Insulin And Insulin Resistance Diet

Type of Drug:

Hormone; antidiabetic agent.

How the Insulin Product Works:

Insulin, normally produced in the pancreas gland, is the major hormone that regulates glucose (sugar) use in the body. Without insulin, sugar

is trapped in the bloodstream and cannot enter the cells of the body where it can be utilized for energy, so blood sugar levels increase, resulting in diabetes. In type 1 (insulin-dependent) and advanced type 2 (non­insulin-dependent) diabetes, the pancreas is not able to make enough insulin to control sugar levels.

Insulin must be injected. If taken by mouth, it would be digested by the acids and enzymes in the stomach.

Uses of The Insulin:

To treat type 1 (insulin-dependent) diabetes mellitus.

To treat type 2 (non-insulin-dependent) diabetes mellitus that cannot be properly controlled by diet, exercise, or weight reduction.

Used in a hospital setting to treat dangerously high blood levels of potassium.

Precautions:

Diet and exercise: It is important to follow the diet and exercise regimen prescribed by your doctor in order to effectively control diabetes. Do not change this regimen unless advised to do so by your doctor.

High blood pressure: High blood pressure in combination with diabetes increases the risk for other health problems (eg, eye or kidney problems, heart attack, stroke). Blood pressure should be monitored frequently. Regular checkups and eye examinations are important.

Smoking: Avoid tobacco products. If you are a smoker and stop, your dose of insulin may need to be reduced.

Brand interchange: Do not change from one insulin product to another unless advised to do so by your doctor. Insulins vary by strength, brand, onset, maximum effect, and duration of activity (see the following table). Become familiar with how the products you are using affect your blood sugar levels.

Insulin mixtures: Patients stabilized on mixtures should have a consistent response. Unexpected responses are most likely to occur when switching from separate injections to mixtures (or vice versa). When mixing 2 types of insulin, always draw the clear regular insulin into the syring first. To avoid dosage errors, do not alter the order of mixing insulin's or change the model or brand of syringe or needle.

It is recommended to use the self-prepared mixtures within the first 5 minutes after mixing. If this is not Possible, clnrify with your doctor, pharmacist, or health care provider the Installs on how to mixtures.

NPH/regular mixtures of insulin are available in premixed formulations of 70% NPH and 30% regular, and of 50% NPH and 50% regular. Insulin lisper NPH/regular mixtures are available in premixed formulations of 75% NPH and 25% regular and of 50% NPH and 50% regular. These mixtures are stable and are absorbed as if injected separately.

High blood sugar: In patients with type 1 diabetes mellitus, high blood sugar levels (hyperglycemia) that are not treated properly with insulin can develop into diabetic retroactions, a life-threatening condition requiring prompt diagnosis and treatment (see the following table for symptoms). Close monitoring and control of blood sugar levels are required to prevent high blood sugar levels from developing.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking insulin. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with insulin:

Decrease the glucose-lowering effect of insulin

AIDS antiviral's (EEG, sauna) ionized (EEG, Android) abutter (EEG, Provencal) lithium carbonate (EEG, Desalt) sporangia (El spar) loop diuretics calcimining (EEG, Calcium) (EEG, nursemaid) condone (EEG, Attars) morphine sulfate (EEG, MS contraceptives, oral Nov um niacin (vitamin 8 3 nicotinic acid) cortices (eg, prednisone) nicotine cyclophosphamide (eg, phenothiazines (eg, prometha- Cytosine) danazol (eg, Danocrine) phenytoin (eg, Dilantin)dextrothyroxine (Choloxin) somatropin (eg, Genotropin) diazoxide (Proglycem) terbutaline (eg, Brethine) diltiazem (eg, Cardizem) thiazide diuretics (eg, hydrodobutamide (eg, Dobutrex) chlorothiazide) epinephrine (eg, Adrenalin thyroid hormone Chloride) (eg, levothyroxine)

Increase the glucose-lowering effect of insulin

ACE inhibitors (eg, ramipril) MAOls (eg, phenelzine) alcohol propoxyphene (eg, Darvon-N) antidiabetic products, oral (eg, alicylates (eg, aspirin) glipizide) somatostatin analog (eg, Notre beta blockers (eg, propranolol) clofibrate (Atromid-S) sulfonamides (eg, trimethoprim disopyramide (eg, Norpace) and sulfamethoxazole) fluoxetine (eg, Prozac) tetracyclines (eg, oxytetracyc- lithium carbonate (eg, Eskalith)

Side Effects of Insulin:

Every drug is capable of producing side effects. Many insulin users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Skin: Rash, itching, redness, or other allergic symptoms at injection site; skin puckering at injection site; skin depression at injection site; skin thickening at injection site; fatty lumps at injection site. For symptoms of high blood sugar and low blood sugar, see Precautions.

Low blood sugar: Insulin use has the potential to cause hypoglycemia, or low blood sugar (refer to the preceding table for symptoms). Hypoglycemia may be due to taking too much insulin, exercising or working more than usual, not eating enough food, or not eating at the appropriate times. Eating sugar or a sugar-sweetened product will often correct the condition and prevent more serious symptoms. Establish a plan with your doctor on how best to treat hypoglycemic reactions. All diabetic patients should carry a source of rapid-acting sugar (eg, candy mints, glucose tablets) to take if symptoms of low blood sugar develop. Commercial products containing 40% glucose are available, such as B-D Glucose tablets. Close self-monitoring of blood glucose is necessary to determine when blood sugar levels are too low. Notify your doctor immediately if you experience ongoing symptoms of low blood sugar.

All patients using insulin should also have a Glucagon emergency kit available, so that family members, Coworkers, or friends can administer the Glucagon to raise blood sugar levels in an unconscious patient with diabetes (see the Glucose Elevating Agents - Glucagon monograph in this chapter). Make sure these people know how to prepare and administer Glucagon.

Pregnancy: If you are using insulin and become pregnant, management of your diabetes will require a greater effort and you should self monitor blood glucose and ketones more often. Rigid control of blood sugar and avoidance of ketones in the blood are desired throughout pregnancy. Insulin requirements may drop immediately following delivery, then increase to pregnancy levels over time.

Breastfeeding: Insulin appears in breast milk, but is destroyed in the stomach of the infant and not absorbed. 8reastfeeding women may require adjustments in insulin dose and diet.

Lab tests may be required to monitor therapy. Tests may include blood glucose, urine ketones, and glycohemoglobin tests.