, no scar tissue build up at the injection site, and no need to keep buying syringes.

So why do so few diabetics use them? The number one reason seems to be pain. Although some people find a needleless injection quite tolerable, many find the pressure required to force the insulin through the skin most uncomfortable. It's not uncommon for the skin at the injection site to bleed, swell and/or bruise.

Another major factor is the initial cost (at least several hundred dollars) although this is offset by the fact that users don't have the ongoing expense of syringes. Not all insurance companies cover the cost of an insulin injector, and many of those that do require a letter from your doctor.

Jet injectors are also more cumbersome and less portable than insulin syringes or insulin pens, not just because they're larger and heavier, but also because users also need to carry an insulin vial (which requires refrigeration), the adapter and, with some models, the nozzle along with it.

It takes more time to set up an insulin injector than it does to fill a syringe. Unlike a syringe or insulin pen, an insulin injector requires maintenance, and has to be taken apart and sterilized on a regular basis. Some people are put off by the noise made by the compression system during use.

There are insulin injectors specially designed for use in children, and even one for dogs and cats, the Zoe Pet Jet. Those who have managed to find a comfortable setting on their jet insulin injector seem quite happy with the devices, and urge new users not to give up if they're not initially comfortable using one.

Diabetes a Common Cause of Gastroparesis

March 1st, 2011

Diabetes is the most common cause of gastroparesis, or delayed gastric emptying. That's because high blood sugar causes chemical changes in nerves, including the vagus nerve, which controls the movement of food through the digestive tract. High blood sugar also damages the blood vessels that carry oxygen and nutrients to the nerves, further impairing their functioning.

When the vagus nerve is damaged, then the passage of food through from the stomach through the digestive track slows, or even stops. People commonly suffer from a wide range of gastroparesis symptoms, making the condition difficult to diagnose. Frequency and severity of symptoms also vary widely from individual to individual. Common symptoms are:

? heartburn

? nausea

? upper abdominal pain

? loss of appetite

? bloating

? stomach spasms

? weight loss

? vomiting undigested food

? feeling full after eating small amounts

? gastroesophageal reflux

? high or low blood glucose levels

Food that stays undigested in the stomach can harden into solid masses called bezoars. Bezoars not only cause nausea and vomiting; they can be dangerous if they block the passage of food into the small intestine. Undigested food can also ferment, leading to bacteria overgrowth.

Gastroparesis can complicate diabetes control in both type 1 and type 2 diabetes by delaying food in the stomach from entering the intestine. This irregular passage of food through the digestive system results in erratic and unpredictable blood glucose levels. When the food is finally absorbed, blood sugar levels may rise unexpectedly.

As a result, diabetics with gastroparesis must check their blood glucose frequently. They may need to adjust their insulin therapy, change the type of insulin they take, or take their insulin after meals instead of before to maintain proper insulin levels.

Gastroparesis is usually a chronic condition. While it can't be cured, it can be treated. People with gastroparesis are advised to eat six small meals a day instead of three large meals, and to avoid hard to digest high fiber and high fat foods and carbonated drinks. Severe cases may require a liquid diet, or even a feeding tube.

Patients are often given a dopamine antagonist such as prescription domperidone for gastroparesis. Domperidone (generic Motilium) treats both the condition and gastroparesis symptoms such as nausea, vomiting, bloating and a "full" feeling. Some sufferers will require antibiotics. Other potential treatments still in the early stages include gastric electrical stimulation, the use of botulinum toxin, and experimental medications.

New Hormone Pathway May Replace Insulin Therapy for Diabetes

March 28th, 2011

Researchers have discovered a hormone pathway that they are hopeful may eventually lead to new type 1 diabetes treatments to replace insulin therapy. Currently, America's approximately one million type 1 diabetics rely on multiple insulin injections per day to control their blood sugar.

The pathway involves a hormone with insulin-like characteristics called fibroblast growth factor 19 (FGF 19). Unlike insulin, FGF 19 does not cause excess glucose to be stored as fat, also raising the prospect of a new anti-obesity treatment.

To read the whole story, click here >Science Daily<.

Frequently Asked Questions About Insulin Pumps

April 1st, 2011

insulin pump type 1 diabetes guide Gary Gilles believes that insulin pump therapy has changed the way people with insulin dependent diabetes handle their condition. Gilles, a health writer and diabetes counselor, has put together a helpful list of FAQ's on insulin pump therapy, answering inquiries from the basic "What is an insulin pump?" to questions about their safety, effectiveness and how to program and troubleshoot an insulin pump.

Click >HERE< to read Gilles' insulin pump FAQ's on Gilles' article links to related posts on the pros and cons of insulin pump therapy, types of insulin pumps, and the latest research.

Insulin Therapy Changing With New and Improved Insulin Delivery Methods

April 14th, 2011

An old insulin syringe
Not that long ago, being insulin dependent meant you had to carry around a syringe and a vial of insulin to deliver your insulin injections, making sure to keep them refrigerated. There are now a variety of methods for insulin delivery on the market, and some promising new developments on the horizon. These include:

1) Insulin pens. Most types of insulin are now available in convenient prefilled pens. Some insulin pens are entirely disposable when empty, and others use a replaceable insulin cartridge, usually containing 300 units. There is a dial on one end to set your desired dose. The pens offer discreet, push button insulin delivery. Some claim the injections are more comfortable than from a needle that has already been dulled by insertion into an insulin vial. Many people prefer to use an insulin pen if they are caring for a diabetic child or pet.

2) Insulin pumps. Insulin pumps are a device about the size of a pager that adhere to the skin and are worn 24/7. Insulin pumps contain an insulin reservoir, a battery powered pump, and a programmable computer chip that allows the user to control insulin dosing.

The pumps is attached to a thin plastic tube called a cannula, which is inserted just under the skin to deliver insulin subcutaneously and continuously. Insulin pump technology is constantly being improved upon. The newer pumps are smaller, and can "communicate" and interact with a continuous blood glucose monitor and computer software for state of the art blood sugar control.

3) Insulin jet injectors. Insulin jet injectors deliver a fine jet of high pressure insulin directly through the skin. The main advantage is that that the insulin delivery system requires no needles. The major disadvantage is that many diabetics find the force required for the insulin to permeate the skin is painful, and may cause bruising. Jet injectors have been on the market since 1979, but have yet to become popular.

4) Insulin patch. The FDA has just approved a new insulin delivery patch. The new device, Finesse, is a small plastic patch-pen roughly 2 inches long and an inch wide that is attached to the skin like a bandage. It can be worn under your clothes, and remains attached during routine activities like sleeping, exercising and even showering.

Patients use a syringe to pre-fill the patch-pen with a three-day supply of insulin, and simply push two buttons to dispense a dose of fast-acting insulin when needed. The insulin is delivered in seconds through a miniature, flexible plastic tube inserted painlessly into the skin. The manufacturer, Calibra is also working on a patch-pen that would deliver a .05 unit insulin dose for children.

5) Inhaled insulin. The FDA approved the first insulin inhaler, Exubera, in 2006. It was a short-acting insulin delivered to the lungs through a device similar to an asthma inhaler. But it never achieved market success, and was discontinued a year later.

But research on inhaled insulin continued, and two new forms are poised to hit the market. One is an insulin inhaler, AFREZZA, which is awaiting FDA approval. The other is an insulin spray which is absorbed through the mouth, called Oral-Lyn. Oral-Lyn is in Phase 111 clinical trials in Europe and North America.

Despite some obvious advantages to the new insulin delivery methods, tried and true insulin syringes remain the most popular way to deliver insulin injections with most insulin dependent diabetics, who no longer consider injections a big deal.

Insulin pens, insulin pumps, and insulin jet injectors are all more costly than insulin syringes, and not always covered by medical insurance.Not all types of insulin are available in insulin pens, and you can't mix insulin types in a pen.

Insulin pumps can kink or otherwise malfunction, posing the danger of inaccurate insulin dosing, and are just too "high tech" for some diabetics. Many diabetics remain skeptical of devices like insulin inhalers and sprays after Exubera's spectacular lack of success.

Still, with the advances being made in insulin pumps, and the pending introduction of an improved inhaled insulin and the insulin patch, the world of insulin therapy is definitely changing - and most would say for the better.

Artificial Pancreas Performs Well in British Trials

April 15th, 2011

model of a pancreas
Pancreas model. Photo: Suleyman Habib
There's good news coming out of Britain for type 1 diabetics. Researchers conducting tests with a closed loop system artificial pancreas were able to better stabilize blood sugar in two groups of study participants than with a conventional insulin pump and - most importantly - to keep their blood sugar from dipping overnight.

An artificial pancreas combines an insulin pump, a continuous glucose monitoring system, and a high tech that provides sophisticated instructions to the insulin pump and glucose monitor depending on blood sugar readings. For example, the computer algorithm computes insulin doses according to rising or falling blood sugar levels, and sends instructions to the insulin pump to deliver the optimum dose. The goal is to have the system act as much as a normal pancreas as possible.

The researchers tested the artificial pancreas in 24 insulin dependent diabetics in two real-life scenarios - an evening meal eaten at home, and a dinner eaten out, including alcohol. Half of the diners were given the artificial pancreas system, while the other half used conventional insulin pump therapy.

To read more on this story online at WebMD, >CLICK HERE.<

Insulin Therapy Can Help Avoid Diabetic Neuropathy

May 19th, 2011

Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, especially in those who have had diabetes for some time. Diabetic neuropathy, or nerve pain, is nerve damage related to high blood sugar levels. Up to 70 percent of diabetics will develop some sort of neuropathy.

There are four types of diabetic neuropathy - peripheral, proximal, autonomic and focal. The symptoms will vary depending on the type you have, but the first signs are usually numbness, tingling and/or pain in the outer limbs - hands, feet, legs and arms.

Peripheral neuropathy is the most common type. Symptoms get worse at night, and include muscle pain and cramping, loss of sensitivity to temperature or pain, and increased sensitivity to touch. Uncontrolled peripheral neuropathy increases the risk of foot ulcers, infection, and even amputation.

The one and only way to treat diabetic neuropathy is to control your blood sugar levels. A major long-term study established that neuropathy was less common in those diabetics controlling their condition through insulin injections. For a comprehensive overview of diabetic neuropathy, including tips on how to prevent and control it, read The Complete Guide to Diabetic Neuropathy at endocrineweb.

"Super Mice" Suggest Promising New Approach to Diabetes Medication

June 14th, 2011

lab mice

Scientists at the prestigious Mayo Clinic are excited about a promising prospective treatment for type 2 diabetes. Type 2 diabetes is a result of the body losing sensitivity to insulin and no longer being able to respond to it. Current diabetes treatments concentrate on increasing insulin levels - either by administering insulin injections, or by stimulating the pancreas to produce more insulin.

A Mayo Clinic Department of Neuroscience research team, led by Malcolm Leissring, Ph.D, took a different approach - blocking the breakdown of insulin after it was released by the pancreas. Conducting studies in mice, the researchers genetically deleted an insulin-degrading enzyme, or IDE, which breaks insulin down into smaller pieces to help control insulin levels in the blood.

The IDE-less rodents were "super mice" in regards to their ability to lower their blood sugar after a meal (a problem for many diabetics). They also had higher insulin levels, weighed less, and had better overall blood sugar control.

"Insulin levels in the blood reflect the balance between how much is secreted and how fast it is broken down," explains Leissring, "Blocking the breakdown of insulin is simply an alternative method for achieving the same goals as existing diabetes therapies."

Unfortunately, IDE inhibitors will need some work before they can be used in humans. The "super mice" eventually overdosed on the trial diabetes drug, becoming insulin resistant and developing classic type 2 diabetes. "It's an example of too much of a good thing becoming bad for you, explains researcher Samer Abdul-Hay, Ph.D, "Deleting all IDE is overkill". He believes that drugs that only partially or temporarily inhibit IDE could be effective long-term diabetes medications.

The study also raises some interesting questions about how diabetes starts. Diabetes is usually believed to cause hyperinsulinemia, or excess insulin levels in the blood. But as the "super mice" with IDE-elevated insulin levels aged, it worked the other way around - the mice lost insulin receptors, became insulin resistant, and developed type 2 diabetes.

Dr. Leissring and his team are currently working on developing more IDE inhibitors, stressing that they in the "early, but exciting days" of their research, and are still unsure if the results will apply to humans. The American Diabetes Association recently awarded them a five-year development grant - a solid indication of its interest in and support for this new avenue of diabetes research.

Oil Refining Expertise Being Applied to Closed Loop Artificial Pancreas

June 15th, 2011

Engineers from the Rensselaer Polytechnic Institute are building on automation techniques used in oil refining to create a closed-loop artificial pancreas for type 1 diabetics. The Institute's Professor B. Wayne Bequette, whose sister developed diabetes early in life, has been fine tuning an increasingly advanced diabetes control system for six years.

The pancreas of a type 1 diabetic produces little or no insulin, leaving them dependent on insulin injections. Blood sugar and insulin levels rise and fall normally during the day, responding to factors like meals, the type of food eaten, stress and exercise. Diabetics must monitor their blood sugar levels frequently, and adjust their insulin dose accordingly.

Bequette's artificial pancreas marries an insulin pump with a continuous glucose monitoring system. The combination quickly and accurately identifies and responds to rapid variations in blood sugar and insulin levels, eliminating the need for frequent testing and guesswork.

To read more about Bequette and his fellow researcher's work on theEngineer >CLICK HERE.<

What is Stiff-Person Syndrome?

August 26th, 2011

One very rare and unusual condition associated with diabetes is Stiff-Person syndrome, also referred to as Myotonic Dystrophy. Stiff-Person syndrome (SPS) is a central nervous system disorder characterized by severe muscle stiffness that moves from place to place in the trunk, arms and legs. SPS affects about 1 in 1 million Americans, and about 1 in 10,000 diabetics.

Someone with SPS is exceedingly hypersensitive to normal stimuli such as sound, touch and emotional stress. A sudden noise, tap or worry can trigger muscle spasms that distort the body into hunched over stiff postures. People with SPS suffer from frequent falls when spasms are triggered by commonplace noises like a door slamming or a car horn. Because people with SPS lack normal protective reflexes, spasms and falls can result in serious injuries, including fractures, muscle tears and joint dislocations.

SPS is also referred to as "Stiff Man Syndrome", although - like many autoimmune conditions - it is much more common in women than in men. SPS usually strikes between the ages of 30 and 50, but the syndrome can also occur as Stiff Baby Syndrome in children under three. Commonly, SPS begins with an exaggerated upright posture due to muscle stiffness in the lower back, and then moves into the legs. As the disease progresses the patient must move very slowly, as rapid movements can trigger severe spasms.

The unusual and unfortunate symptoms of SPS can be confused with those of fibromyalgia, Parkinson's disease or multiple sclerosis. Sufferers may also be misdiagnosed as having an anxiety or psychosomatic disorder. A diagnosis of SPS is aided by the detection of elevated levels of the antibody glutamic acid decarboxylase (GAD), which is present in the cerebral spinal fluid of about 80% of SPS cases.

GAD antibodies tests are also an important diagnosis tool for diabetes mellitus. GAD tests are used to differentiate between types of diabetes, to predict the risk and track the progression of the disease, and to predict the need for insulin therapy in type 2 diabetics. GAD reduces the brain's main inhibitory transmitter, GABA. It's theorized that this reduction of GABA interferes with the modulation of spinal cord reflexes, resulting in the hyperactivity and hyperexcitabity that characterizes SPS.

SPS can be treated, but not cured. Symptoms can be eased with a combination of anti-anxiety medications, anti-convulsants, muscle relaxers and pain medication. A recent study proved intravenous immunoglobulin treatment (a therapy for autoimmune diseases and immune deficiencies) effective in reducing stiffness and hypersensitivity in patients with Stiff-Person syndrome. Another study using the arthritis drug rituximab led to disappointing results.

The cause of SPS remains a mystery, but it appears to be an out of kilter autoimmune response in the brain and spinal cord. SPS is associated with other autoimmune diseases such as diabetes, pernicious anemia, thyroiditis, and the skin disease vitiligo. The National Institute of Neurological Disorders and Stroke is continuing to both conduct and support research into SPS, focusing on uncovering the cause of this rare and curious condition.

New Disposable Insulin Delivery Device About to Hit the Market

September 14th, 2011

Valeritas, an American medical technology company focused on the development and commercialization of innovative drug delivery solutions, is poised to begin marketing a new disposable insulin delivery device called the V-Go Disposable Insulin Delivery Device.

The V-Go is designed to provide an alternative to multiple daily insulin injections for adult type 2 diabetics using basal-bolus insulin therapy. The V-Go delivers a continuous preset rate of basal insulin (20, 30 or 40 units of insulin per 24 hours) and allows for on demand bolus dosing at mealtimes (in two unit increments up to 36 units).

Users fill the V-Go with their desired insulin dose using an included disposable filling accessory, the V-Go EZ Fill. The small, lightweight (about 1 ounce when full) device delivers insulin subcutaneously for 24 hours, after which it is replaced with a new one. The discreet device is worn under a patient's clothing, and should not be exposed to direct sunlight or high temperatures, although it can be submerged in up to three feet of water.

The non-electronic V-Go was tested using both Humalog insulin lispro and Novolog (insulin aspart), and achieved FDA approval at the end of 2010. The company has been pursuing financing to market it ever since, and has just announced that it has raised $150 million to bring the V-Go Disposable Insulin Delivery Device to market.

"Millions of adult patients suffer from type 2 diabetes and require insulin," says Valeritas CEO Kristine Peterson, "We believe the V-Go will be an important treatment option to assist in the management of their diabetes." To visit the V-Go site and to sign up for email updates on the availability of the innovative insulin delivery device, >Click Here.<

Insulin Nasal Spray Tested as an Alzheimer's Treatment

September 16th, 2011

insulin nasal spray

Ateam of Department of Veteran Affairs (VA) researchers were intrigued by studies that suggested that low levels of insulin in the brain could contribute to Alzheimer's disease. The researchers, led by Dr. Suzanne Craft, decided to test the benefits of restoring normal insulin levels in the brains of Alzheimer's patients.

Insulin is an important hormone which plays a major role in turning blood sugar into energy for cells. A lack of insulin, or an inability to properly use it, results in diabetes. Diabetes is a known risk factor for Alzheimer's, although the connection is not yet clear.

Alzheimer's is a disease in which cognitive functioning declines over time, causing progressive memory loss, loss of motor and language skills, impaired reasoning, emotional instability, and eventually full-blown dementia. The disease is associated with abnormal protein deposits in the brain called plaques.

The VA team used an insulin nasal spray that could deliver insulin rapidly and directly to the brain without increasing insulin levels elsewhere in the body. They recruited 104 adults with mild amnestic cognitive impairment or mild to moderate Alzheimer's disease. They divided the participants into three groups, with one group receiving 20 international units (IU) of insulin, one receiving 40 IU, and the third receiving an inactive saline placebo. The insulin dose or placebo was delivered daily through a nasal spray for four months.

Memory, cognition and functioning ability tests were conducted on the participants both before and after the four month period. The patients in the treated groups showed an increase in brain glucose metabolism following insulin therapy. Both insulin doses improved the patients' general cognition and functioning about 20%, and the 20 IU insulin dose also improved memory. The group receiving the placebo showed a slight decline in cognitive abilities. The treatment did not result in any major side effects, although some participants did report a mild headache or a runny nose.

Insulin appears to protect the brain against the toxic effects of beta-amyloid, the protein behind the brain plaques present in Alzheimer's. It also prevents the formation of a toxic form of the protein tau, a biomarker for Alzheimer's found in the cerebrospinal fluid. Insulin also promotes cell repair and growth, which may also help combat degenerative brain disease.

VA Chief Research and Development Officer Dr. Joel Kupersmith says, "VA researchers are exploring a number of possible approaches to help prevent of effectively treat this devastating disease, and these are among the most promising results to date." The research is even more important and encouraging because there is currently no effective treatment to delay or treat Alzheimer's disease.

There are a great many unanswered questions about the connection between insulin and Alzheimer's, and it's still premature to consider insulin a new treatment. Researchers still don't know much of the daily insulin injections required by many diabetics gets into the brain, and what effects it may have in the brain of the average diabetic.

Researchers are calling for further studies to explore the use of insulin to treat Alzheimer's, and to hopefully establish an optimal insulin dosage and dosing schedule. Any treatment which could improve the lives of the estimated 5.4 million Americans that suffer from Alzheimer's and their caregivers can not come soon enough.