h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Insulin is a broad-reaching enzyme, controlling the creation of fats, storage of sugars and regulation of Blood Glucose absorption. In cases of Diabetes Mellitus, insulin can be used to control blood sugar levels, allowing the diabetic to live a semi-normal life. In order to regulate, most Type 1 diabetics will mix different types of insulin to attempt to achieve this effect. I will now attempt to give you more information about Insulin than any non-diabetic would ever need to know.

Insulin was first isolated in 1921, and was released commercially by the Eli Lilly company in 1922. Originally it was extracted from sheep, pig and cattle. Pork and Beef insulin were still in widespread use as of 1980, and are still available for special situations today. Animal insulin, although effective, does not respond as efficiently as human insulin, leading to increased difficulties with hypoglycemia. Human-Synthesized (recombinant DNA) insulin became available in 1982. Identical to the insulin produced by the human body, it allowed for tighter control of blood sugar levels. During the 1990's, Human-Analog insulins insulins became available. These are extremely short-acting, allowing for tight control via small dosages throughout the day.

In addition to the source, there are also different types of insulin available. Suspension chemicals are used to delay the onset of the dosage. Listed below are the types of insulin available and some information about each. Onset time is when the dosage begins having an effect on blood glucose levels. Peak time is when the insulin is fully distributed throughout the body and is most efficient. This is the time when hypoglycemic or "insulin" reactions are most common. End time is when the dosage has been used up and is no longer in the system. Numbers in parenthesis are for animal insulins. Times are in hours.


"Regular"/R -- Onset (.75).5 - Peak (2-6)2.5-5 - End (7-10)8
Probably the most widely-used insulin, Regular was the shortest-acting variety until the advent of Human-Analog insulins.

"NPH"/N -- Onset (2)1 - Peak (5-12)4-12 - End (18)24
Mixed with an isophane solution, NPH delays it's effectiveness, allowing dosages to be mixed with Regular or other short-acting insulins, reducing the number of injections required daily.

70/30 -- Onset .5 - Peak 2-12 - End 24
A mixture 70%NPH/30%Regular. Generally prescribed for older patients, new diabetics, and people who dont want to/aren't capable of calculating multiple dosages.

"Lente"/L -- Onset 2.5 - Peak 7-15 - End 22
Mixed with a Zinc suspension. Spreads the dosage out across long periods. Usually used in combination with Regular/Human Analog. Not prescribed very often anymore.

"Ultralente"/U -- Onset 4 - Peak (--)8-10 - End (72)48
Mixed with an Extende Zinc suspension. Animal forms had no peak, with doses required at 24-hour intervals. Human varieties have a very slight peak, and are usually taken twice daily. Ultralente is an extremely long-acting insulin, used to cover the body's basal release of sugars. Regular/Analog/NPH insulins are usually used in combination for processing of intake. Generally prescribed when a patient is either on an unpredictable schedule or is grossly out of control.

Humalog/Velosulin -- Onset .25 - Peak 1-3 - End 8
Human-Analog insulins. Extremely short-acting, these insulins are taken directly before ingesting, with the dosage based on what's going to be eaten. Allows the patient the ability to constantly adjust dosage based on intake, giving them a more flexible schedule. Generally used in combination with all other insulins.


Now for the CAVEAT: I am NOT a doctor, merely an Insulin-Dependent diabetic who has decided to research as much as he can to live a healthier life. If you are diabetic, and wish to alter your insulin program, SEE YOUR DOCTOR! The prescription you are on is the one best suited to your lifestyle and capabilities.

I hope this has further enlightened you as to how lucky you are to not have to worry about any of this!

A friend of mine was diagnosed as insulin dependant, but decided that the chore of having to be less than a fortnight from insulin was too high a price to pay. His specialist told him that ifhe didn't start injecting, he would be in hospital from ketoacidosis within three days. He decided to use blood tests, diet and exercise, and coped perfectly well for four years, until he was spotted as having undiagnosed coeliac disease. At this point he had to be hospitalised to deal with the coeliac disease, and they insisted on giving him insulin (no choice in it, they just insisted), and now he is stuck with insulin. However, he has NEVER had a good explanation from any medical professional as to why the "impossible" dietary control he was using worked for 4 years. they usually just acuse him of lying.
Any ideas?

I've a couple of ideas:

First, before insulin was successfully refined in the 1920s, some people managed to survive diabetes, albeit restrictedly, quite well for a time. Nobody in these circumstances lived long enough, however, for diabetic complications (the literature for which didn't really start being written until the 1960s or so) to present and make their possibilities known. It's quite possible that your friend had a metabolism which enabled him to 'get by' on what is effectively a solely dietary control regimen, but it could not have been pleasant, nor convenient (two of the most crucial considerations in diabetic control today, judging by some responses) to do so.

Second, your friend may just have been lucky - which happens an awful lot, given the little we actually know about how diabetes works. Some people have metabolic facilities which others just don't have, and individual differences, it sounds like to me, were working in your friend's favour. How long he could have continued this way is an open question, of course, but it might be interesting to speculate.

Not much to go on, but I suspect it's the best you might do...!

First of all - I'm a TypeI "sufferer" as well, so I won't start making absurd comments - don't worry!

The development of an insulin nose or mouth spray (I can't remember which...) has reached the stage that it will come on to the market in a years time or so.

Interestingly enough, I do not believe it will make a great difference to current diabetes treatment - you will still HAVE to use the insulin and eat according to your controlled diet.

The injection part is not the irritating part to diabetes, I feel. It is what I named just now: the strict control of everything.

Only when the action of the insulin taken controls the blood sugars itself, as is needed, will real progress be made!

Have fun,
Madcow

I think any diabetic would say that the discipline is probably the hardest part... Especially when say, eating at a restaurant and having to ask the waiters all sorts of questions about the food... Great fun!

But when it's an "all day, everyday" thing, it can get to you after a while...

Over the Christmas period I have consumed sugar and fats with less regard to my BSL.

After a heavy meal with alll the wrong things I expected a high BSL, but instead got a reading in single figures. Conversly, when I have eaten abstemiously and exercised the BSL has shot up to a ludicrous level.

I inject religiously and test regularly. All of this leaves me confused about how to manage BSL. The more that I exercise the better it is generally. What is confusing is how prosciptive I need to be and why doing everything right has led to a massive increase in BSL.

I am also frightened of things that are lurking in the wings, even if if I continue to 'play the game'.

My weight has reduced by about twenty pounds, and I have all but given up on alcohol and have put much more effort into exercising.

Fatigue, after even a moderate amount of effort, is frustrating. Also I agree with comments about the monotony of the daily routine of constant monitoring the daily dosages of insulin and BSL.

I would welcome further comments on any of these topics

goldencamus, the same thing happens to me...I get surprised by how relatively low my blood is after a blowout, then how high it can be after a particularly "good" meal. Sometimes there doesn't seem to be any rhyme or reason for it.

Deb