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Diabetes treatment with insulin

If a person with diabetes can't produce their own insulin they will be prescribed regular insulin injections under the skin or through an insulin pump. Some people who don’t make enough insulin may also need insulin through injections or a pump.

Insulin is a hormone that the body uses to regulate blood sugar or glucose levels.

Most people in the UK using insulin receive synthetic human insulin or insulin analogues. For a small number of people, animal insulin is still used because it works better for them.

Who needs insulin?

People with diabetes who may need insulin therapy include:

  • People with type 1 diabetes where insulin is the only medication that can be used to control the increases in blood sugar that occur with the condition.
  • People with type 2 diabetes where insulin can be used alone or in combination with diabetes medication.
  • Women with gestational diabetes during pregnancy.

What are the types of insulin used for diabetes?

The diabetes care team will discuss the appropriate type of insulin to use.

The 6 main types of insulin are:

  • Rapid-acting analogue - Injected just before, with food, or after a meal. Lasts around 4 hours.
  • Long-acting analogue - Usually injected once a day to cover all meals.
  • Short-acting insulin - Injected 15–30 minutes before a meal and lasts for up to 8 hours.
  • Medium- and long-acting insulin - Used once or twice a day alone or with short acting insulins/rapid-acting analogues. Can last up to 30 hours. They are cloudy in appearance.
  • Mixed insulin - Combining medium- and short-acting insulin.
  • Mixed analogue - Combining medium-acting insulin and rapid-acting analogue.

How is insulin injected?

Insulin can be injected using a needle and syringe, cartridge, or prefilled pen systems. Insulin pumps are also available to deliver insulin at a pre-set rate from a small machine about the size of a pack of cards.

Where on the body should insulin be injected?

Where you inject your insulin into your body may affect the timing of its benefit to you. The abdomen (tummy) has the fastest rate of absorption, followed by the arms, thighs, and buttocks. Absorption is also the most consistent in the abdomen.

Rotation (moving the site of the injection around) within the selected site of insulin injection is important to prevent the breakdown and scarring of fat tissue under the skin, a condition known as lipoatrophy. By rotating within the site selected rather than between multiple sites on the body, the absorption of insulin remains relatively constant.

Of course, in hospital, insulin may be given as an intravenous dose that gets more rapidly absorbed than either a dose given directly under the skin or in the muscle.

What are the side effects of insulin?

The major side effects that can occur when taking insulin for diabetes include:

  • Low blood sugar ( hypoglycaemia)
  • Hypertrophy or enlargement of the area of the body that has received too many insulin injections
  • Rash at the site of injection or over the entire body (rare)
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