Dr. Ahmed
What is an improper use or insufficient use of insulin? Your question has two components:
- Improper use of Insulin and
- Insufficient use of Insulin
Insulin is life-saving medicine for patients with Diabetes mellitus Type 1. However, improper use of insulin can be ineffective and your blood glucose may fluctuate tremendously. Similarly, if you are using insulin properly but the dose is not sufficient or more than your requirement, it can result in either inadequate control or serious side effects.
How to properly use and inject insulin?
Insulin should be used only in patients with Diabetes mellitus. All patients with Diabetes Mellitus Type 1 require insulin. Certain patients with Diabetes Mellitus Type 2 also require insulin for optimal glucose control.
Type 2 Diabetes patients who undergo a surgical procedure, are acutely ill, are pregnant, or have inadequate control of blood glucose despite oral medicines also require insulin.
Insulin is an injectable medicine and should be administered subcutaneously into the skin. For proper administration, follow these steps:
- Keep insulin refrigerated but do not freeze it.
- When administering insulin, take the vial out of the fridge and keep it at room air for a few minutes.
- Put it on the palmar surface of the hand and roll it a few times. This will mix the insulin and raise its temperature to match the body temperature.
- Insert the insulin syringe into the vial and keep it upside down.
- Pull the syringe plunger and draw the correct units of insulin.
- Inject it into the anterior abdomen at least three fingers away from the naval. Keep the needle straight (in a vertical 90 degrees) and inject it straight into the skin. Thin lean patients can make a fold and then inject it directly into the skin.
- Once all the units have been injected, wait for ten seconds and then withdraw the insulin needle.
Which site should be used for injecting insulin?
Preferably you can inject insulin into the anterior abdomen, three fingers away from the naval. Try to rotate sites. Do not inject insulin into one area all the time.
If you are not comfortable, you can also inject insulin into the anterior thighs. Avoid injecting insulin in your forearm, hands, and legs.
What is an Improper use of Insulin?
People who are newly prescribed insulin usually have difficulty injecting and properly using insulin. Insulin should be injected as described above.
Try to inject insulin into the anterior abdomen. Injecting insulin directly into the vein or skin that is infected or inflamed can have serious side effects.
Improper use of insulin by people without diabetes:
Also, do not use insulin if you are not diabetic. Some people misuse it for its anabolic effects. Insulin causes weight gain and increases muscle mass. Non-diabetic people who use it for weight gain or muscle strength may end up with serious and permanent brain damage and coma.
Insulin use other than diabetes should be strongly discouraged
Factitious hypoglycemia is a condition when a person injects insulin to lower blood glucose. This is self-induced hypoglycemia and is usually intentional. Most of the patients who have factitious hypoglycemia have an underlying psychiatric disorder or have some mental issue. However, some patients intentionally lower their blood glucose for personal gains.
Other instances of improper use of insulin:
Insulins are of different types. Short and rapid-acting insulins are usually administered before meals to cover the postmeal rise in blood glucose. Basal insulins such as Levemir, glargine, and Degludec are intended for basal control of blood glucose.
Basal insulins usually have little impact on the postmeal rise in blood glucose. Basal Insulins are either administered once or twice daily.
Tresiba to Lantus Conversion Guidelines: Calculate Your Dose
Improper timings of insulin?
“Improper timings of insulin” is when you inject the rapid and short-acting insulin after meals or skip meals after you inject the short-acting or rapid-acting insulin. Similarly, if you inject basal insulin before each meal with the hope to control your post-meal blood glucose is not recommended and should be avoided.
Which Insulin can you combine?
It is best to inject insulins separately, however, you can combine Regular Insulin and NPH insulin in a single syringe before administration.
Other insulins should not be combined in a single syringe. If you are using basal insulin, try to use one basal insulin. Do not use insulin Glargine, Levemir, and Degludec at the same time.
Xultophy 100/3.6 (Insulin Degludec and Liraglutide) for Obese Diabetics
You can use short-acting insulin or rapid-acting insulin before each meal and any one of the basal insulins. Try avoiding pre-mixed insulins and basal insulin with the same meal. Occasionally your physician may advise premixed insulin such as Humulin 70/30, Novomix 70/30, or Humalog Mix 25 before breakfast and basal insulin at night. But these combinations should only be used if prescribed by your physician.
In addition, do not use premixed insulin or short-acting/ rapid-acting insulin with sulfonylureas or other insulin secretagogues.
Nocturnal Hypoglycemia: Symptoms, Causes, Treatment, & Prevention
What is insufficient use of insulin?
Insufficient dosage of insulin is when the amount of insulin administered does not optimally control your blood glucose. People may intentionally reduce their dosages because of the high cost of insulin.
Some patients have high insulin requirements. Increasing the dose above a certain limit may be associated with anxiety. High insulin requirements can add up to the cost as well. It is important to add an insulin sensitizer (such as metformin) to the medication regimen to reduce their insulin requirements.
In addition, when the insulin dose exceeds 40 to 60 units, the “bubble effect” may be observed. “Bubble effect” is the loss of insulin efficacy when high doses of insulin are administered as a single dose. To reduce the “bubble effect”, it is advised to either split the insulin dose to twice daily or use an ultra-long-acting insulin such as Insulin Degludec (Tresiba).
In Conclusion:
Insulin is a life-saving medicine but simultaneously can be associated with serious side effects it not administered properly.
