Diabetes Self-Management Blog

Editor’s Note: This is the third post in our miniseries about diabetes drugs. Tune in on August 28 for the next installment.

insulinThe first installment of our medicines miniseries, “Diabetes Drugs: Insulin,” yielded a variety of questions from readers. Here, we present a selection of these questions along with responses from Dr. Marino.

My endocrinologist assures me that I have Type 2 diabetes because I have predominantly abdominal fat. Do you have any thoughts on this?

The diagnosis of adult-onset diabetes is not always straightforward. There is a condition called latent autoimmune diabetes of adults, or LADA, that may occur in up to 10% of people with diabetes who initially do not require insulin. You should discuss this with your health-care provider; if appropriate, he could check for this condition with various blood tests. A diagnosis of LADA might have implications for your therapy, since there is some evidence that people with this condition have more of an insulin deficiency than people with Type 2 diabetes. However, no large studies have been done to help determine the best therapy for LADA.

With that said, the goal is to optimize the current insulin therapy you are on. As mentioned in “Diabetes Drugs: Insulin,” the best method of insulin administration is to combine long-acting and rapid-acting insulin to provide good blood glucose control throughout the day without causing hypoglycemia (low blood glucose). I would suggest that you work closely with your health-care provider to optimize your blood glucose control. This may mean more frequent blood glucose measurements throughout the day to determine how to change your daily doses. Another option you may want to explore with your health-care provider is an insulin pump. And as always, a diet and exercise plan that is designed in partnership with your health-care provider is recommended.

In your experience, does insulin therapy protect people with diabetes from the complications of the disease, such as amputations, kidney failure, and heart attack?

The goal of any therapy for diabetes is to keep blood glucose levels within the target range. In multiple large clinical trials such as the Diabetes Complications and Control Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) Study, which looked at people with Type 1 diabetes, and the United Kingdom Prospective Diabetes Study (UKPDS), which looked at people with Type 2 diabetes, complications were significantly reduced by improved blood glucose control. The beneficial effects in the UKPDS study occurred regardless of the drug used to obtain good control (including insulin).

Within two weeks of starting insulin therapy, I gained 9 pounds, mostly in the waist area. I exercise regularly, but the weight problem remains. Doesn’t this defeat the purpose of using insulin?

As noted in “Diabetes Drugs: Insulin,” insulin is an energy-storing hormone that can be associated with weight gain. There are many potential reasons for insulin causing weight gain, but one possible reason is that the insulin produces a lower blood glucose level than your body is used to, which leads to “defensive” eating to combat the perceived hypoglycemia. You should keep track of your diet and your blood glucose levels during the day in a diary that you can review with your health-care provider.

There are several drugs for Type 2 diabetes, including metformin (brand name Glucophage and others) and exenatide (Byetta), that do not produce weight gain or that produce weight loss. However, none of them are as effective at improving HbA1c (an indicator of blood glucose control over the previous 2–3 months) as insulin. You should discuss with your doctor what other options might be of use in your specific circumstances.

Is it possible to be allergic to insulin?

Insulin allergy does occur, but it is relatively rare. Medically speaking, an allergy to insulin usually involves the development of a very specific class of antibodies called IgE antibodies. (This is the same class of antibodies that causes allergies to other drugs, such as penicillin.) IgE antibodies are not to be confused with insulin antibodies, which do occur in many people who receive insulin. These insulin antibodies are of the IgG class and do not cause an “allergic” reaction. To read about a person with a true insulin allergy, click here.

I’d love to understand how exercise makes insulin more effective. I have Type 1 diabetes, and when I exercise, I need less insulin — sometimes even no insulin — even if I consume carbohydrate while doing this.

Insulin requirements vis-à-vis exercise is a very large topic. A person’s blood glucose response to exercise depends on how well the person’s blood glucose is in control and the type and intensity of the exercise, as well as the person’s level of physical fitness. In general, glucose uptake in muscle depends on glucose transporters (proteins that serve to ferry glucose into the cell) in the muscle cell membrane, and these are known to increase during exercise and to stay elevated for several hours after exercise. Many other aspects of how these transporters and other signals are stimulated by exercise are not fully known. For more details, see the book Nutritional Applications in Exercise and Sport, by Ira Wolinsky and Judy A. Driskell, as well as the article “Exercise-induced increase in muscle insulin sensitivity.”

Click here for other installments of “Diabetes Drugs.”

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Comments
  1. Dear Dr. Merino.

    Thanks for all your efforts.

    I read the article of the patient with the true allergy. He was on a tremendious amount of insulin at 2.4U/Kg/day. If I understood this correctly if you are “really” allegic there are sighs at the skin near the injection sites.

    It is also interesting to see a scientific study of the increase in insulin snsitivity with exercise. this is a phenomena that nearly all diebetics report.

    Posted by CalgaryDiabetic |
  2. Dear Dr. Merino

    I’m type 2 diabetic and using 2 types of insulin already (Luntus and Humalog)for 19 years. I would like to know, why manufacturers do not provide us with simple way to test insulin. When weather is above 90 degrees and I carry insulin with me on the street, I want to know how good insulin is after exposure to temperature, and sometimes some insulin still left after 28 days, if I would have an easy test, I would still use it until vial is empty. I pay for every medicine cash and it would help me to save money. I came to conclusion that manufacturers do not provide us with the simple way to test insulin just to increase their sales.

    Truly
    Zakhary

    Posted by Zakhary |
  3. You ask a very interesting question about determining insulin stability. Insulin is a protein and its biologic activity is dependent upon it retaining its three-dimensional physical structure, since it interacts with the insulin receptor in a “lock and key” type relationship. If this structure is changed or modified, the insulin can lose its ability to activate the receptor and consequently not function to lower glucose levels.This obviously can have disastrous consequences. The three-dimensional structure depends upon the insulin not changing chemically or physically, either of which can occur with exposure to heat, freezing, shaking, or simply time. A common way in which insulin degrades is to form “fibrils,” or clumps of insulin particles, that can be detected by eye. By the time this occurs, the process of degradation is well advanced. Changes that occur in a more subtle way or at least not detectable by eye can only be detected through sophisticated laboratory equipment such as CD ultra-violet spectrophotometers, nuclear magnetic resonance spectrometers, and liquid chromatography mass spectrometers. Needless to say these are all techniques that require a laboratory. No one has yet figured out a simple method to determine if insulin has begun to degrade. So what insulin manufacturers do is to put their products under “field-like” conditions and determine how long they can last without significant degradation and use that information to inform patients and health-care providers how to handle the insulin and how long the insulin may be used. If anything, they err on the conservative side. but that is in the interest of preventing people from using an insulin preparation that might be ineffective. The link below will lead you to an extensive publication, albeit dated, about insulin stability and what several companies have done to evaluate this issue.

    http://care.diabetesjournals.org/content/26/9/2665.full?ijkey=079589a7fc819b75da4e946e13e9cc846a6be831&keytype2=tf_ipsecsha

    Posted by Mark T. Marino |
  4. I have diabetes 2, I was taking double my dose of medicine, actos plus, prandin, and glypizede, because my A1C has been 7.7.
    I need to lose 10 to 20 pounds,I stopped eating starch, I made a hearty vegetable soup,(I griled chicken breasts, and add about 2 oz to each soup serving) and decided to have soup and salads for lunch and dinner, and fruit 3 times a day. I have oatmeal plus fruit, ground flax seed and some wheat bran and 6oz of milk, since I started yesterday, my sugar has dropped to almost normal,
    Do you think this is right diet for a diabetic?
    I would appreciate your comments…..

    Posted by Sonia Menendez |
  5. I’d like to ask about another reaction that isn’t mentioned here. I’m taking Novilin 70/30, and when I was switched to it last year, I began to have problems with my feet and legs swelling. My doctor and diabetic practioner assure me it is not because of the insulin, but I’m not convinced. I never had problems before, and now it has been over a year with this. Sometimes my feet swell to the point of impairing my walking. No other reason has been found. Then my coworker told me he was just changed to the same insulin, and guess what, he has the same problems. He can barely walk with his swollen feet and legs. We are both shuffling around. Can this truly be the insulin? Help!

    Posted by Mary |
  6. DIABETES SELF-MANAGEMENT,

    I’VE HAD TYPE 1 DIAB. SINCE 10-06-1981. I AM A 47 YEAR YOUNG MAN, DEALING WITH IT FOR 28 YRS.!!!

    I DO MY BEST CONTROLLING MY BLD. SUGARS-BUT I’D ALSO LIKE TO LET YOU KNOW, THAT I AM ALSO FIGHTING M.S.!!! SO TALK ABOUT A “DUBLE-WHAMMY”!!! I THANK YOU FOR ALL YOUR E-MAILS TO ME, I READ THEM, AND ENJOY THEM TREMENDOUSLY. I ALSO USE M.S. WATCH ON A DAILY BASIS AS WELL. I ALWAYS TELL PEOPLE “LETS KEEP TRYING TO SHINE”, SO I’LL LEAVE YOU ALSO WITH THAT THOUGHT, LET’S KEEP ON SHINING!!!

    Posted by MICHAEL PORCELL |
  7. Insulin edema (the medical term for swelling due to fluid retention) was described as long ago as 1926 (see reference below). It has also been described in newly diagnosed pediatric patients with Type 1 diabetes as well as adults with diabetes. It is a very rare reaction. The papers below describe the syndrome. Please discuss any potential treatment regimen with your health-care provider, as the treatment suggested in the Diabetes Care article would not be standard of care today.

    Cal West Med. 1926 April; 24(4): 482–484.

    Journal of Endocrinological Investigation
    2000, vol. 23, no3, pp. 187-188 (14 ref.)

    Diabetes Care July 1993 vol. 16 no. 7 1026-1028

    Posted by Mark T. Marino |
  8. I’ve been a type 1 diabetic for 8 years taking both pills and insulin with readings in the 400-600 range alot of stress in my life due to ex husband, now my sugar levels are about 120- 150 without taking any meds due to no insurance, and ex husband and stress out of my life, could I be cured of this? I exercise and have lost 45 pounds.Feel great, what is going on with my body?

    Posted by Carol Lynch |
  9. For Novolog insulin coverage at ratio of 1:7 the nutritional label says 30 grams of carbs and 29 grams of sugar. Do I cover the sugar as well as the carbs?
    If you could clarify this for us PLEASE!!
    Thanks!!!!

    Posted by suzie |
  10. Does diabetes affect your legs to make you in so much pain you can’t stand right or walk and are always in pain I need to know this is very important!!!!

    Posted by jessica delaney |
  11. I also need to know if you have type 2 diabetes and are taking narcotics does that make you sick everyday and never taking your insulin cause this is in reference to my mother cause she complains everyday all day long about how much pain she is in I need to know yhis cause she is blaming everything on diabetes please help me and let me know what are the symptoms of type 2 diabetes please tell me!!!!!!

    Posted by jessica delaney |
  12. have been type 2 for 10 years. I too gained weight with lantus/apidra and metformin and still have high readings. I recently was on vacation and unable to take lantus/apidra for a week and noticed 5 lb weight loss and stomach decreasing. Of course I like that but know possibly this is a bad thing. I do go another 2 weeks to see what would happen and have lost 12 lbs but blood ranges 190-275. Started back on lantus 36 hrs ago and scales show i have gained 4 pounds with no eating changes? Is there anything to help with this except exercise?

    Posted by marianne |
  13. Dr. Merino’
    I was recently Diagnosed with Type 2 diabetes 5 weeks ago I was placed in the hospital with a blood sugar of almost 400 mg/dl as of to days date with a strict low carbohydrate diet I have averaged a great 90 mg/dl over the last 10 days by taking 1 shot of Lantus in the morning and 1 Glucuphage 1000mg in the afternoon. my concern is that my doctor is on vacation and there was a couple of days the my count dropped in the low 70s so I stopped one of my medications with out being able to inform my doctor the medication that was stopped is called Amaryle 4mg it seemed to make me feel sick when I would take this medication I would drop in count about 70 pts… I hope I have done the rite thing… any suggestion?? and if I am on the rite track would it be possible for any type 2 person such as myself to take just pills instead of the insulin shots?….. Thank you,
    Louis

    Posted by Louis |
  14. I AM A TYPE 2 DIABETIC AND RECENTLY AS MUCH AS 4 DAYS AGO, I WAS PUT ON HUMLIN N, BECAUSE MY GLUGOSE WAS 9.9..LAST MONTH 8.4….
    QUESION IS, WHAT ARE THE SIDE EFFECTS? I WAS DOING GOOD WITH BLOOD SUGARS SINCE INSULIN, NOW 108-112…FOR BREAKFAST, I HAD CERAL (CHERRIOS) WITH 1/2 BANANA,BLOOD SUGAR BEFORE MEAL 108,9:30AM. THEN ABOUT 2-3 HRS LATER ATE EGG WITH 2 PIECES OF WHOLE WHEAT BREAD WITH NUTS IN IT, CALL OATWHEAT.TOOK BLOOD AT THE TIME BEFORE THAT MEAL AND WAS 271!

    lAID DOWN TO TAKE NAP AND HAD TO GO TO BATHROOM, ACTUALLY I HAD DIAREA EARLIER IN DAY AS WELL. I FOUND THERE WAS BLOOD IN THE TOILET AND WHEN I WIPED.
    WOULD THIS HAVE AN EFECT?
    HAD COLONOSCOPY A FEW MONTHS BACK AND WAS NEG.

    Posted by Barb |
  15. For suzie. When a food label gives total carbs and sugars, the sugars are already included in the total carbs. You do not count them again. The label with 30 grams total carbs and 29 grams sugar means 29 of that 30 grams was sugar and 1 gram was some other kind of carbohydrate, usually some type of starch. I hope that helps. It is an important distinction when you are trying to match your mealtime insulin to your carbohydrate intake.

    Former CDE.

    Posted by bk |
  16. I self monitor my blood sugar record. I am taking 25 units of Lantus at night before going to bed. In the morning I take 10 units of Lantus and 10 units of Novolog. At noon and before dinner I take 10 units of Novolog. In addition I take metforman twice a day.
    My morning blood sugar readings range from 150 to 212. My noon blood sugar readings range from 259 to 201. My before dinner blood sugar readings range from 109 to 222.
    I do not understand why my blood sugar readings are so erratic.
    I used to weigh 250 and now I am down to 264. My dietitian and my health care provider wants me down to between 205-219, I am 71 and 72 inches in height.
    Why is my insulin readings much lower at all times during the day and before bedtime?

    Posted by Ron Hewitt |

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Insulin & Other Injected Drugs
Insulin for Type 2 (07/14/14)
FDA Approves Inhalable Insulin (07/03/14)
FDA Approves Weekly Type 2 Diabetes Medicine (04/18/14)
Do You Know Your Insulin Level? (10/25/13)

 

 

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