Let's learn exactly about insulin injections. This is very important for controlling your diabetes!

If you are living with Diabetes Mellitus, you may have heard about the insulin injection. Perhaps your doctor has even told you to use it. So what is this insulin? What happens with it? Are there different types? You may also have questions like these. Let's talk about all of it simply and clearly today, shall we? There is nothing to be afraid of, once you know these things, you will feel more at ease.

What is insulin? Why do we need it?

Simply put, insulin is a very important hormone that is produced inside our bodies. There is a small organ called the pancreas, right, inside our stomach? That is where this hormone called insulin is produced.

So, what does this insulin do? The main job of insulin is to take the sugar (glucose) from the food we eat, from the blood, and send it into the tiny cells in the body, helping us make the energy we need to do our daily work. Think of it like you need a key to open the door of a house, you need a key called insulin to send sugar into our cells.

So, why does someone with diabetes need to take insulin externally? When you have diabetes, either the pancreas produces too little insulin, or the amount of insulin produced is not enough for the body, or the insulin that is produced cannot work properly. For whatever reason, the sugar in the blood cannot enter the cells and accumulates in the blood, causing the blood sugar level to rise. That's when you need to give insulin externally as an injection to control the blood sugar level. This is like supplying something that is lacking in our body.

Let's understand how an insulin injection works? (Onset, Peak, Duration)

Now, when your doctor prescribes you an insulin, you may have heard three other words mentioned along with its name: 'Onset', 'Peak', and 'Duration'. Although these are English words, knowing exactly what they mean is very important for managing your diabetes. Let's see what each of these means.

'Onset' (time of onset)

'Onset' is how long it takes for insulin to start working in your body after you inject it, meaning it starts to lower your blood sugar. Just like it takes a while for us to start riding a bike, some insulins take a while to start working. Some start working quickly, while others take a little longer.

'Peak' (time of maximum activity)

'Peak' is the time when insulin is injected and works most actively to lower blood sugar. This is when insulin has the greatest effect. During this 'Peak', blood sugar levels can suddenly drop too low (a condition called `Hypoglycemia'). Therefore, it is very important to be aware of these 'Peak' times and be careful about things like eating during those times.

'Duration' (total active time)

'Duration' refers to how long the insulin's effects last in your body. This means that after a single injection, it will help control your blood sugar for how many hours. Some insulins work for only a few hours, while others work for 24 hours or longer.

These things like 'Onset', 'Peak', and 'Duration' vary greatly from one type of insulin to another. That's why your doctor will choose the insulin that's right for you, based on many factors, such as your eating habits, how you exercise, and your daily activities.

Let's see what these types of insulin are.

There are several types of insulin. They are mainly classified according to how quickly they start working (Onset), when they have their maximum effect (Peak), and how long they last in the body (Duration).

Rapid-acting insulin

This type of insulin, as the name suggests, starts working very quickly. It usually starts working within 5-20 minutes of being injected. Its 'peak', or maximum effect, occurs within 1-3 hours , and its total effect lasts about 3-5 hours . It is often taken before or during meals.

• Examples: `Insulin glulisine (Apidra®)`, `Insulin aspart (Novolog®)`, `Insulin lispro (Humalog®)` (U-100/U-200).

Imagine that you are getting ready to eat rice now. Then, taking this type of insulin will help you quickly control the amount of sugar that is added to your blood from the food you eat.

Short-acting insulin

This is also called 'Regular insulin'. These are not as fast as the Rapid-acting insulin mentioned earlier, but they work relatively quickly. It takes about 30-60 minutes to start working. The 'Peak' occurs between 2-4 hours , and the effect lasts about 5-8 hours . This is also usually taken about 30 minutes before a meal.

• Example: `Regular insulin (Novolin R, Humulin R)`.

Intermediate-acting insulin

This type of insulin takes about 1-2 hours to start working. The 'peak' is a bit late, between 4-12 hours . Since these have a duration of action of about 14-24 hours , there are times when you have to inject them twice a day.

• Example: `NPH insulin (Novolin N, Humulin N)`.

Long-acting insulin

This is also called 'basal' insulin. These help control blood sugar levels, just like our body's natural insulin, throughout the day. Some of these don't have a clear 'peak', so there's less risk of blood sugar dropping too low. The effect can last for 24 hours or longer.

• Examples:
• `Insulin detemir (Levemir®): Takes about an hour to start working. Peak effect can occur between 3-14 hours . Effects last up to 24 hours .
• `Insulin glargine U-100 (Lantus®, Basaglar®): Takes 3-4 hours to start working. There is no clear 'peak' . The effect lasts up to 24 hours .
• `Insulin glargine U-300 (Toujeo®): Takes about 6 hours to start working. This also does not have a 'peak' . The effect can last up to 36 hours .
• `Insulin degludec U-100/U-200 (Tresiba®): Takes about an hour to start working. This also does not have a 'peak' . The effect can last up to 42 hours .

When taken once (or maybe twice) a day, this type of insulin helps keep blood sugar levels stable throughout the day, just as our bodies receive small amounts of insulin throughout the day.

Pre-mixed Insulin

As the name suggests, these are a combination of two types of insulin, rapid-acting and intermediate-acting, or similar compounds. This means that one injection does both. These are often taken before meals.

• Examples:
• `Pre-mixed insulin 70/30 (70% NPH and 30% Regular)`: Takes half an hour to an hour to start working. Peak time is between 2-12 hours . Effect lasts 10-16 hours .
• `Pre-mixed insulin 50/50 (50% NPH and 50% Regular)`: Takes half an hour to an hour to start working. Peak time is between 2-12 hours . Effect lasts 10-16 hours .
• Humalog® Mix 75/25 (75% insulin lispro protamine and 25% insulin lispro): Starts working in 5-20 minutes . Peak time is 1-2 hours . Effects last 10-16 hours .
• Humalog® Mix 50/50 (50% insulin lispro protamine and 50% insulin lispro): Starts working in 5-20 minutes . Peak effect is 1-2 hours . Duration of action is 10-16 hours .
• `NovoLog® Mix 70/30 (70% insulin aspart protamine and 30% insulin aspart)`: Starts working in 5-20 minutes . Peak time is 1-2 hours . Effect lasts 10-16 hours .

When using mixed insulin like this, it can reduce the number of injections per day, which is a great convenience for some people.

How do you inject insulin? Where should you inject it?

There are several places on our bodies that are suitable for insulin injections.

• Abdominal area: About two inches around the navel (umbilicus), and around that area.
• Thigh area of ​​the legs: The top and back of the thigh.
• The back of the upper arm.
• Buttock area.

It is very important not to inject insulin in the same place every day. If you do, the fatty tissue under the skin in that area can thicken and form lumps. This is called `Lipohypertrophy`. When this happens, the body absorbs less insulin from that area, and the insulin does not work properly. Therefore, you should change the injection site every day. This is called `rotation` . For example, if you inject on the left side of the stomach today, you should inject on the right side tomorrow, and the day after that, you should alternate, such as injecting on the left thigh.

Your doctor or Diabetic Nurse Educator will teach you exactly how to inject insulin, how to use a syringe, and how to use an insulin pen if you have one. It is very important to follow these instructions exactly.

What are the possible side effects of using insulin?

Like any medication, insulin can have minor side effects. But there's nothing to worry about, as being aware of these can largely control and prevent them.

Hypoglycemia - low blood sugar

This is the most important thing we all need to be careful about when taking insulin. Simply put, this condition called `Hypoglycemia` occurs when the blood sugar level drops too low.

• What are the symptoms?
• Sudden sweating
• Feeling like your body is shaking
• Heart palpitations
• Feeling anxious, restless
• Feeling very hungry
• Feeling dizzy, lightheaded
• Voice changes, slurring when speaking
• Blurred vision
• If this condition becomes very severe, it can even lead to loss of consciousness. Therefore, it is very important to be aware of these symptoms.

• Why is this happening?
• Eating late or skipping a meal.
• Taking too much insulin.
• Exercising more than usual, not eating enough to compensate, or not reducing insulin.

• What to do? As soon as you feel these symptoms, you should eat some sugar as soon as possible. For example, you can drink a few glucose tablets, 2-3 teaspoons of sugar dissolved in a little water, drink some fruit juice (with sugar), or drink a little sweetened drink. Then, after a while, eat a small meal containing complex carbohydrates (e.g. a slice of bread, a few biscuits). It is very important to talk to your doctor about this and know exactly what to do in an emergency.

Local Allergic Reaction

This is actually a very rare occurrence. The area where the insulin injection was given may become red, slightly swollen, and itchy. This usually goes away on its own in a few days. However, if it persists or gets worse, you should definitely tell your doctor.

Weight gain

Some people may gain a little weight when they start taking insulin. This is because, before, sugar was not properly entering the cells due to diabetes, but now, thanks to insulin, that sugar starts to be used as energy. Also, excess energy is stored in the body, which can lead to weight gain. But don't worry, you can largely control this weight gain by eating a healthy, balanced diet and exercising daily.

Keep these things in mind when using insulin:

• Insulin taken before meals: Rapid-acting insulins such as Humalog®, Novolog®, and Apidra® should usually be taken about 15 minutes before meals. Regular insulin should be taken about 30 minutes before meals. Sticking to these timings is very important for controlling blood sugar levels after meals.
• Mixing insulin: Some types of insulin (for example, rapid-acting or regular insulin and NPH insulin) can be mixed in the same syringe. But only if your doctor tells you to do so. However, never mix insulin from one company with insulin from another. For example, Humulin-R® (from Eli Lilly) should not be mixed with Novolin-N® (from Novo-Nordisk). This is because the methods used to make these insulins and the preservatives they contain may be different, so the effects of mixing them together have not been studied.
• Your doctor will determine the type of insulin that is right for you, how much (dose) you need to take, how many times a day you need to take it, and when you need to take it. It is important to follow your doctor's instructions exactly. Do not change the dose or timing as you feel like it.
• If you use insulin pens, use only the recommended needles that fit your pen. It is best to use a new needle each time you inject insulin. Reusing the same needle over and over can cause pain, infection, and blunting of the needle, which can prevent the insulin from being delivered properly.
• It is also important to keep insulin at the right temperature. Sealed insulin vials or pens that are not being used should be kept in the refrigerator (not the freezer section). A vial or pen that has just been used can be kept at room temperature (out of direct sunlight and excessive heat). The length of time varies depending on the type of insulin. Check the leaflet that comes with your insulin, or ask your doctor or pharmacist.

Finally, what to remember (Take-Home Message)

Living with diabetes can be challenging at times. However, insulin is a valuable medicine that can help you control your blood sugar levels, protect you from the complications that diabetes can cause, and help you live a healthy, happy life.

Don't be afraid of insulin or think of it as a big problem. Think of it as your friend, someone who is there to help you and take care of you.

If you have any questions or even the slightest doubt about insulin or diabetes, don't be shy or embarrassed to ask your doctor, diabetes nurse, or pharmacist. They are all ready to help you and answer your questions.

By using insulin correctly, following your doctor's instructions, eating a healthy diet, and getting some exercise every day, you can manage your diabetes well and live a happy life. I wish you all the best!

` Insulin, Diabetes, Types of Insulin, Hypoglycemia, Insulin Injections, Apidra, Novolog, Humalog, Lantus, Levemir, Tresiba, NPH