Let's learn more about insulin. Why is it so important for our bodies?

You've probably heard the word insulin, right? Maybe if someone in your family has diabetes, or if you yourself are a diabetic, this name is very familiar. So, what is insulin? Why is it so important for our body? Let's talk about it simply, in a way that you can understand.

What is insulin? What does it do?

Simply put, insulin is a hormone that is naturally produced in our bodies. It is made by an organ called our pancreas. The main function of insulin is to help our body's cells use the sugar, or glucose in medical terms, from the food we eat as energy.

Think of it this way, the cells in our body are like little houses. These houses need energy to work. That energy comes from glucose. However, in order for this glucose to enter the houses called cells, it needs a key to open the door. That key is insulin. When insulin opens the doors of the cells, the glucose in the blood goes into the cells and is converted into energy.

Now you understand the importance of insulin, right? If for some reason our pancreas does not produce insulin properly, or if the body cannot use the insulin it produces properly, that glucose cannot enter the cells. Then what happens is that the glucose level in the blood simply increases. This is what we call high blood sugar (hyperglycemia) . If this situation continues, we will face a disease called diabetes.

There are also types of insulin that are administered externally as a treatment for people with diabetes. We will talk about that later.

Does insulin lower blood sugar levels or increase them?

Yes, insulin lowers your blood sugar levels. That's its main job. But our bodies work in a very strange way. There's another hormone that helps keep blood sugar levels in balance, and that's glucagon. While insulin lowers blood sugar, glucagon raises blood sugar levels when needed. These two hormones work together to keep our blood sugar levels in a healthy range.

However, when you take insulin externally as a treatment for diabetes, sometimes if you take more than the required amount, your blood sugar level can drop too low. This is called hypoglycemia . If this happens, you need to eat or drink some sugar quickly to correct it. There are also glucagon injections that can be given if your blood sugar drops severely. It is best to talk to your doctor about this.

Where is insulin produced?

As we mentioned earlier, insulin is produced in our pancreas. To be precise, this insulin hormone is produced by beta cells in special clusters of cells called islets of Langerhans in the pancreas. This is an endocrine process of the pancreas. That is, the insulin produced is released directly into the blood.

The pancreas also has another function, which is exocrine , which is the release of enzymes through ducts that help digest food.

What medical conditions can be associated with insulin?

Whether insulin naturally decreases, increases, or does not function properly in the body, various medical conditions can occur.

Diabetes conditions that occur when there is not enough insulin

If insulin is not working properly, blood sugar levels rise, leading to diabetes. Some types of diabetes can be caused by damage to the pancreas:

• Type 1 diabetes: This is an autoimmune condition. Simply put, our own immune system attacks the beta cells that make insulin. Over time, the body's natural production of insulin is almost completely lost.
• Type 3c diabetes (also known as pancreatogenic diabetes): This occurs when the pancreas is damaged and no longer produces insulin. This condition can be caused by conditions such as chronic pancreatitis and cystic fibrosis . It can also occur after the pancreas has been surgically removed (pancreatectomy).
• Latent autoimmune diabetes in adults (LADA): This is also caused by an autoimmune reaction, like type 1 diabetes. However, it develops more slowly. LADA is usually diagnosed in people over 30 years of age.

Conditions caused by insulin resistance

This is also a major cause of diabetes. Insulin resistance is when our muscle, fat, and liver cells don't respond properly to insulin. It's like the key in the door lock not working. This can lead to conditions like:

• Prediabetes: This is a condition where blood sugar levels are higher than normal, but not high enough to be called type 2 diabetes. Insulin resistance is the main cause.
• Type 2 diabetes: This condition occurs when insulin resistance increases to the point where the pancreas cannot control it, causing blood sugar levels to rise.
• Gestational diabetes: This is a condition that can develop during pregnancy. Researchers believe that hormones released by the placenta cause insulin resistance. Gestational diabetes develops when the pancreas is unable to overcome this resistance. However, it often improves after the baby is born.

In addition, there is a genetic type of diabetes called Maturity-onset diabetes of the young (MODY) . This is also called monogenic diabetes . It is caused by a genetic mutation that is passed down through generations and affects the way the body makes and uses insulin.

A condition caused by too much insulin

A very rare tumor called an insulinoma can cause the pancreas to produce too much insulin. This can cause frequent, sometimes severe, low blood sugar. In most cases, these insulinomas can be cured with surgery.

What types of insulin are there for diabetes?

There are many types of insulin available to treat diabetes. Most come in injectable form - either through a needle, a pen or a pump. There are also inhaled insulins. If you have diabetes, your doctor will determine the type and dose that is right for you. The dose may be adjusted as needed.

Insulin types are mainly divided based on how quickly they take effect and how long they last in the body .

• Rapid-acting insulin: This type of insulin starts working within 5-20 minutes and lasts for about 3-5 hours. It works best one to two hours after being injected. Insulin glulisine is one of these types. Inhaled insulin also falls into this category. These are usually taken before meals.
• Regular insulin or short-acting insulin: These include Novolin R® and Humulin R® . They start working within 30-45 minutes of being injected and last for about 5-8 hours. They peak at 2-4 hours after being injected.
• Intermediate-acting insulin: This type takes about two hours to start working. It works best between 4 and 12 hours after being injected. It lasts for about 14-24 hours. Isophane insulin (NPH) is one of these types.
• Long-lasting insulin: This type of insulin takes about an hour to reach the bloodstream and start working. It works best between 3 and 14 hours after injection. It lasts about a day. Insulin glargine is an example of this type.
• Ultra long-acting insulin: This type of insulin takes about six hours to reach the bloodstream and remains active at the same level for several hours (meaning it doesn't peak all at once). It lasts about two days. Insulin degludec is one of these types.

Important: Always follow your doctor's instructions for the type, dose, and method of insulin prescribed for you. Never change your insulin dose without consulting a doctor.

Are there any side effects of insulin treatment?

The most common complication of insulin therapy is low blood sugar levels (hypoglycemia) caused by taking too much insulin.

Apart from that, there are other side effects that may occur rarely:

• Skin reactions at insulin injection sites: When insulin is injected repeatedly into the same area, fat can build up under the skin, forming lumps. Or, the fat can break down and form dimples in the skin. This is called localized lipodystrophy . This can reduce the absorption of insulin. That's why it's important to rotate insulin injection sites frequently.
• Allergic reaction to insulin: Some people can have an allergic reaction to some types of insulin. This can cause pain, burning, then skin discoloration, itching, and swelling around the injection site for a few hours.
• Insulin antibodies: Very rarely, because the insulin given externally is slightly different from the natural insulin produced in the body, our body can make antibodies against it. These antibodies can prevent the insulin given externally from working properly. In this case, you may need to take very large doses of insulin.

What are the best places to inject insulin?

You can inject insulin into several places on your body. In general, the best places to inject insulin are the places where you have fat (adipose tissue). These are:

• Your stomach area - but at least 2 inches (5 centimeters) away from your navel.
• The front or sides of your thighs.
• The back of your upper arms.
• The top of your buttocks.

As mentioned earlier, you should rotate the sites where you inject insulin to avoid skin complications. If you inject one site today, inject it in a different site the next day. You can ask your diabetes care and education specialist or doctor for more information about this.

Is there such a thing as a normal insulin level?

In fact, there is no "normal" for insulin levels. This is because everyone is different, and your insulin needs can vary greatly from hour to hour throughout the day. There are several factors that can affect your insulin levels:

• The type and amount of food you eat (especially foods containing carbohydrates).
• When you eat and how often you eat .
• Your activity level and what type of exercise you do (for example, cardio or weightlifting).
• Whether you are sick or under stress .
• Are you awake or asleep?
• Other types of hormones.
• Some medications, such as corticosteroids .

Also, there is no standard test that only checks your insulin levels. Most often, blood sugar levels are checked.

Do people with Type 2 Diabetes still need insulin?

Not everyone with type 2 diabetes, but some people, need insulin to manage the disease well.

There are many other types of medications for type 2 diabetes. For example, oral pills and GLP-1 agonist injections . These medications work to combat insulin resistance in different ways. However, if insulin resistance is severe, these medications alone may not be enough to keep blood sugar levels healthy. That's when insulin is needed.

How long can a person with diabetes go without insulin?

A person with insulin-dependent diabetes requires exogenous insulin to survive. Without it, a life-threatening complication called Diabetes-related Ketoacidosis (DKA) can develop.

DKA is a sudden, severe complication. It can develop within 24 hours. It can develop even more quickly if you are vomiting. It is important to call a doctor or go to the hospital as soon as you experience symptoms of DKA. If left untreated, DKA can be fatal.

The most important things to remember from what we have talked about (Take-Home Message)

So, you probably now understand that insulin is an essential hormone that helps our bodies stay healthy and function properly.

• Insulin is a natural hormone produced by our pancreas. It helps transport sugar (glucose) from the blood into cells and create energy.
• If your body cannot make enough insulin or use it properly, your doctor may prescribe external insulin as a treatment for diabetes.
• If you have been prescribed insulin, use it exactly as your doctor tells you. Follow the dosage, time, and injection site exactly.
• If you experience symptoms of hypoglycemia (e.g., sweating, shaking, fainting, rapid heartbeat), take some sugar immediately.
• If you have symptoms of diabetic ketoacidosis (DKA) (e.g., excessive thirst, frequent urination, nausea, vomiting, stomach pain, difficulty breathing, fruity breath odor) , seek medical advice immediately.

It is very important to take care of your health. If you have any questions about insulin or diabetes, don't hesitate to talk to your doctor.

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