Insulin is a hormone that is made in the pancreas. Specifically, there are special cells in the pancreas, called beta cells, that produce insulin. There are also alpha cells in the pancreas that make glucagon, another hormone. But back to insulin: when insulin is made in the beta cells, it initially is in the form of “proinsulin,” which then splits into C-peptide and insulin. C-peptide plays a key role in the diagnosis of type 1 diabetes, as well as diabetes treatment, because it indicates how much insulin the pancreas is making.
Insulin helps the body use glucose from the carbohydrate in food for energy, and prevents glucose levels in the blood from rising too high. Insulin attaches to cells to absorb glucose from the bloodstream, much like a key that opens a lock. Once inside the cells, glucose is then used for energy. What happens if you have more glucose in your blood than the cells need? Insulin will funnel that extra glucose in your liver where it’s stored. If your blood glucose drops too low or if you need more fuel for, say, exercise, glucagon signals the liver to release that stored glucose.
If you have type 1 diabetes, you need to replace the insulin that your body no longer makes. Insulin can be injected, using a syringe or an insulin pen; it can also be infused by using an insulin pump. There is no insulin “pill” at this time. There are different types of insulin that mimic how insulin works in the body; for example, rapid-acting insulin starts to work in 5–15 minutes and is typically taken before you eat a meal. Intermediate and long-acting insulins start to work more slowly, and are used to help keep blood glucose levels steady between meals and overnight while you’re sleeping. You will likely need to use two different types of insulin to help you manage your blood glucose. Your doctor and diabetes educator should work with you to decide the best type and amount of insulin to take, and give you guidance on how to adjust your insulin for changes in food and physical activity, and for times when you need more insulin, such as when you are sick or under stress.
Who should be part of my diabetes care team?
You don’t have to go it alone when you have diabetes. In fact, the more support that you get from your health-care team, family and friends, the easier it will be to successfully manage your diabetes. But who should be on your health-care team? For starters, your primary-care provider — a physician, physician’s assistant or nurse practitioner, for example — is the gatekeeper and can help coordinate your care. Ideally, you should have an endocrinologist, which is a doctor who specializes in the treatment of diabetes. A certified diabetes care and education specialist (formerly known as a certified diabetes educator) can teach you how to inject insulin or use an insulin pump, check your blood glucose, and make sense of your blood glucose readings. A dietitian can help you develop an eating plan that works with your lifestyle and helps to keep your blood glucose levels within your target range. An ophthalmologist can provide you with annual dilated eye exams to detect (and treat, if necessary) eye problems, such as diabetic retinopathy. If you have complications, you may need to see a cardiologist (heart specialist), a nephrologist (kidney specialist), neurologist (nerve specialist) or a podiatrist (foot care specialist). Your pharmacist can help you learn more about the medications that you may need to take. Finally, because you may feel overwhelmed, discouraged or even depressed about having diabetes, a mental health provider can be an invaluable member of your team to provide you with support. You might be more comfortable finding support from other people who live with type 1 diabetes, whether that’s from a support group or an online community.
If you aren’t sure how to put together your own team, talk with your primary-care provider. Also, look for resources in your community — for example, your local hospital may have a diabetes program. You can also call your local office of the American Diabetes Association. They can point you to programs and specialists in your community, as well. Finally, remember that you are the center of your health-care team. Don’t be afraid to ask questions and speak up if something isn’t working for you. Your team is there to work together to support you.