When To Take Insulin For Type 2 Diabetes?

When To Take Insulin For Type 2 Diabetes
Terms To Know – Short- or rapid-acting insulin taken at or before mealtimes to control blood sugar levels. Intermediate- or long-acting insulin taken to keep blood sugar levels steady between meals and overnight. Rapid-acting insulin taken at mealtimes and long-acting insulin taken once or twice a day.

When does a type 2 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

Can a type 2 diabetic just take insulin?

People with type 2 diabetes are occasionally treated with ‘intensive’ insulin regimens. Intensive insulin treatment requires multiple injections of insulin per day or the use of an insulin pump.

Can a type 2 diabetic overdose on insulin?

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

Can a diabetic go one day without insulin?

It is not safe to go without it even for a day. Insulin pumps work differently from multiple daily injection (MDI) insulin regimens because they hold only rapid-acting insulin and deliver it continuously, much like a pancreas, which secretes small amounts of insulin a needed.

Can insulin damage kidneys?

Abstract – We review some of the effects that insulin exerts on glomerular and tubular functions. In healthy subjects, insulin has little or no effect on renal hemodynamics, glomerular filtration rate, or permeability to albumin. In patients with noninsulin-dependent diabetes, hyperinsulinemia selectively increases urinary albumin excretion.

In vivo, euglycemic hyperinsulinemia is associated with reduced urinary sodium excretion both under conditions of forced and normal diuresis.
Whether the principal site of this action is the proximal or distal tubule remains somewhat controversial.
The effect, however, is not mediated by insulin-induced hypokalemia and antikaliuresis, as it is still observed when plasma potassium concentrations and urinary potassium excretion are maintained.

Hyperglycemia potentiates insulin antinatriuresis through an effect on the proximal tubule (sodium-glucose cotransport). Insulin antinatriuresis is accompanied by a reduction in the urinary excretion of uric acid. Both the antinatriuretic and antiuricosuric effect of insulin are preserved in states of insulin resistance of glucose metabolism (obesity, diabetes, essential hypertension).

What happens if you use insulin and don’t need it?

A grand dame with hidden aces: The non-diabetic uses of insulin : © 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.

This brief communication reviews the non-diabetic uses and utility of insulin. It highlights the lesser known uses in medicine, psychiatry, suregery and diagnostics that this versatile peptide has. Keywords: Applied pharmacology, insulin, non-traditional uses The discovery of insulin is thought to be one of the most dramatic turns in the medical history.

Insulin is the most important anabolic hormone in the body. Over the past century, researchers have discovered multiple pleiotropic effects and actions of this molecule. While extensive work has been published, on a regular basis, about advances in biochemistry, physiology, and pharmacology of insulin, no review has targeted the spectrum of non-diabetic uses of this hormone. When To Take Insulin For Type 2 Diabetes Several hormones including insulin are used as an essential component of synthetic growth media for cell culture. They promote growth of mammalian cells by increasing the permeability of cell membranes to glucose and making nutrients available to the cells.

Although invariably every mammalian cell will require insulin for survival, the degree of requirement varies with different cell lines. Insulin is also used for similar reasons in organ preserving solutions. Organs extracted for transplant purposes are preserved in insulin containing solutions. Insulin tolerance test is the most reliable provocative test for growth hormone deficiency.

An insulin tolerance test is age independent and reproducible. Insulin is administered into the patient and blood samples are taken after every 15 minutes over the next hour to determine whether the growth hormone levels have risen in response to insulin.

Since growth hormone is a counter-regulatory hormone and is released when blood glucose level falls below normal, an insulin tolerance test deliberately lowers the blood glucose level to check whether there is an increase in the release of growth hormone. Failure of release of growth hormone would suggest growth hormone deficiency.

Insulin is also used in narcoanalysis to reduce an individual’s self-control over one’s thoughts and cause him to reveal the thoughts or memories which he would otherwise have suppressed. The central nervous system has an absolute requirement for glucose.

A reduction in blood glucose level causes a decrease in all the higher mental functions. Narcoanalysis uses this principle to reduce the higher mental control on the thoughts or memories. This would cause the subject to reveal the required information which he might not have disclosed ordinarily. It is useful for psychiatric and forensic purposes.

The legal status of narcoanalysis is still debatable. The solutions used for total parenteral nutrition often contain a small amount of insulin. Regular insulin added to parenteral nutrition solution manages hyperglycemia, improves absorption of nutrients and reverses negative protein balance.

Insulin availability in such solutions ranges from 10 to 95%. Rapid infusion of the parenteral nutrition, as is the usual case, would cause severe hypoglycemia if the insulin were not there to cause the glucose to be absorbed rapidly into the cells. It also prevents other complications such as muscle wasting which are common in bed-ridden patients.

Glucose–insulin–potassium solution (GIP or GIK solution) is given after a myocardial infarction to increase the usage of glucose by the myocardium and maintain the integrity of membrane ionic pumps. The GIP solution provides the glucose needed by the myocardium in reperfusion conditions and protects the cellular membrane and keeps the membrane pumps functional.

It prevents changes in intracellular concentrations of sodium, potassium and calcium ions, thus preventing cardiac arrythmias.
Insulin also has direct anti-inflammatory and anti-apoptoic effects.
Although most studies have shown positive results, GIP solution has not received as wide an acceptance among cardiologists as one might predict and is therefore not very commonly used.

Insulin has also been used by many as a substance of abuse for body building. Insulin with growth hormone is being used by many athletes and body builders for increasing their muscle mass. When supplied with growth hormone, it causes an increase in lean body mass since both the hormones are highly anabolic.

Since insulin has a very short half-life in the body, it is exceedingly difficult to detect insulin abuse using laboratory tests. This knowledge is attracting more and more athletes toward this illegal practice. Insulin supplied exogenously or produced endogenously also has an effect of suppressing ghrelin.

How do you know type 2 diabetes is getting worse?

Final Words – These are some signs that your type 2 diabetes is getting worse. Other signs like a tingling sensation, numbness in your hand or feet, high blood pressure, increase in appetite, fatigue, blurred vision, trouble seeing at night, and more shouldn’t be overlooked.

Just as you would visit a clinic for allergy testing charlotte when you notice any symptoms, you should do the same if any of the mentioned signs show up. Not heeding to these signs can worsen the condition and even pose fatal risks. Get connected to your diabetes management services provider and work together to get your blood glucose level under control.

BESbswy BESbswy Please follow and like us: Tags: allergy testing charlotte, allergy testing clinic, diabetes management services, diabetes management services charlotte

What insulin level is type 2 diabetes?

Results are interpreted as follows: Below 5.7% is normal.5.7% to 6.4% is diagnosed as prediabetes.6.5% or higher on two separate tests indicates diabetes.