Insulin 101: A Guide for Type 2 Diabetes Management

Join us as we demystify insulin treatment for type 2 diabetes! We'll break down the different types of insulin, how they work, and when you might need to start them. We'll also cover practical tips for injecting insulin, factors that affect its effectiveness, and how to handle special situations like eating out and travel. This episode is packed with essential information to empower you to manage your type 2 diabetes and live a healthier life!

Takeaways

• The purpose of insulin is to allow glucose to enter the body's cells for energy.
• In type 2 diabetes, the body develops insulin resistance, leading to complications if not managed.
• Insulin is classified into rapid, short, intermediate, long, and very long-acting types.
• Administering insulin can be done via pens or syringes, with specific techniques for effective delivery.
• It's important to rotate injection sites to avoid scar tissue and ensure proper absorption.
• Physical activity can affect insulin absorption and blood sugar levels.
• Patients should be aware of their insulin needs when eating out or traveling.
• Managing diabetes requires understanding how different factors affect blood sugar levels.
• Communication with healthcare providers is crucial for effective diabetes management.
• Staying motivated and informed can lead to better health outcomes.

Keywords

diabetes, insulin, patient education, health podcast, diabetes management, insulin types, insulin administration, health tips, family medicine, medical education

Transcript

Speaker 2 (00:09)
Hi, welcome back to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.

Speaker 1 (00:23)
and I'm Nicole Aruffo I'm a nurse

Speaker 2 (00:25)
And we are so excited you were able to join us here again today. We had our biggest week last week. We had our biggest week, most downloads ever, and we're halfway through the month of December and we've already had our best month ever.

Speaker 1 (00:41)
This is when we go viral.

Speaker 2 (00:42)
So

hopefully this is where it happens big. You know, I download the TikTok and that's been not for my personal use, but for making videos. So if you're interested in finding something like that, can talk your checkups on TikTok. But we did go to dinner this week, this Friday. We mentioned we were hanging out with some friends. How did you enjoy that?

Speaker 1 (00:53)
Your checkups on TikTok.

It was really good. think every- we got a lot of food. You and Matt both ate a lot of food.

Speaker 2 (01:07)
It was.

Well, I, you know, we had the four entree bit and you were like, whoa, whoa, whoa. I had ordered three already, which I felt really good about myself. I like ordered for the table. So I felt like that was nice. I know I had that in me. It did. Yeah, it tickle my Y chromosome. And then I'm going through and I'm like, yeah, can we get the rigatoni short rib? Let see if I can do this. The rigatoni short rib, the brand Zeno.

Speaker 1 (01:24)
without tickling your Y-crooms.

Speaker 2 (01:40)
What else happened? There was a Cacio Pepe and that was it. I was going to say the salmon and you were like, whoa, whoa, That's a lot because then we also got...

Speaker 1 (01:55)
collectively decided as a group, no salmon.

Speaker 2 (01:59)
I'm not so sure that that happened. No, did. No, we decided no pumpkin gnocchi. You and Melissa really were like, yeah, your eyes lit up with the salmon. You can't resist that. It did happen. Then there was that moment that those people were sitting next to us. And there were two interactions, two social interactions to be aware of. So I was going talk about the dish first.

Speaker 1 (02:21)
Yeah.

The dish.

Speaker 2 (02:27)
Yeah, like when you notice someone at a restaurant has a dish that you like and like, how do you find out what that dish is? I was going to be aggressive and like ask the people who are eating. Apparently that's frowned upon. So then I ended up asking the server who was very nice and then he gave me the whole pitch and like, how could you not? It was delicious. Yeah. And then tell us about that other interaction.

Speaker 1 (02:52)
gosh. The interaction?

Speaker 2 (02:56)
Not the interaction, not the like hand on the arm for for Matt, but there was a throuple that we thought was interesting. Or presumed to be a throuple.

Speaker 1 (03:02)
There was a throuple. Yeah,

I think it was. Like in the wild. And not to yuck anyone's yum. But it was interesting to see.

Speaker 2 (03:15)
No, they were very handsy. They were all over each other. They were having a great time. And we saw that throuple. And then another double date, as we'll call it, another double date came by. Guy had a nice sweater on, didn't remember where it came from.

Speaker 1 (03:30)
probably because his wife bought it for him.

Speaker 2 (03:32)
Yeah. So there was that. They did the same thing to us. They were like, what dish is that? So what goes around comes around at the end of the day. And then we had our dessert, which was this dish called C is for cookie, which turns out it was just a cookie with the cookie dough ice cream, which

Speaker 1 (03:54)
I love baby skill and it was so good.

Speaker 2 (03:56)
That's my favorite type of ice cream, is cookie dough ice cream. So it was delicious, all in all. Great meal, great company. Awesome time. I loved it, the love.

Sorry to anyone who doesn't like Stephen Star restaurants. do. That guy does make delicious food. I guess he's not omnipotently everywhere making the food, but maybe he makes the designs for the food. And what do we eat this weekend?

Speaker 1 (04:27)
Well, you were asleep or at work for most of the weekend. Tonight though, we're filming later. It's a Sunday night already and we had grilled cheese and tomato soup and it was good. Cause cold out, you like don't feel good.

Speaker 2 (04:44)
And so I just got it felt right. and then I mean, when I got called in and you text me and say, like, are you available to come down in 10 minutes? And let me tell you, I am the luckiest man on the planet. When Nikki rolls up to the hospital with a gigantic sub and what a gigantic Italian sub and a diet coke and salt and vinegar chips. And I felt so taken care of.

Speaker 1 (05:02)
Thank

Speaker 2 (05:13)
I, the dread that I had when I got called in and ended up staying the entire day and night, but.

Speaker 1 (05:18)
He got him at 5 a.m.

Speaker 2 (05:20)
But that made the day so much more tolerable and my belly was full. And speaking of people who have full bellies, let's talk about diabetes today. are we going to talk about today, Nick? What a segue.

Speaker 1 (05:31)
Yay.

today in our diabetes series, we're talking about insulin.

Speaker 2 (05:40)
Yeah. So if you didn't catch up last week.

Speaker 1 (05:44)
We talked about like every other med, but insulin last week. If you're a loyal listener, you already listened. And if not, maybe go listen.

Speaker 2 (05:52)
Yep, I would go listen to that one, definitely. Insulin's more complicated, and we felt like it deserves a whole episode, especially the why of insulin and the how of insulin, which is also really important. So Julie, just to get back into it, the purpose of insulin is that it's a hormone produced by the pancreas, and it acts as a key. And it allows glucose to enter the body's cells for energy. We've talked about this before, but.

really just trying to, if you're joining us for the first time here, we're so happy to have you but want to catch you up. But in type 2 diabetes, the body develops some sort of insulin resistance. And that means that the cells don't actually respond as properly to the insulin like they should. And so eventually, over time, the pancreas may also struggle to produce enough insulin to keep up with the needs. It's almost like if the engine of a car is going, going, going, going, going, and then all of a sudden it's just kind of

slowly over time peters out and burns out or just all at once just shuts off. And we've talked in the past about how like there's a ton of good reasons why you should manage your diabetes in terms of microvascular complications like blindness, kidney failure, foot ulcers that require amputation and sexual dysfunction in men and big blood vessel complications like increasing the risk of heart attack and death.

So when we're thinking about blood sugar control, we're also thinking about daily blood sugar control, measuring blood sugars when you first wake up in the morning or two hours after meals. But there's also the hemoglobin A1C, which we've said in the past is like the blood sugar report card over the last three months. And in most people who have diabetes who are young, that goal may be seven. And as you age, it could be a little higher, very reasonably. Okay, Nick. So.

Last week we did talk about all of these other diabetes medicines. And sometimes people have blood sugar that is too high. The person needs insulin to bring down the blood sugar. Or they're losing weight and they're peeing a lot. And then that's our sign that the body ran out of insulin and the pancreas isn't doing its job anymore. That's basically the time in type 2 diabetes, and I guess type 1, when it's time to bring insulin on board.

So when we're thinking about insulin, can you tell us the major classes of insulin that exist and how we think about, like, how do we break down insulin into different types?

Speaker 1 (08:31)
So insulin is classified into different categories based on how fast that they work. And this is like nothing groundbreaking. There are very long names for other different classes of medications, but not for insulin. So we have rapid acting insulin, short acting, intermediate acting, long acting, followed by very long acting insulin.

Speaker 2 (08:50)
Nice.

That's nice. It keeps it, at least that part, simple. insulin can otherwise get pretty complicated. But that's why we're doing this here today. All right. let's see what the very rapid acting insulins will start there. They begin working in minutes. And they usually last for a few hours. So they start working in 15 minutes. They peak in effect in an hour and usually last for about four, give or take.

And these insulins are ideal for controlling blood sugar spikes after meals. So there are a lot of different names to these insulins. There's both generic names and brand names. And so I'll just name a couple of them so that when you're having conversations with your doctor, you can have some better idea about what they are. So these are some rapid acting insulins. There's insulin Lispro with some brand names like Humalog. There's insulin Aspart.

which has some popular brand names like Novolog or Fiasp. There's also insulin glulicine, which isn't as common, brand name Apedra. And then there's a more concentrated version of insulin Lispro, which is Humalog U200, but also maybe a little less common.

Speaker 1 (10:23)
Okay. So our short acting insulin takes about 30 minutes to start working. And this one, the brand name is called Humalin. And again, I guess endocrinologists aren't that creative in the, in the naming department. Well, I guess it's not an endocrinologist, but you know what I mean? Endocrine people.

Speaker 2 (10:49)
Mark the given.

Speaker 1 (10:50)
generic

is named insulin regular.

Speaker 2 (10:53)
Way.

Yeah, this is a common one they use in the hospital for really, really sick patients. Sometimes you see it outside the hospital, too. Shout us out in the fan mail if you do take insulin, my dealer. So then there's intermediate acting insulins. These insulins start working within one to two hours. They peak in about four to six, and they last up to 18. And so they can be used in some different strategies about how to control blood sugar in a day, according to those.

peaks and troughs and how long they last. Common names are insulin NPH, which is also a brand name Humalin N. But I feel like a lot of people just refer to this as NPH. And then there's a couple other ones that, know, insulin Lispro protamine. So this is mixed with a rapid acting insulin Lispro and the protamine part, which is a little bit longer acting. And then its cousin, insulin aspart protamine.

And so that also has the mixed rapid acting aspart and other parts. And then there's regular insulin, 500 units per milliliter, humulin, regular U500. And those, just a reminder, are intermediate acting insulins. So then there are long acting insulins. And they provide a steady background level of insulin. And they typically last for about 24 hours. Common names for these include insulin glargine with brand names

Basaglar or Lantus And then this one, it seems to be coming off the market is insulin detemir which also has a brand name Levimir. And then there are very long acting insulins named insulin Degladec or Traceba is the brand name and insulin Glargine 300 or 2JO, which is a different brand name as well.

So now that we talked about what types of insulin there are, I think it may be helpful to think about how your doctor usually starts thinking about using insulin. If someone is just getting started and their diabetes is less, not as controlled as it could be, usually it's recommended to start with one of those basal long acting insulins. And it's usually taken once daily and that can offer better and more consistent blood sugar control. The initial dose is usually pretty low.

and it's weight-based, a lot of times ends up looking at somewhere between 10 and 20 units. And then gradually over time, the dose is adjusted based on the person's needs. And for that reason, it's really important for you to be able to measure your blood sugar over the course of the day with proper form, getting the most accurate information possible. For a long-acting insulin, the fasting blood sugar is usually the most consistent piece of information to use to make adjustments

to that type of insulin. And we're to have a whole episode on low blood sugar. But once you start using insulin, that introduces the risk of low blood sugar. And that's something really important to do and to keep track of. And if it does happen, to let your doctor know. Sometimes, insulin therapy with just a long-acting insulin doesn't get the job done. And so there needs to be combination therapy, where sometimes a long-acting insulin is used with a short meal time insulin.

or some other regimen in general. That combination is usually called prandial insulin. Prandial meaning meal time. If you ever hear anyone say that. And like I mentioned, those are usually the rapid or short acting insulins. And sometimes, I mean, they do this in kids all the time. They adjust based on the size of the meal. But a lot of times in adults, they just keep it standard throughout the day because for one reason or another, I talked to a pharmacist about this recently and they just didn't quite know why.

Adults don't do that. We talked about insulin. We talked about different types. We talked about why we use it and even like how people usually get started taking it. But what about administering insulin? How is insulin usually get into the body for the patient?

Speaker 1 (15:01)
There are two, well, two main methods.

It's always administered by an injection of some sort.

Usually now it's with a pen, like a multi-dose pen. Less often it's with a vial and like a separate vial and then you get separate needles. Usually if you're getting that then like your insurance is probably being really annoying. Usually everyone gets a pen. And then there are like insulin pumps which we're not going to talk about but that's also another way or like a pod. With the needle and syringe you get a needle.

to draw it up from the vial and then with the pen needle you have to put the needle onto the pen and then you there's like a dial on the end of it that you dial up to how many units that you need and then it's a subcutaneous injection so it's just like goes into the fat it's not going into the muscle so it's not like when you like get a flu shot and it like goes really deep and hurts really bad it's just if you are like pinching up

Speaker 2 (15:51)
easy.

Speaker 1 (16:09)
the fat on like your stomach or the back of your arm or your leg.

Speaker 2 (16:13)
So you're talking about the actual delivery of the medication with the pen, and then you were giving us advice about the plunger.

Speaker 1 (16:19)
Yeah, anytime you're injecting anything, not even insulin, any ozempics, girlies out there. Sure. mean, it's an injection medicine. And EpiPen is a big one, too, that we always teach. So when you're injecting, as you're going into your skin, never have your thumb on the back of the plunger or the part that you press to actually get the medicine in you, because your thumb can

press that or like put pressure on that before it actually gets into your skin and then you're not getting the full dose of everything.

Speaker 2 (16:54)
You see that a lot.

Speaker 1 (16:57)
Um, well, I don't know if I see that a lot, but like we teach that. So you hold it like a fist, don't put your thumb anywhere. And then once it's in your skin, then you put your thumb up and inject it into yourself.

Speaker 2 (17:08)
So the needle, when you put the pen on the body part, the needle's already going in. And once the needle is in, then you press.

Speaker 1 (17:18)
Then

the needle's in, then you press. And then at least we always taught, hold it there for 10 seconds. Honestly, it's like a manufacturer thing with the pens. We found some manufacturers recommend five seconds, some recommend 10. So we always just teach parents. Once it's in, count to 10 and then.

Speaker 2 (17:37)
The other piece, what sites can you use?

Speaker 1 (17:41)
So typically, your belly, kind of in the area around your belly button, your thighs, and the back of your arms. And it's always important to keep rotating those sites, because if you keep injecting into the same spot, then you'll develop some scar tissue, and then the medicine won't absorb as much.

Speaker 2 (18:03)
Do people actually find themselves able to reach the back of their arm? Or does that, like, people get some help for that?

Speaker 1 (18:10)
I mean, you can do it, like reach the back of your arm.

Speaker 2 (18:13)
Do people sometimes have like their family members help give injections? Yeah. That's a pretty normal commonplace thing. So like maybe you could share this with a loved one or a neighbor or a neighbor who has a medicine that needs to be injected. Is there anything to that? Can you reuse needles or?

Speaker 1 (18:33)
No, you cannot reuse needles. Don't do it. You'll probably get some sort of like little sharps container to have in your house, but get rid of it. It's a one and done. On the pens, they just twist off and there's a safety on it. So once you are done injecting and you pull it out, the little like sleeve goes over the needle and then you untwist it and get rid of it.

Speaker 2 (18:58)
there we go. And then what's like, is there a particular angle to go?

Speaker 1 (19:04)
Yeah,

honestly 90 degrees is best specifically with the pen needles because they have that like safety sleeve on it so you can't really get get in there at like a 45 degree angle if you have just a regular subcutaneous needle that doesn't have any kind of like guardrail I guess for lack of a better word. Sure. You can but really with the pen you don't really have an option other than 90 degrees. So just go straight in.

Speaker 2 (19:32)
Where do people like keep these pens?

Speaker 1 (19:36)
Some have to be kept in the refrigerator after a certain amount of time, but not all of them. Okay. Don't ask me which ones.

Speaker 2 (19:45)
Yeah, yeah, yeah. But I've also seen people walk around with them. They're manageable, think. They fit in bags, little fanny packs.

Speaker 1 (19:54)
Yeah, they're little...

Speaker 2 (19:56)
Also, knowing if you have multiple pens, I've seen people get confused with this, knowing what color pen is for what time of day, like what's your meal color pen or your long acting pen and working that out with your pharmacist or doctor to see like which one is most important. And just to stay organized, too, so you have a better grasp on your health. I think you really made like injecting insulin very simple there.

Speaker 1 (20:25)
Yeah, it's a simple thing. figuring out if you're someone who has to figure out a dose based on how much you eat, sometimes I think that can be... I mean, that's where most of the work is, figuring out exactly how much to give yourself or to give a loved one or a neighbor. actually doing it is... It seems scary at first, but it's really not. Once you do it a couple of times, you get used to it.

Speaker 2 (20:51)
It's a big leap for people and they get very anxious. The prospect of going on insulin is very intimidating and sure there's a lot of ins and outs to it, but at least when it comes to delivering it, think hopefully here we were able to kind of encapsulate it into what is a pretty manageable thing. more thoughts about the delivery of insulin or like getting it in?

or injectable meds.

Speaker 1 (21:18)
The thumb thing is a big one.

Speaker 2 (21:20)
Yeah, I guess I feel like some people would really aggressively just like put it on and.

Speaker 1 (21:25)
Sometimes

you're like the motion of like moving your arm down. You're just kind of intuitively moving your thumb down. Sure. And kind of getting rid of some of that.

Speaker 2 (21:35)
But you like need to put the pen down, pierce the skin, kind of hold it there, and then press the button. Which is like, at first I wasn't, I'm glad we did it, I haven't been giving.

Speaker 1 (21:48)
probably been doing it wrong. Is that?

Yeah, you have to tell people the thumb thing for injections. Epi pens are a big one because people put their thumb on the needle side and then they inject themselves with epi. my They end up in the hospital. Whoever needs the epi pen. I haven't seen it personally, but.

Speaker 2 (22:05)
Have you seen this?

The New York Times online. but you hear stories. Wow. All right. So I think take times and transition here to the last part of our episode. Once people are on insulin, it seems like there are many factors that can affect how the insulin is absorbed and how it's used in the body. And this will become a little bit more clear once we talk. There are a couple of major things we're going to talk about. We're going to talk about the insulin dose, the injection site.

and what physical activity does. So the larger the insulin dose, the actual absorption of the insulin may be a little slower than smaller doses, which is something to consider, especially like at the higher doses of the long acting insulin, Glargine. You know, it takes about 100 units to get to that level. And at that point, you might consider thinking about switching to twice daily dosing of that if it's a weight based dose.

Switching to injection sites, insulin is absorbed at different rates in the body. And so it's absorbed most quickly from the abdomen and a little slower from the leg and the butt, and then has an intermediate rate from the arm. And so it also can be affected by the amount of fat under the skin, with some areas having more fat absorbing a little bit more slowly than other areas. And then physical activity is a big one. This probably could deserve a whole episode breakdown.

But certain activities that increase blood flow, like exercise, saunas, hot baths, they can speed up insulin absorption. And that can potentially lead to low blood sugar, otherwise called hypoglycemia. And so that is something to consider. Smoking itself reduces blood flow. And so that slows down insulin absorption. So if your therapy isn't working that well, maybe you'll consider stopping smoking. And then each person is different.

in different ways. so sometimes from person to person, their own metabolism might be doing things differently.

Speaker 1 (24:16)
I think going back to the physical activity, think when someone who maybe was newly diagnosed with diabetes or newly is on insulin and they're a very active person, like they play a sport or, you know, do whatever kind of exercise regularly, I think is a little bit frustrating at first for them to figure out like, what does this activity do to my blood sugar? What do I have to?

Because I think it's also one of those things where you're like eating before a workout or you're eating before like a long run. And then how much insulin do I give myself? Should I give myself insulin? It's one of those like things that you kind of is probably going to be frustrating and you need to figure out. you'll figure it out.

Speaker 2 (25:05)
Yeah, then, you know, there's, especially when it comes to diabetes, the whole thing to wrap your arms around to understand for yourself, a loved one or

Speaker 1 (25:16)
a neighbor.

Speaker 2 (25:18)
And so there are other situations where diabetes and insulin management come up a lot. Think about eating out. I mean, if you go out to eat, restaurant foods are higher in calories and fat content. And so that may change how your insulin needs to be managed. If you're having a surgery, you may get advice about how to manage your insulin before surgery. And think about when you're traveling. Do you need extra refills of your insulin when you're going to be heading out and you're not going to be near a pharmacy?

a little bit of forward thinking and planning. And altogether, you know, we tried to make this simple. We give you this resource so you can listen back, show it to a loved one or a neighbor. But try to stay motivated because there are so many benefits to be had by taking care of yourself and treating your diabetes that make it really, really worth it. And if there are any specific questions that come up or I want like a further dive on insulin itself.

This episode is obviously titled insulin 101. So there is definitely room for a 102, three, four. You know what I mean. Any last thoughts or any other tidbits on insulin and managing? OK.

Speaker 1 (26:32)
Well, take your insulin.

Speaker 2 (26:36)
Thank you so much for coming back to another episode and another week of your checkup. Hopefully you were able to learn something about insulin for yourself, a loved one or... Please check out our website. Visit us on Instagram. Send us an email. Visit our TikTok. Send us some fan mail. Really send us some fan mail. It goes right to our account and I see it as soon as you send it. And I would love to hear from...

Speaker 1 (26:46)
a neighbor.

Speaker 2 (27:02)
friends and neighbors all over the country because we see that you guys listen in all over the place and send us ideas. If you have a question that you'd like to be answered on a tasty tip episode, please let us know and we'll try to put that together for you real quick. But otherwise, most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky Thank you and goodbye.

Speaker 1 (27:21)
I'm Nicole Aruffo.

Bye.

Speaker 2 (27:32)
This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor. And make sure you go get your own checkup with your own personal doctor.

Speaker 1 (28:08)
I am not your nurse.