How Does Insulin Treat Diabetes?

How Does Insulin Treat Diabetes
Insulin, Blood Sugar, and Type 2 Diabetes – Insulin is a key player in developing type 2 diabetes. This vital hormone—you can’t survive without it—regulates blood sugar (glucose) in the body, a very complicated process. Here are the high points:

The food you eat is broken down into blood sugar. Blood sugar enters your bloodstream, which signals the pancreas to release insulin. Insulin helps blood sugar enter the body’s cells so it can be used for energy. Insulin also signals the liver to store blood sugar for later use. Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too. Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you haven’t eaten for a while.

That’s when everything works smoothly. But this finely tuned system can quickly get out of whack, as follows:

A lot of blood sugar enters the bloodstream. The pancreas pumps out more insulin to get blood sugar into cells. Over time, cells stop responding to all that insulin—they’ve become insulin resistant. The pancreas keeps making more insulin to try to make cells respond. Eventually, the pancreas can’t keep up, and blood sugar keeps rising.

Lots of blood sugar in the bloodstream is very damaging to the body and needs to be moved into cells as soon as possible. There’s lots of insulin, too, telling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat. Yep, weight gain. And what’s more serious, the stage is set for and,

How does insulin medication work?

pronounced as (in’ su lin) Human insulin is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone.

Human insulin is in a class of medications called hormones. Human insulin is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way.

The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar. Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems.

Using medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease.

Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Human insulin comes as a solution (liquid) and a suspension (liquid with particles that will settle on standing). to be injected subcutaneously (under the skin).

Human insulin is usually injected subcutaneously several times a day, and more than one type of insulin may be needed. Your doctor will tell you which type(s) of insulin to use, how much insulin to use, and how often to inject insulin. Follow these directions carefully. Do not use more or less insulin or use it more often than prescribed by your doctor.

Human insulin (Myxredlin, Humulin R U-100, Novolin R) solution may also be injected intravenously (into a vein) by a doctor or nurse in a healthcare setting. A doctor or nurse will carefully monitor you for side effects. Human insulin controls high blood sugar but does not cure diabetes.

  1. Continue to use human insulin even if you feel well.
  2. Do not stop using insulin without talking to your doctor.
  3. Do not switch to another brand or type of insulin or change the dose of any type of insulin you use without talking to your doctor.
  4. Human insulin comes in vials, prefilled disposable dosing devices, and cartridges.

The cartridges are designed to be placed in dosing pens. Be sure you know what type of container your insulin comes in and what other supplies, such as needles, syringes, or pens, you will need to inject your medication. Make sure that the name and letter on your insulin are exactly what your doctor prescribed.

If your human insulin comes in vials, you will need to use syringes to inject your dose. Be sure that you know whether your human insulin is U-100 or U-500 and always use a syringe marked for that type of insulin. Always use the same brand and model of needle and syringe. Ask your doctor or pharmacist if you have questions about the type of syringe you should use.

Carefully read the manufacturer’s instructions to learn how to draw insulin into a syringe and inject your dose. Ask your doctor or pharmacist if you have questions about how to inject your dose. If your human insulin comes in cartridges, you may need to buy an insulin pen separately.

Talk to your doctor or pharmacist about the type of pen you should use. Carefully read the instructions that come with your pen, and ask your doctor or pharmacist to show you how to use it. If your human insulin comes in a disposable dosing device, read the instructions that come with the device carefully.

Insulin Treatment in Patients with Type 2 Diabetes

Ask your doctor or pharmacist to show you how to use the device. Never reuse needles or syringes and never share needles, syringes, cartridges, or pens. If you are using an insulin pen, always remove the needle right after you inject your dose. Dispose of needles and syringes in a puncture-resistant container.

  1. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.
  2. Your doctor may tell you to mix two types of insulin in the same syringe.
  3. Your doctor will tell you exactly how to draw both types of insulin into the syringe.
  4. Follow these directions carefully.
  5. Always draw the same type of insulin into the syringe first, and always use the same brand of needles.

Never mix more than one type of insulin in a syringe unless you are told to do so by your doctor. Always look at your human insulin before you inject. If you are using a regular human insulin (Humulin R, Novolin R), the insulin should be as clear, colorless, and fluid as water.

Do not use this type of insulin if it appears cloudy, thickened, or colored, or if it has solid particles. If you are using an NPH human insulin (Humulin N, Novolin N) or a premixed insulin that contains NPH (Humulin 70/30, Novolin 70/30), the insulin should appear cloudy or milky after you mix it. Do not use these types of insulin if there are clumps in the liquid or if there are solid white particles sticking to the bottom or walls of the bottle.

Do not use any type of insulin after the expiration date printed on the bottle has passed. Some types of human insulin must be shaken or rotated to mix before use. Ask your doctor or pharmacist if the type of insulin you are using should be mixed and how you should mix it if necessary.

Talk to your doctor or pharmacist about where on your body you should inject human insulin. You can inject your human insulin in the stomach, upper arm, upper leg, or buttocks. Do not inject human insulin into muscles, scars, or moles. Use a different site for each injection, at least 1/2 inch (1.25 centimeters) away from the previous injection site but in the same general area (for example, the thigh).

Use all available sites in the same general area before switching to a different area (for example, the upper arm). This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

How insulin works step by step?

How does insulin work? – Insulin is produced in the islets of Langerhans (pancreatic islets), which are small isolated clumps of special cells in the pancreas. Insulin works alongside glucagon, another hormone produced by the pancreas, to manage the levels of glucose in your blood.

  • Both insulin and glucagon are secreted directly into your bloodstream, and work together to regulate your blood glucose levels.
  • Insulin should stop your blood sugar from rising too high and glucagon should prevent it from becoming too low.
  • Insulin is produced by the beta cells of the pancreatic islets.

Insulin is released when you have just eaten a meal and the level of glucose in your bloodstream is high. It works by stimulating the uptake of glucose into cells, lowering your blood sugar level. Your liver and muscles can take up glucose either for immediate energy or to be stored as glycogen until it’s needed.

What happens to the body when you take insulin?

Descriptions – Insulin is one of many hormones that helps the body turn the food we eat into energy. Also, insulin helps us store energy that we can use later. After we eat, insulin works by causing sugar (glucose) to go from the blood into our body’s cells to make fat, sugar, and protein.

  1. When we need more energy between meals, insulin will help us use the fat, sugar, and protein that we have stored.
  2. This occurs whether we make our own insulin in the pancreas gland or take it by injection.
  3. Diabetes mellitus (sugar diabetes) is a condition in which the body does not make enough insulin to meet its needs or does not properly use the insulin it makes.

Without insulin, glucose cannot get into the body’s cells. Without glucose, the cells will not work properly. To work properly, the amount of insulin you use must be balanced against the amount and type of food you eat and the amount of exercise you do.

  • If you change your diet, your exercise, or both without changing your insulin dose, your blood glucose level can drop too low or rise too high.
  • A prescription is not necessary to purchase most insulin.
  • However, your doctor must first determine your insulin needs and provide you with special instructions for control of your diabetes Insulin can be obtained from beef or pork pancreas glands.
See also:  How Many People Suffer From Diabetes?

Another type of insulin that you may use is called human insulin. It is just like the insulin made by humans but it is made by methods called semi-synthetic or recombinant DNA. All types of insulin must be injected because, if taken by mouth, insulin is destroyed in the stomach.

What 3 things does insulin do?

Insulin is a hormone created by your pancreas that controls the amount of glucose in your bloodstream at any given moment. It also helps store glucose in your liver, fat, and muscles. Finally, it regulates your body’s metabolism of carbohydrates, fats, and proteins.

How does insulin work in simple terms?

Definition: Insulin Insulin is a hormone that lowers the level of glucose (a type of sugar) in the, It’s made by the beta cells of the pancreas and released into the blood when the glucose level goes up, such as after eating. Insulin helps glucose enter the body’s cells, where it can be used for energy or stored for future use.

What is the main action of insulin?

How is insulin controlled? – The main actions that insulin has are to allow glucose to enter cells to be used as energy and to maintain the amount of glucose found in the bloodstream within normal levels. The release of insulin is tightly regulated in healthy people in order to balance food intake and the metabolic needs of the body.

  1. This is a complex process and other hormones found in the and pancreas also contribute to this blood glucose regulation.
  2. When we eat food, glucose is from our gut into the bloodstream, raising blood glucose levels.
  3. This rise in blood glucose causes insulin to be released from the pancreas so glucose can move inside the cells and be used.

As glucose moves inside the cells, the amount of glucose in the bloodstream returns to normal and insulin release slows down. Proteins in food and other hormones produced by the gut in response to food also stimulate insulin release. Hormones released in times of stress, such as adrenaline, stop the release of insulin, leading to higher blood glucose levels to help cope with the stressful event.

Does insulin lower blood sugar immediately?

How Insulin Treatment Lowers High Blood Sugar Levels Medically Reviewed by on March 07, 2021 Insulin is a hormone your pancreas makes to lower blood glucose, or sugar. If you have diabetes, your pancreas either doesn’t make enough insulin or your body doesn’t respond well to it.

  • Your body needs insulin to keep the blood sugar level in a healthy range.
  • Each diabetes type affects insulin production in a different way.
  • Type 1 diabetes causes damage to the beta cells in your pancreas that make insulin.
  • As a result, your body can’t produce enough of this hormone.
  • Type 2 diabetes gradually makes it harder for your beta cells to work, and also makes all the cells of your body less able to pull in and use insulin.

In both types of diabetes, sugar from the foods you eat builds up in your blood. Constantly having high blood sugar damages your blood vessels. Over time, diabetes can cause problems with your nerves, eyes, kidneys, heart, and other organs. Everyone with type 1 diabetes and some people with type 2 diabetes take a lab-made form of insulin to control their blood sugar.

Insulin treatment works in much the same way as natural insulin that the pancreas makes. After you eat, your body breaks down carbohydrates into glucose. That glucose goes into your bloodstream and causes your blood sugar level to rise. When you take insulin, it helps to move glucose out of your bloodstream and into cells.

Your cells use some of that sugar for energy and then store any leftover sugar in your fat, muscles, and liver for later. Once the sugar moves into your cells, your blood glucose level should go back to normal. You can’t take insulin as a pill because enzymes in your stomach would break it down during digestion.

Insulin comes in four types. Each one starts to work at a different speed and controls blood sugar for a different amount of time: Rapid-acting insulin starts to lower blood sugar within 15 minutes and its effects last for 2 to 4 hours. Short-acting insulin starts to work within 30 minutes and its effects last for 3 to 6 hours. Intermediate-acting insulin starts to work within 2 to 4 hours and lasts for 12 to 18 hours. Long-acting insulin starts to work in a few hours and its effects last for 24 hours.

© 2021 WebMD, LLC. All rights reserved. : How Insulin Treatment Lowers High Blood Sugar Levels

How does insulin burn fat?

What’s the Problem With Insulin, Then? – When explained like that, insulin sounds like an alright dude. We can’t live without it, Why, then, is it viciously attacked by mainstream diet “gurus”? Why are we told it makes us fat and sick? Because one of insulin’s vital roles in the body relates to fat storage: it inhibits the breakdown of fat cells and stimulates the creation of body fat,

  • That is, insulin tells the body to stop burning its fat stores and instead, absorb some of the fatty acids and glucose in the blood and turn them into more body fat.
  • This makes it an easy target and scapegoat, and this is why the carbohydrate is often pilloried right next to it.
  • The “logic” goes like this: High-carb diet = high insulin levels = burn less fat and store more = get fatter and fatter And then, as a corollary: Low-carb diet = low insulin levels = burn more fat and store less = stay lean At first glance, these statements sound plausible.

Simple explanations are popular. But they’re based on myths and pseudoscience.

What foods should I avoid if I have insulin resistance?

9. Foods to avoid for insulin resistance – If you’re managing insulin resistance through what you eat, it’s important to cut down on processed foods with added sugar. Foods like these increase your risk of a blood sugar spike:

soda, juice, and sweet tea refined grains, including white rice, white bread, and cereal with added sugar ultra-processed snack foods like candy, cookies, cakes, and chips

What happens without insulin?

Causes of type 1 diabetes – Type 1 diabetes is an autoimmune condition, where the immune system (the body’s natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them. Without insulin, your body will break down its own fat and muscle, resulting in weight loss.

  • This can lead to a serious short-term condition called diabetic ketoacidosis.
  • This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated,
  • This results in the body being unable to produce insulin, which is required to move glucose out of the blood and into your cells to be used for energy.

This is called Type 1 diabetes. Read more about the causes of type 1 diabetes

What are the 5 functions of insulin?

Definitions and Concepts – Insulin is a peptide hormone secreted by the β cells of the pancreatic islets of Langerhans and maintains normal blood glucose levels by facilitating cellular glucose uptake, regulating carbohydrate, lipid and protein metabolism and promoting cell division and growth through its mitogenic effects.

Insulin resistance is defined where a normal or elevated insulin level produces an attenuated biological response; 2 classically this refers to impaired sensitivity to insulin mediated glucose disposal.3 Compensatory hyperinsulinaemia occurs when pancreatic β cell secretion increases to maintain normal blood glucose levels in the setting of peripheral insulin resistance in muscle and adipose tissue.

Insulin resistance syndrome refers to the cluster of abnormalities and related physical outcomes that occur more commonly in insulin resistant individuals. Given tissue differences in insulin dependence and sensitivity, manifestations of the insulin resistance syndrome are likely to reflect the composite effects of excess insulin and variable resistance to its actions.3 Metabolic syndrome represents the clinical diagnostic entity identifying those individuals at high risk with respect to the (cardiovascular) morbidity associated with insulin resistance.3

How long does insulin last in the body?

Has your doctor prescribed insulin to help manage your type 1 or type 2 diabetes ? You’ll want to know how and when to take it, what side effects could happen, and what other changes you may need to make. Use this list of questions as a starting point when you talk with your doctor. What type of insulin do I need? Insulin comes in four basic forms:

  1. Rapid-acting insulin starts to work within 30 minutes after injection. Its effects only last 2 to 3 hours.
  2. Regular- or short-acting insulin takes about 30 minutes to work and lasts for about 3 to 6 hours.
  3. Intermediate-acting insulin takes up to 4 hours to work fully. It peaks anywhere from 4 to 12 hours, and its effects can last for about 12 to 18 hours.
  4. Long-acting insulin begins to work in about 2 hours and then lasts up to a full day, steadily without a real peak.

Your doctor can tell you which type will work best with your diabetes type and blood sugar level. How should I give myself insulin? You can inject or inhale it. To inject insulin, you can use a syringe, pen, or pump. There is also a needle-free option called a jet injector.

Pens are easiest to use, pumps deliver insulin continuously, and syringes are the least expensive. Find out how many times a day you’ll need to inject, and how much insulin to inject in each dose. If you use an insulin pump, ask your doctor when you’ll need to give yourself an extra amount of insulin (bolus).

If you have type 1 diabetes, you may need up to three or four injections daily. People with type 2 diabetes may need just one shot of insulin a day, possibly increasing to three or four injections. There is also a rapid-acting inhaled insulin that you can use before meals only.

If you have type 1 diabetes, you must also use long-acting insulin. Talk with your doctor about the pros and cons of each method. The decision may come down to cost, so find out which method your insurance will cover. If you don’t have insurance or your plan won’t pay for the type of insulin delivery method you prefer, ask your doctor about programs that can help you cover the cost.

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When should I take my insulin? There isn’t one simple answer to this question. It depends on things such as:

  • The type of insulin you use (fast-acting, premixed, etc.)
  • How much and what type of food you eat
  • How much exercise you get
  • Other health conditions you have
  • The type of insulin delivery system (such as shots, pump, or inhaler) you use

Your doctor may want you to take insulin a half-hour before meals, so it’s available when sugar from food enters your bloodstream. Find out exactly when during the day you need to take each of your injections, and what to do if you forget to give yourself an injection.

  1. If I inject insulin, does it need to be in a certain part of my body? Most people inject it into their lower belly area, since it’s easy to reach.
  2. Be sure to stay at least 2 inches from the belly button.) You can also inject insulin into your arms, thighs, or buttocks.
  3. Ask your doctor or diabetes educator to show you the right way to inject, including how to keep your needle and skin clean to prevent infections.

Also learn how to rotate the injection site so you don’t develop hard, fatty deposits under the skin from repeated injections. Does insulin affect other medicines I take? Some drugs can intensify low blood sugars caused by insulin. Tell your doctor about all the medicines you take, even those you bought without a prescription.

What can I eat while taking insulin? Ask your doctor for food recommendations to help your insulin work best. For instance, you’ll want to know how much to eat at each meal, which types of foods are best for you to eat, whether you need to have snacks, and when you should eat. If you drink alcohol, ask your doctor if that’s OK while you’re taking insulin, and what your limit should be.

What is my target blood sugar level? Your doctor should tell you how often you need to check your blood sugar using your blood glucose meter, Find out your target blood sugar range before and after meals, as well as at bedtime, For most people with diabetes, the targets are:

  • 70 to 130 milligrams per deciliter (mg/dL) before meals
  • Less than 180 mg/dL 2 hours after a meal

Ask what to do if your blood sugar doesn’t stay within range, and how often you need to have your A1C level tested. What side effects could I have from the insulin? The most common side effects are low blood sugar and weight gain. Ask your doctor what others you might have, and what to do if you get them.

  • How should I store my insulin? Most insulin makers recommend storing it in the refrigerator, but injecting cold insulin can be uncomfortable.
  • Make sure it’s at room temperature before injecting.
  • Ask your doctor whether to store your insulin in the fridge or at room temperature.
  • Also find out how long your insulin will last, and how to tell if it has gone bad.

Can I reuse syringes? Doing so can lower your costs, but it is not without risk. Ask your doctor if that’s safe for you, and how to keep your syringes clean so you don’t get an infection. If you throw out your syringes after each use, ask how to safely dispose of them.

Why do Type 2 diabetics need insulin?

Glucose gets into the cells with the help of a hormone called insulin. In type 2 diabetes, the body stops responding to normal or even high levels of insulin, and over time, the pancreas (an organ in the abdomen) does not make enough insulin to keep up with what the body needs.

When does a diabetic need insulin?

Why Insulin Can Become Necessary for a Person with Type 2 Diabetes | Diabète Québec Starting insulin treatment should not be seen as a setback. People with type 2 diabetes may require insulin when their meal plan, weight loss, exercise and antidiabetic drugs do not achieve targeted blood glucose (sugar) levels.

  • Diabetes is a progressive disease and the body may require insulin injections to compensate for declining insulin production by the pancreas.
  • That is why starting insulin treatment should never be seen as a failure.
  • Starting insulin treatment should never be seen as a failure.
  • Treatment with insulin may be added to an antidiabetic medication or completely replace it.

Regardless of the treatment, lifestyle habits (diet, exercise, stress management) are essential to managing diabetes. Many people are reluctant to inject insulin for various reasons:

Fear of pain or needles Guilt Impression that this is the “last resort” Fear of hypoglycemic attacks Fear of weight gain Memories of loved one who had to take insulin

If this is the case, do not hesitate to discuss your concerns with a health care professional. Some of your fears may be due to false beliefs. Learning more about today’s insulin treatment will probably allay your fears. For many people, insulin is an effective way to achieve good blood-sugar control, which can prevent or delay certain diabetes complications over the long term.

  • Every person with diabetes being treated with insulin should be trained by a health care professional.
  • This training should include the different injection steps, as well as the treatment and prevention of hypoglycemia, which can occur in anyone on insulin.
  • Research and text: Cynthia Chaput, Dietitian Scientific review: Louise Tremblay, Nurse.M.

Ed. June 2014 – Revised May 2016 : Why Insulin Can Become Necessary for a Person with Type 2 Diabetes | Diabète Québec

What organ does insulin target?

Abstract – Insulin is a key hormone regulating glucose homeostasis. Its major target tissues are the liver, the skeletal muscle and the adipose tissue. At the cellular level, insulin activates glucose and amino acids transport, lipid and glycogen metabolism, protein synthesis, and transcription of specific genes.

  1. Insulin-induced biological responses are mediated by a specific cell-surface receptor with tyrosine kinase activity.
  2. This receptor is a heterotetrameric protein consisting of two extracellular alpha subunits containing the ligand binding site, and two transmembrane beta subunits containing the hormone-sensitive enzymatic activity.

The first step following insulin binding consists in receptor autophosphorylation on multiple specific sites and phosphorylation of cellular substrates. We will review the receptor structure, its mechanism of activation, and the autophosphorylation process.

  • Two of the insulin receptor substrates have been identified as IRS-1 and Shc.
  • IRS-1 is phosphorylated at several sites by the insulin receptor, and acts as a docking protein by associating several SH2-containing proteins.
  • One of these proteins is the p85 subunit of P13-kinase which is rapidly stimulated by insulin in adipocytes and skeletal muscle.

The phosphorylated IRS-1 also associates Grb2, as does the phosphorylated Shc. This allows recruitment of the preformed complex Grb2-Sos to the plasma membrane. Sos is then capable of stimulating the Ras protein, which in turn activates Raf, the first element of the MAP-kinase cascade.

Does insulin lower blood sugar immediately?

How Insulin Treatment Lowers High Blood Sugar Levels Medically Reviewed by on March 07, 2021 Insulin is a hormone your pancreas makes to lower blood glucose, or sugar. If you have diabetes, your pancreas either doesn’t make enough insulin or your body doesn’t respond well to it.

  • Your body needs insulin to keep the blood sugar level in a healthy range.
  • Each diabetes type affects insulin production in a different way.
  • Type 1 diabetes causes damage to the beta cells in your pancreas that make insulin.
  • As a result, your body can’t produce enough of this hormone.
  • Type 2 diabetes gradually makes it harder for your beta cells to work, and also makes all the cells of your body less able to pull in and use insulin.

In both types of diabetes, sugar from the foods you eat builds up in your blood. Constantly having high blood sugar damages your blood vessels. Over time, diabetes can cause problems with your nerves, eyes, kidneys, heart, and other organs. Everyone with type 1 diabetes and some people with type 2 diabetes take a lab-made form of insulin to control their blood sugar.

  • Insulin treatment works in much the same way as natural insulin that the pancreas makes.
  • After you eat, your body breaks down carbohydrates into glucose.
  • That glucose goes into your bloodstream and causes your blood sugar level to rise.
  • When you take insulin, it helps to move glucose out of your bloodstream and into cells.

Your cells use some of that sugar for energy and then store any leftover sugar in your fat, muscles, and liver for later. Once the sugar moves into your cells, your blood glucose level should go back to normal. You can’t take insulin as a pill because enzymes in your stomach would break it down during digestion.

Insulin comes in four types. Each one starts to work at a different speed and controls blood sugar for a different amount of time: Rapid-acting insulin starts to lower blood sugar within 15 minutes and its effects last for 2 to 4 hours. Short-acting insulin starts to work within 30 minutes and its effects last for 3 to 6 hours. Intermediate-acting insulin starts to work within 2 to 4 hours and lasts for 12 to 18 hours. Long-acting insulin starts to work in a few hours and its effects last for 24 hours.

© 2021 WebMD, LLC. All rights reserved. : How Insulin Treatment Lowers High Blood Sugar Levels

What happens if you inject insulin into a non diabetic?

Insulin poisoning with suicidal intent Department of Endocrinology, Army Hospital (Research & Referral), Delhi Cantt, India Find articles by Department of Endocrinology, Army Hospital (Research & Referral), Delhi Cantt, India Find articles by Department of Endocrinology, Army Hospital (Research & Referral), Delhi Cantt, India Find articles by Department of Endocrinology, Army Hospital (Research & Referral), Delhi Cantt, India Find articles by Department of Endocrinology, Army Hospital (Research & Referral), Delhi Cantt, India Find articles by : © Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report a 27-year-old paramedical lady with no known comorbidities, who presented with rapid-onset coma with hypoglycemia (plasma glucose at admission was 35 mg/dL). Clinical alertness suspected and confirmed the diagnosis of exogenous insulin administration probably with suicidal intent. During the course of her ICU stay, she developed bradycardia and hypotension which required ionotropic support. She remained in coma for 90 hours. A total of 470 g of dextrose was infused until she regained consciousness. No other complications of insulin overdose were observed during her stay in the hospital. Recovery was complete without any residual neurological deficits. Insulin administration should be kept in differential diagnosis when any case presents with coma and hypoglycemia, especially in paramedical personnel. Keywords: Hypoglycemic coma, insulin, suicide Insulin is essential for survival in type 1 diabetes mellitus and insulin-requiring type 2 diabetes mellitus patients. The same insulin if taken in overdose in these patients or in non-diabetics can lead to hypoglycemic coma which can have varied outcome from complete reversal to death. Since the introduction of insulin therapy in 1921, diabetics have used insulin overdose as a mode of suicide. Insulin poisoning is also used as a mode of suicide in non-diabetics, especially medical and paramedical personnel and relatives of diabetic patients. We report a case of a paramedical personnel injecting insulin with suicidal intent and discuss the various issues in management. A 27-year-old paramedical personnel without any comorbidities, working as an assistant in the operation theater, was found to be drowsy and drenched in sweat with bradycardia (34 beats/min) and hypotension (80/50 mm of Hg). She was immediately shifted to ICU. She was pale and there was no cyanosis, icterus, clubbing, lymphadenopathy, or any evidence of external injury. Temperature was 99.0°F, with a respiratory rate of 20/min and cold peripheries. Pupils were bilateral 3 mm, reactive to light, and oculocephalic reflex was preserved. Deep tendon reflexes were brisk and plantars were flexor. Meningeal signs were absent. Her systemic examination was unremarkable. An electrocardiogram showed sinus bradycardia. Atropine was given intravenously and normal saline infusion started. Blood pressure remained low which prompted initiation of norepinephrine drip. Capillary blood glucose (CBG) was 35 mg/dL, hence 50 mL of 50% dextrose bolus was given and 5% dextrose infusion started. Her neurological status started deteriorating and she rapidly lapsed into coma, 90 minutes from her initial presentation. At this stage, pupils were bilateral 2 mm and nonreactive, with loss of occulocephalic reflex and dysconjugate deviation of eye. She continued to have bradycardia and hypotension. Repeat CBG was 32 mg/dL and bolus of 50 mL 50% dextrose was repeated. No history could be gathered regarding the preceding events. At this stage, in addition to malaria, encephalitis, cerebrovascular accident, exogenous insulin administration was considered as another staff detected one empty vial of insulin. Blood samples were drawn for glucose, insulin, and c-peptide. Patient had an episode of generalized tonic clonic seizure which was treated with intravenous lorazepam 4 mg. Again a bolus of 50 mL of 50% dextrose was repeated and 10% dextrose infusion started. There was no recurrence of seizure. Patient was transferred to our tertiary care center. Magnetic resonance imaging (MRI) of the brain was normal. Cerebrospinal fluid analysis was normal except for hypoglycorrhizia (CSF glucose 10 mg/dL and plasma glucose 15 mg/dL). Her other parameters were as follows: Hemoglobin 12.4 g/dL, total leukocyte count 7400 cells, normal differential count, normal urine examination, urine pregnancy test negative, blood urea nitrogen 12 mg/dL, serum creatinine 0.9 mg/dL, sodium 136 mEq/L, potassium 3.9 mEq/L, phosphorous 1.7 mg/dL, magnesium 2.1 mg/dL, calcium 9.1 mg/dL, total bilirubin 0.8 mg/dL, serum glutamic oxaloacetic transaminase (SGOT) 33 IU/L, serum glutamic pyruvate transaminase (SGPT) 31 IU/L, alkaline phosphatase 122 IU/L, total protein 6.9 g/dL, and albumin 4.1 g/dL. Arterial blood gas showed a pH of 7.39, bicarbonate of 22 mmol/L, and pCO 2 of 39 mmHg. CBG was measured hourly and dextrose infusion rate adjusted to maintain blood glucose around 200 mg/dL. While on dextrose infusion, there were at least two instances when CBG was less than 50 mg/dL, which were managed with 50% dextrose boluses. After 24 hours, Ryle’s tube feeding was started with mixed meal preparation. Patient remained comatose for 36 hours after which her sensorium fluctuated. Pulse rate normalized and the ionotropic support was gradually tapered and stopped. Sensorium started to improve gradually and she regained full consciousness with no neurological deficit 90 hours after the initial presentation. Serum electrolytes were measured serially and were within normal range. The graphical representation of blood glucose over 90 hours is depicted in, She was diagnosed as a case of depression on psychiatric evaluation and started on antidepressant. Serum insulin was 402 μIU/mL (for a random sample <112 μIU/mL) and c-peptide was <0.3 ng/mL (1.1–4.4 ng/mL). These results confirmed the diagnosis of exogenous insulin administration as a cause for hypoglycemia in this patient. Hypoglycemia is clinically defined as blood glucose levels low enough to cause symptoms and signs. Biochemically, it is defined as plasma glucose less than 55 mg/dL in healthy adults. However, in diabetics, blood glucose of less than 70 mg/dL is considered to be hypoglycemia. Confirmation of hypoglycemia is by Whipple's triad – 1) signs and/or symptoms consistent with hypoglycemia, 2) low plasma glucose, and 3) resolution of signs and/or symptoms after rising of plasma glucose. However, if irreversible damage to brain has occurred, the third criterion would be unlikely to be fulfilled. Hypoglycemia can have varied presentation. Its clinical diagnosis is mainly based on symptomatology. These have been divided as neurogenic and neuroglyopenic. The neuroglyopenic symptoms range from subtle behavioral abnormalities to loss of consciousness and seizures. Hypoglycemia can also present with hypotension and bradycardia as it was in this patient. Diaphoresis with bradycardia and hypotension drives the clinician to search for a cardiovascular cause and hypoglycemia is not thought of until blood glucose is measured. Hypoglycemia in a non-diabetic can be due to either exogenous or endogenous hyperinsulinemia, in addition to drugs, tumors, critical illness, and hormone deficiencies. Exogenous hyperinsulinemia due to surreptitious use of insulin is diagnosed when during hypoglycemia, insulin level is elevated (at least 3 μIU/mL) with low c-peptide (less than 0.6 ng/mL). Consumption of sulfonylurea was excluded in our patient as there was no increase in c-peptide. Sulfonylurea produces endogenous hyperinsulinemia which leads to elevated c-peptide and insulin as c-peptide is co-secreted in equimolar concentration with insulin from pancreatic β cells. Exogenous insulin administration as a mode of suicide may be more common in medical and paramedical personnel. In one study, out of the 25 patients managed for insulin overdose, five were non-diabetic health care professionals. As our patient did not give history probably due to administrative reason, homicidal and accidental administration of insulin is unlikely. Hence, suicidal intent was strongly suspected. It is also more common in patients with psychiatric disorder and in relatives of diabetics. All types of insulin have been used for suicidal intention, including the short- and long-acting insulins. When long-acting insulin is taken, there can be delayed effects. Short-acting insulins can also produce delayed effects. This is explained on the basis of depot effect. Significant reduction in local blood flow results by compression of tissue at injection site, when large quantity of insulin is injected. Delayed effects can also be seen in the presence of renal or hepatic dysfunction. In diabetics, lipoatrophy at the injection site or circulating antibodies against insulin can produce delayed effects. CSF analysis in hypoglycemia shows low glucose levels. Equilibration of glucose between plasma and CSF takes about 2 hours. CSF glucose reflects plasma glucose from a few hours earlier. But this can be misleading sometimes, especially in septic encephalomeningitis. High doses of insulin can lead to dyselectrolytemia. Insulin excess leads to salt and water retention and resultant dilutional hyponatremia. There can be intracellular shift of potassium and phosphorous, leading to hypokalemia and hypophosphatemia. Our patient had hypophosphatemia at initial evaluation which spontaneously corrected. Acute pulmonary edema can complicate insulin overdose due to sympathetic activation and hepatic steatosis has also been reported with suicidal insulin toxicity. Management of hypoglycemia is with dextrose. As the plasma insulin levels increase and reach a level of 50–60 μU/mL, the hepatic glucose output is completely suppressed and glucose needs to be given exogenously. Most patients require dextrose infusions for prolonged period. Whenever an episode of hypoglycemia occurs, it can be treated with boluses of 50% dextrose and at other periods with 5 or 10% dextrose solutions. The average requirement of glucose till full recovery can be anywhere between 160 and 1100 g and the duration of treatment might vary from 12 to 62 hours. Our patient required 470 g of dextrose which was given over a period of 90 hours. If there are no contraindications, Ryle's tube feeding with a mixed meal should be initiated. Dextrose infusion can itself be a cause for excessive insulin secretion especially in non-diabetics and lead to recurrent hypoglycemia. Excision of subcutaneous fat at the injection site has been shown to drastically reduce the dextrose infusion rates. We have successfully diagnosed and treated a young patient, who presented with coma and hypoglycemia due to exogenously administered insulin with probable suicidal intent. Insulin administration should be kept in differential diagnosis when any case presents with coma and hypoglycemia, especially in paramedical personnel. Source of Support: Nil, Conflict of Interest: None declared.1. Beardwood JT. A case of attempted suicide with insulin. JAMA.1934; 102 :765–6.2. Hawton K, Clements A, Simkin S, Malmberg M. Doctors who kill themselves: A study of methods used for suicide. Q J Med.2000; 93 :351–7.3. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.2009; 94 :709–28.4. Auer RN, Hall P, Ingvar M, Siesjo BK. Hypotension as a complication of hypoglycemia leads to enhanced energy failure but no increase in neuronal necrosis. Stroke.1986; 17 :442–9.5. Mégarbane B, Deye N, Bloch V, Sonneville R, Collet C, Launay JM, et al. Intentional overdose with insulin: Prognostic factors and toxicokinetic/toxicodynamic profiles. Crit Care.2007; 11 :R115.6. Thewjitcharoen Y, Lekpittaya N, Himathongkam T. Attempted suicide by massive insulin injection: A case report and review of literature. J Med Assoc Thai.2008; 91 :1920–4.7. Wong OF, Tsui KL, Kam CK. A case of acute insulin poisoning. Hong Kong J Emerg Med.2006; 13 :232–4.8. Tofade TS, Liles EA. Intentional overdose with insulin glargine and insulin aspart. Pharmacotherapy.2004; 24 :1412–8.9. Seehusen DA, Reeves MM, Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician.2006; 68 :1103–8.10. Ortega E, Wagner A, Caixas A, Barcons M, Corcoy R. Hypoglycemia and pulmonary edema: A forgotten association. Diabetes Care.2000; 23 :1023–4.11. Jolliet P, Leverve X, Pichard C. Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration. Intensive Care Med.2001; 27 :313–6.12. Campbell IW, Ratcliffe JG. Suicidal insulin overdose managed by excision of insulin injection site. Br Med J.1982; 285 :408–9. Articles from Indian Journal of Endocrinology and Metabolism are provided here courtesy of Wolters Kluwer - Medknow Publications : Insulin poisoning with suicidal intent

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