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Whole milk contains considerable fat while skimmed milk has much less. It is a continual balancing act for all people with diabetes, especially for those taking insulin.
People with insulin-dependent diabetes typically require some base level of insulin basal insulin , as well as short-acting insulin to cover meals bolus also known as mealtime or prandial insulin.
Maintaining the basal rate and the bolus rate is a continuous balancing act that people with insulin-dependent diabetes must manage each day. This is normally achieved through regular blood tests, although continuous blood sugar testing equipment Continuous Glucose Monitors or CGMs are now becoming available which could help to refine this balancing act once widespread usage becomes common.
A long-acting insulin is used to approximate the basal secretion of insulin by the pancreas, which varies in the course of the day.
The advantage of NPH is its low cost, the fact that you can mix it with short-acting forms of insulin, thereby minimizing the number of injections that must be administered, and that the activity of NPH will peak 4—6 hours after administration, allowing a bedtime dose to balance the tendency of glucose to rise with the dawn , along with a smaller morning dose to balance the lower afternoon basal need and possibly an afternoon dose to cover evening need.
A disadvantage of bedtime NPH is that if not taken late enough near midnight to place its peak shortly before dawn, it has the potential of causing hypoglycemia.
One theoretical advantage of glargine and detemir is that they only need to be administered once a day, although in practice many people find that neither lasts a full 24 hours.
They can be administered at any time during the day as well, provided that they are given at the same time every day.
Another advantage of long-acting insulins is that the basal component of an insulin regimen providing a minimum level of insulin throughout the day can be decoupled from the prandial or bolus component providing mealtime coverage via ultra-short-acting insulins , while regimens using NPH and regular insulin have the disadvantage that any dose adjustment affects both basal and prandial coverage.
Glargine and detemir are significantly more expensive than NPH, lente and ultralente, and they cannot be mixed with other forms of insulin. A short-acting insulin is used to simulate the endogenous insulin surge produced in anticipation of eating.
Regular insulin, lispro, aspart and glulisine can be used for this purpose. Regular insulin should be given with about a minute lead-time prior to the meal to be maximally effective and to minimize the possibility of hypoglycemia.
Lispro, aspart and glulisine are approved for dosage with the first bite of the meal, and may even be effective if given after completing the meal.
The short-acting insulin is also used to correct hyperglycemia. The usual schedule for checking fingerstick blood glucose and administering insulin is before all meals and sometimes also at bedtime.
More recent guidelines also call for a check 2 hours after a meal to ensure the meal has been 'covered' effectively.
First described in ,  what physicians typically refer to as sliding-scale insulin SSI is fast- or rapid-acting insulin only, given subcutaneously, typically at meal times and sometimes bedtime,  but only when blood glucose is above a threshold e.
A more complicated method that allows greater freedom with meal times and snacks is " carb counting. In Europe, people who are not familiar with the DAFNE regime can take an educational course where the basic starting insulin dose guideline is "for every 10g of carbohydrates you eat, take 1 unit of insulin".
DAFNE courses also cover topics that naturally work alongside this regime, such as blood glucose monitoring, exercise and carbohydrate estimation to help the person work out their personal control requirements.
People can also use their total daily dose TDD of insulin to estimate how many grams of carbohydrates will be "covered" by 1 unit of insulin, and using this result, estimate how many units of insulin should be administered depending on the carbohydrate content of their meal.
Some alternative methods also consider the protein content of the meal since excess dietary protein can be converted to glucose via gluconeogenesis.
With DAFNE, most dosages involve a fair degree of guesswork, especially with non-labeled foods, and will only work fairly consistently from one dosage to the next if the person is aware of their body's requirements.
For example, a person finds they can take 1 unit of insulin to 10g of carbohydrates in the morning and the evening, but find that their body requires more insulin for a meal in the middle of the day so they have to adjust to 1 unit per 8.
Other less obvious factors that affect the body's use of insulin must also be taken into account. For example, some people may find that their bodies process insulin better on hot days so require less insulin.
With this, the person again has to adjust their dose to the best of their understanding from their past experiences. The DAFNE regime requires the person to learn about their body's needs through experience, which takes time and patience, but it can then become effective.
People with fluctuating insulin requirements may benefit from a closed-loop predictive modeling approach.
As an extension on "carb counting", in this closed-loop predictive modeling approach, the four daily insulin dosages needed to reach the target blood sugar levels for the "normal" daily carbohydrate consumption and amount of physical activity, are continuously adjusted based on the pre-meal and pre-night blood sugar level readings.
Each new blood sugar reading provides the feedback to fine-tune and track the body's insulin requirements.
Within this strategy, the key specific factors, which have to be determined experimentally, are the blood sugar correction factor and the carbohydrate ratio.
The blood sugar correction factor sets both the "proportional gain" and "integral gain" factors for the four feedback loops. When taken too low, deviations from the target blood sugar level are not corrected for effectively, when taken too high, the blood sugar regulation will become unstable.
Since in this approach, the carbohydrate ratio is only used to account for non-standard carbohydrate intakes, it is usually not required to work with meal specific ratios.
Proper modeling of the amount of insulin remaining to act in the person's body is essential in this strategy, for instance to ensure that any adjustment in the amount of basal insulin is accounted for when calculating the bolus amounts needed for the meals.
Due to the need to account for each insulin's activity profile, analyze past blood sugar trends, and to factor in non-standard carbohydrate intakes and exercise levels, this strategy requires a dedicated smartphone application to handle all the calculations, and to return meaningful dosing recommendations and expected blood sugar levels.
Constants should be set by a physician or clinical pharmacist. The abuse of exogenous insulin carries with it an attendant risk of hypoglycemic coma and death when the amount used is in excess of that required to handle ingested carbohydrate.
Acute risks include brain damage , paralysis , and death. Symptoms may include dizziness, weakness, trembling, palpitations , seizures, confusion, headache, drowsiness, coma, diaphoresis and nausea.
All persons suffering from overdoses should be referred for medical assessment and treatment, which may last for hours or days. The possibility of using insulin in an attempt to improve athletic performance was suggested as early as the Winter Olympics in Nagano, Japan , as reported by Peter Sönksen in the July issue of Journal of Endocrinology.
The question of whether non-diabetic athletes could legally use insulin was raised by a Russian medical officer. The book Game of Shadows , by reporters Mark Fainaru-Wada and Lance Williams, included allegations that baseball player Barry Bonds used insulin as well as other drugs in the apparent belief that it would increase the effectiveness of the growth hormone he was alleged to be taking.
Bodybuilders in particular are claimed to be using exogenous insulin and other drugs in the belief that they will increase muscle mass.
Bodybuilders have been described as injecting up to 10 IU of regular synthetic insulin before eating sugary meals.
Insulin, human growth hormone HGH and insulin-like growth factor 1 IGF-1 are self-administered by those looking to increase muscle mass beyond the scope offered by anabolic steroids alone.
Their rationale is that since insulin and HGH act synergistically to promote growth, and since IGF-1 is a primary mediator of musculoskeletal growth, the 'stacking' of insulin, HGH and IGF-1 should offer a synergistic growth effect on skeletal muscle.
Insulin is often measured in serum, plasma or blood in order to monitor therapy in people who are diabetic, confirm a diagnosis of poisoning in hospitalized persons or assist in a medicolegal investigation of suspicious death.
Interpretation of the resulting insulin concentrations is complex, given the numerous types of insulin available, various routes of administration, the presence of anti-insulin antibodies in insulin-dependent diabetics and the ex vivo instability of the drug.
Other potential confounding factors include the wide-ranging cross-reactivity of commercial insulin immunoassays for the biosynthetic insulin analogs, the use of high-dose intravenous insulin as an antidote to antihypertensive drug overdosage and postmortem redistribution of insulin within the body.
The use of a chromatographic technique for insulin assay may be preferable to immunoassay in some circumstances, to avoid the issue of cross-reactivity affecting the quantitative result and also to assist identifying the specific type of insulin in the specimen.
A combination therapy of insulin and other antidiabetic drugs appears to be most beneficial in people who are diabetic, who still have residual insulin secretory capacity.
In the United States the unit price of insulin has increased steadily from to The annual cost of insulin for people with type 1 diabetes in the U.
In the U. Food and Drug Administration approved the use of Exubera , the first inhalable insulin. Inhaled insulin claimed to have similar efficacy to injected insulin, both in terms of controlling glucose levels and blood half-life.
Currently, inhaled insulin is short acting and is typically taken before meals; an injection of long-acting insulin at night is often still required.
Accurate dosing was a particular problem, although people showed no significant weight gain or pulmonary function decline over the length of the trial, when compared to the baseline.
Following its commercial launch in in the United Kingdom, it was not as of July recommended by National Institute for Health and Clinical Excellence for routine use, except in cases where there is "proven injection phobia diagnosed by a psychiatrist or psychologist".
In January , the world's largest insulin manufacturer, Novo Nordisk , also announced that the company was discontinuing all further development of the company's own version of inhalable insulin, known as the AERx iDMS inhaled insulin system.
Mann remains optimistic about the concept. There are several methods for transdermal delivery of insulin. Pulsatile insulin uses microjets to pulse insulin into the person, mimicking the physiological secretions of insulin by the pancreas.
Some diabetics may prefer jet injectors to hypodermic injection. Both electricity using iontophoresis  and ultrasound have been found to make the skin temporarily porous.
The insulin administration aspect remains experimental, but the blood glucose test aspect of "wrist appliances" is commercially available. Researchers have produced a watch-like device that tests for blood glucose levels through the skin and administers corrective doses of insulin through pores in the skin.
A similar device, but relying on skin-penetrating "microneedles", was in the animal testing stage in Intranasal insulin is being investigated.
The basic appeal of hypoglycemic agents by mouth is that most people would prefer a pill or an oral liquid to an injection.
However, insulin is a peptide hormone , which is digested in the stomach and gut and in order to be effective at controlling blood sugar, cannot be taken orally in its current form.
The potential market for an oral form of insulin is assumed to be enormous, thus many laboratories have attempted to devise ways of moving enough intact insulin from the gut to the portal vein to have a measurable effect on blood sugar.
A number of derivatization and formulation strategies are currently being pursued to in an attempt to develop an orally available insulin.
Another improvement would be a transplantation of the pancreas or beta cell to avoid periodic insulin administration. This would result in a self-regulating insulin source.
Transplantation of an entire pancreas as an individual organ is difficult and relatively uncommon. It is often performed in conjunction with liver or kidney transplant, although it can be done by itself.
It is also possible to do a transplantation of only the pancreatic beta cells. Nearly half of those who got an islet cell transplant were insulin-free one year after the operation; by the end of the second year that number drops to about one in seven.
However, researchers at the University of Illinois at Chicago UIC have slightly modified the Edmonton Protocol procedure for islet cell transplantation and achieved insulin independence in diabetic people, with fewer but better-functioning pancreatic islet cells.
Beta cell transplant may become practical in the near future. Additionally, some researchers have explored the possibility of transplanting genetically engineered non-beta cells to secrete insulin.
Several other non-transplant methods of automatic insulin delivery are being developed in research labs, but none is close to clinical approval. From Wikipedia, the free encyclopedia.
Redirected from Novolin. Use of insulin protein and analogs as medical treatment. For the psychiatric treatment, see Insulin shock therapy.
For the insulin protein, see Insulin. US : B No risk in non-human studies. See also: Insulin analog.
Main article: Insulin pump. See also: Intensive insulinotherapy and Conventional insulinotherapy. This article needs to be updated.
Please update this article to reflect recent events or newly available information. February See also: Artificial pancreas.
Main article: Inhalable insulin. Main article: Islet cell transplantation. Retrieved 4 September Ask your doctor or pharmacist if you don't understand all instructions.
This insulin should look cloudy after mixing. Do not use the mixture if it looks clear or has particles in it. Call your pharmacist for new medicine.
Use a different place each time you give an injection. Do not inject into the same place two times in a row. Do not inject this medicine into skin that is damaged, tender, bruised, pitted, thickened, scaly, or has a scar or hard lump.
If you use an injection pen, use only the injection pen that comes with this insulin. Attach a new needle before each use.
Do not transfer the insulin from the pen into a syringe. Sharing these devices can allow infections or disease to pass from one person to another.
You may have low blood sugar hypoglycemia and feel very hungry, dizzy, irritable, confused, anxious, or shaky.
To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar fruit juice, hard candy, crackers, raisins, or non-diet soda.
Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency.
Blood sugar levels can be affected by stress , illness, surgery, exercise, alcohol use, or skipping meals.
Ask your doctor before changing your dose or medication schedule. Insulin is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care.
Follow your doctor's instructions very closely. Keep this medicine in its original container protected from heat and light.
Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator.
Throw away any insulin that has been frozen. Refrigerate and use until expiration date ; or. Store at room temperature and use within the number of days specified in the Instructions for Use provided with your medicine.
Store the injection pen at room temperature do not refrigerate. Do not store the injection pen with a needle attached.
In-use insulin is stable for only a certain number of days. Do not use two doses at one time. Seek emergency medical attention or call the Poison Help line at Insulin overdose can cause life-threatening hypoglycemia.
Symptoms include drowsiness, confusion, blurred vision, numbness or tingling in your mouth, trouble speaking, muscle weakness, clumsy or jerky movements, seizure convulsions , or loss of consciousness.
Insulin can cause low blood sugar. Avoid driving or operating machinery until you know how Novolin N will affect you. Avoid medication errors by always checking the medicine label before injecting your insulin.
Some brands of insulin isophane and syringes are interchangeable, while others are not. Avoid drinking alcohol. It can cause low blood sugar and may interfere with your diabetes treatment.
Get emergency medical help if you have signs of insulin allergy: redness or swelling where an injection was given, itchy skin rash over the entire body, trouble breathing, chest tightness, feeling like you might pass out, or swelling in your tongue or throat.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.
Novolin N side effects in more detail. Novolin N may not work as well when you use other medicines at the same time.
This includes prescription and over-the-counter medicines, vitamins , and herbal products. Some drugs can also cause you to have fewer symptoms of hypoglycemia, making it harder to tell when your blood sugar is low.
Not all possible interactions are listed here. Tell your doctor about all medicines you start or stop using. Novolin N drug interactions in more detail.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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