Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

DIABETES MELLITUS – The scourge of Indians -- Part V

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,

The Nobel Prize for physiology and medicine in 1923 went to Drs. Frederick Banting, a young surgeon, and Prof: John McLeod, a physiologist, both from Toronto, for the discovery of insulin, a hormone produced by the beta cells of pancreas. Dr. Banting shared his prize with Charles Best, a medical student working with him.

The discovery of insulin was one of the biggest breakthroughs of 20th century and indeed revolutionized the treatment of Diabetes Mellitus – Type 1 and 2. In spite of increased awareness and the advances in the management of DM T 2, the glycemic control of many patients still fall short of the target level. So it behooves all patients to get a better understanding of their problem to achieve adequate control. In DM T 2, insulin is added as a supplemental therapy to the oral hypoglycemic drugs.

The commercial insulin preparations have evolved rapidly from the crude Zinc Insulin in the 1950s to more purified versions of human insulin in the 1980s to the “insulin analogs” (analogues) of today. Insulin analog is a synthetic insulin designed to mimic the body’s natural pattern of insulin release. These analogs are often called “designer insulin” and their greatest advantage is the predictable duration of action. Their action-profiles allow more flexibility thus lowering the risk for hypoglycemia. The analogs are now rapidly replacing human insulin in our clinical practice.

What I am going to tell you next would sound a bit too technical but I believe every diabetic patient should have some basic knowledge of the different types of insulin, how quickly they work, when they peak in the blood (the time of maximum action in producing hypoglycemia), and how long they last. Although insulin is available in different strengths, the most common one in usage is “U-100” which means there are 100 units per ml. That makes it easy to count the units when you withdraw the drug into a syringe. Here are the types of insulin available for general use.

  1. Fast - acting insulin, also called regular insulin, begins to work within 15 minutes after injection, peaks in 1 hour, and continues to work for 2 to 4 hours and then fade off. Hence, it is important to inject them within 5-10 minutes of eating. Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog) belong in this group.

  2. Intermediate-acting insulin reaches the bloodstream within 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Humulin N, Novolin N are in this category.

  3. Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period. They include Insulin detemir (Levemir) and insulin glargine (Lantus)

  4. Pre-mixed is a mixture of fast acting and intermediate acting and helps to keep the blood sugar steady for the best part of day and night. Examples are Humulin 70/30, Humalog mix 75/25, Humalog mix 50/50, etc.

Your doctor may use a combination of these types in order to achieve 24 hour control of blood sugar. Insulin pens with needles are now available for convenient injections, especially when travelling. A pen is the size of a large marker and, carries a self-contained cartridge prefilled with insulin. The reusable types need to be loaded with a cartridge every time you use it. The disposable pens come filled with a premeasured amount of insulin and can be discarded when empty. In addition, “insulin pumps” are available that can deliver a bolus of regular insulin as needed.

In addition to insulin, another group of injectable medications for DM T 2 has arrived on the market. These include three drugs: “exenatide (Byetta), long-acting exenatide (Bydureon) and liraglutide (Victoza).” The advent of these drugs has been heralded as a monumental advance in diabetes care. They also promote weight loss and carry low risk for hypoglycemia.

All patients on insulin should be on a personalized “insulin plan” that can be created with the help of the treating diabetic team. Diabetic educators will come to the patient’s house to teach the technique of administering insulin and answer questions and doubts.

To be continued . . .

Dr. Ravindra Nathan is a Brooksville cardiologist and author of a new book, “Stories from My Heart.”

homeeventsbiz directorysubscribecontact uscontentclasses/places of worship newseditorialhealthimmigration
Real ESTATEfinanceayurvedatechno cornermoviesfashionmusic/dancebooksbusiness beatscene to be seenart/youthastrology
Read the Editor's Blog. By Nitish Rele Classifieds Motoring Cuisine Astrology Art/Youth Books Music and Dance Fashion Movies Techno Corner Finance Immigration Health Editorial News Classes/Places of Worship Content Find us on Facebook!