Updated April 26, 2005

Insulin Therapy for Type 2 Diabetes

by Virginia Peragallo-Dittko, R.N., B.C.-A.D.M., M.A., C.D.E.

The rapid-acting insulins aspart and lispro can start to lower your blood glucose within five minutes of an injection, so they should be taken just before or after meals. If you wait too long to eat after injecting aspart or lispro, your blood glucose level could drop too low.

Mixing insulins. Insulin glargine (Lantus) cannot be mixed in the same syringe with any other insulin. All of the other insulins can be mixed together but if you mix Lente or Ultralente with any other insulin product, you must inject immediately after filling the syringe; if you don’t, the action profile—or the time it takes the insulin to start working, reach peak effectiveness, and taper off—will change.

Insulin delivery systems. Insulin is injected into a fatty part of the body so that the blood supply that feeds fat can absorb the insulin for use in the body. A syringe filled with insulin from a vial is the traditional method of delivering insulin. Pen-shaped devices called insulin pens, which are either prefilled with insulin or loaded with a cartridge of insulin, are also used. Devices prefilled with insulin called insulin dosers, which have a large display or dial for easier measurement of insulin doses, are also available.

The insulin delivery system that you choose to use can be based on your preferences, cost of the system and reimbursement, manual dexterity, visual acuity, and your unique lifestyle issues.

Storage. All insulin vials or pens not in use should be stored in the refrigerator. Most opened vials of insulin can be stored at room temperature for up to 28 days, after which they should be discarded. Prefilled insulin pens, insulin dosers, and insulin cartridges have very specific room temperature storage guidelines of 7, 10, 14, or 28 days depending on the type of insulin. Insulin stored beyond the room temperature storage guideline may be significantly less effective if used.

Checking blood glucose levels. There is no exact formula for deciding on an insulin dose, but one of the key factors used in regulating insulin doses is your blood glucose level. Blood glucose monitoring becomes an indispensable tool when you make the transition to insulin therapy. How often you need to check your blood glucose depends at least in part on the type of insulin prescribed. Plan to check more frequently when you first begin insulin therapy so that adjustments to your regimen can be made.

Side effects
The most common side effect of insulin therapy is hypoglycemia, or low blood sugar. Hypoglycemia is also a side effect of the sulfonylureas, the pills that stimulate the pancreas to secrete more insulin. Most episodes of hypoglycemia can be traced back to one of the following: taking too much insulin or oral medicine, skipping or delaying a meal, exercising strenuously without having a snack or carbohydrate drink, and drinking alcohol. Common signs and symptoms of hypoglycemia include sudden weakness, shaking, sweating, headache, hunger, palpitations, confusion, blurred vision, and irritability.

If you suspect you have hypoglycemia, check your blood glucose level with your meter to confirm it. To treat low blood sugar, eat or drink 15 grams of carbohydrate, wait 15 minutes for the carbohydrate to be absorbed, and check your blood glucose level again. If it has not increased in 15 minutes, eat or drink another 15 grams of carbohydrate and check again in 15 minutes. Some common foods containing 15 grams of carbohydrate include 4 ounces of orange juice, 6 ounces of ginger ale, 3 BD glucose tablets, 4 Dex4 tablets, and 6 saltine crackers.

Some people put up with frequent hypoglycemia because they can manage it well. But frequent hypoglycemia is a sign that something is wrong, and it can even be dangerous. When untreated or unrecognized, hypoglycemia can lead to seizures and loss of consciousness. Report episodes of hypoglycemia to your health-care provider.

Virginia Peragallo-Dittko is a diabetes nurse specialist and Director of the Diabetes Education Center at Winthrop-University Hospital in Mineola, New York.

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