DIABETES IN PREGNANCY

Hi today we are joing to discuss about diabetes in pregnancy.

Diabetes, it's certainly not a problem that's unique to pregnancy, but it's something weal ways have to discuss when we're talking about pregnancy because it can really complicate that picture quite a bit.

 

So firstly, diabetes and pregnancy split up into two different categories. There's the category of women who had diabetes before becoming pregnant, and that's called pre-gestational diabetes. So that category is referred to as pre-gestational diabetes. Pre for before, gestational for pregnancy, so before pregnancy diabetes. And then there are the women who become diabetic during their pregnancy, which is called gestational diabetes. So that's the second category,gestational diabetes. And 90% of cases, so that's nine of every 10 cases of diabetes in pregnancy falls into this category of gestational diabetes. And then the other 10% are pre-gestational diabetics. 

So there's something about pregnancy that makes women more susceptibleto developing diabetes and we'll discuss exactlywhat that is in just a bit. But firstly, why do weeven split up diabetes into these two different groups? Well, if a woman haspre-gestational diabetes, that means that her blood sugars may have been poorly controlled at the time that the baby was conceived. Or even during the first eight weeks of the pregnancy, during a period called organogenesis. So the first eight weeks of pregnancy is a period called organogenesis, when the fetus' organs are made. And those high levels of glucose during that really pivotal time can lead to a miscarriage or it can lead to significant anomalies within the fetus. However, with gestational diabetes, that problem with glucose control develops during the pregnancy, in some ways because of the pregnancy. And usually the glucose control isn't impaired until the second trimester, so after the point of conception and after the point of organogenesis. So miscarriage and fetal anomalies don't tend to be a problem with gestational diabetes. 

But that's not to say that gestational diabetes doesn't harm the fetus. Rather, diabetes as a whole, so regardless of the category, can cause preterm labor. It can cause problems with the growth of the fetus. It can even lead to stillbirth. And one of the complications that we tend to think about a lot, that tends to be talked about a lot, is fetal macrosomia. So fetal macrosomia. So let me explain that a little bit. Alright, so if mom has diabetes, the basic gist of it allis that her glucose levels tend to run on the high side. And glucose can cross the placenta, into the bloodstream of the fetus. That's like one of the main purposes of the placenta, to allow glucose to enter the baby's bloodstream as an energy supply. So then when mom has high glucose levels in her blood, then the fetus has high glucose levels in its blood. And that drives the release of insulin in the fetus, because that's the body's primary response to glucose, to release insulin. Insulin is kind of the key that allows cells to open up their doors and take up glucose and use it. And so that insulin that's released in the fetus allows glucose to be taken up. And insulin does a few other things. It also stimulates fat storage in the body, right? And it also binds to receptors on different organs, such as the heart and the liver, and it causes them to grow. It causes the organs to actually grow in size. And so the end result of it all, the end result of the high glucose levels in the mom, leading to high glucose levels in the baby, leading to high insulin levels in the baby, is that the baby grows to a larger size than normal, which is called fetal macrosomia. Macro for large and soma for body. So larger body. Now another thing that I want to mention is that in pre-gestational diabetes, so again, diabetes before the point of pregnancy, the impaired glucose control is more long-standing. 

So these women are more likely to have diabetic complications such as kidney damage or vascular problems, so blood vessel related problems, and damage to the retina. And pregnancy can aggravate these complications, so it can it make worse. So it's really important to monitor these conditions throughout the pregnancy. Now, I want to stop dancing around the issue of why women can become diabetic during pregnancy. A lot of it has to do with the hormones that are released during pregnancy. So hormones such as HPL, that's not one that many people have heard of, right? It stand for human placental, human placental lactogen. Alright, so that's HPL. Another hormone is cortisol. So the body's main stress hormone. Another one that you may have heard of before is growth hormone, that's released in a large quantity during pregnancy. And then finally, progesterone. Progesterone, which is exceptionally important for the maintenance of a healthy pregnancy. So these hormones are released during pregnancy and they have lots of important roles. And among their many, many roles, these hormones increase mom's production of glucose during pregnancy to make sure that the fetus has enough of the glucose, enough of its primary fuel source. And that leads to high glucose levels within the mom's blood. And you might be thinking,"Well, that's no problem, "because the glucose will cause insulin to be released "and that insulin will cause mom's cells "to take up the glucose and problem solved. "You don't have high glucose levels in the blood any more." Well, unfortunately, it doesn't really work that way, because these same hormones make the mom's body resistant to insulin. So that the cells don't respond to insulin and don't take up as much glucose from the blood. And this is done for a purpose. It's actually done so that you can reduce mom's utilization of the glucose so that more of the glucose is available for the fetus. And that's why you can end up with high blood glucose levels and diabetes in pregnancy. Or if you had diabetes before you became pregnant, it can become worse during pregnancy. So, given that diabetes can cause all of these complications for mom and baby during pregnancy, it goes without saying that we do our absolute best to screen for it during pregnancy. So for women who have a normal risk of having diabetes, we do a routine screen. So for all women, all average women, we do a routine screen around 26 to 28 weeks into the pregnancy. And that screening testis usually in the form of a glucose tolerance test.

So the screening test is often called the glucose tolerance test, where the woman is given a very specific amount of glucose and her blood glucose levels are measured at one, two, or three hours after consuming that very specific amount of glucose. And if her blood glucose levels are above the normal range, then she's found to be diabetic. And if a woman is diagnosed with diabetes during her pregnancy, we do our best to control it with diet. And if that doesn't work, then insulin is kind of our second line of treatment. And it's also important to know that gestational diabetes, so again, diabetes that occurs during pregnancy, kind of as a process of pregnancy, increases the risk of a woman having overt diabetes after the pregnancy is over. So it's really important to follow up with all these women after they deliver. Kind of the set point, six weeks after they deliver to test them for diabetes. Okay, so that is gestational diabetes in a nut shell. 

DIABETES MELLITUS AND INSULIN

Hi, today we will be discussing about the relationship between diabetes mellitus and insulin.

We can break down food into many different types of nutrients. One of the most important nutrients our body needs is a sugar called glucose, which is the fuel that powers the cells of our body. Glucose is transported throughout the body by blood and requires careful regulation, since too much glucose in the blood can lead to disastrous consequences, such as diabetes mellitus. Read this article to learn more about the symptoms, cause, and treatment of this disease.

Let’s talk about blood glucose regulation first. The body has many ways to increase or decrease the amount of glucose in the blood. Some ways to increase blood glucose include eating a meal, synthesizing glucose from scratch, or releasing glucose from storage, while some ways to decrease blood glucose are to transport glucose into cells, which either use up glucose for energy or store it. Throughout the day, the body is constantly making slight adjustments to keep blood glucose levels at an optimal range. These slight adjustments are controlled by the hormones insulin and glucagon, but in this article, we’ll focus on insulin. Insulin is released into the bloodstream when blood glucose is high, such as after a meal. It signals to cells to take in glucose for energy or storage. It also prevents more glucose from being synthesized or released from storage. Therefore, the overall effect of insulin is to decrease blood glucose levels. Diabetes mellitus, or simply diabetes, occurs when this insulin signalling pathway is broken. Without proper functioning of insulin, blood glucose levels skyrocket. Despite glucose being a very important source of fuel for the body, too much of it in the blood is extremely damaging. In the short term, high blood glucose leads to the hallmark symptom of diabetes: glucosuria, or glucose in the urine. In fact, the term “mellitus” means “honey” in Latin to reflect this symptom of sweet-tasting urine. How does this occur?

At the kidneys, glucose is filtered out of the blood and into the urine, but is later transported back into the blood since the body does not want to lose this valuable source of fuel. This reabsorption uses proteins which have a maximum rate of transport. When there is too much glucose in the blood, more of it is filtered into the urine. Even at their maximum transport rate, the proteins cannot transport all of the glucose out of the urine, leading to glucosuria. This causes excess urination, since the presence of glucose in the urine draws in more water by osmosis. Excess thirst and dehydration are a consequence of this since more water is lost through urine. In addition, since cells cannot take up glucose for energy without insulin, the body perceives itself to be “starving”, leading to both increased appetite and fatigue. In the long term, high blood glucose damages blood vessels in the eyes and kidneys, which is why diabetes is the leading cause of adult blindness and kidney failure. High blood glucose also damages nerves, leading to loss of sensation in the feet and hands. When those areas get injured, such as from cuts or from blood vessel damage, the person does not notice the injury, leading to infections and necrosis that eventually require amputation. Most importantly, the damage to blood vessels in the heart and brain can lead to high blood pressure, stroke, and heart attacks, which account for most of the deaths in diabetic patients.

Most diabetes cases can be divided into two types based on how the insulin signalling pathway is malfunctioning. Type 1 diabetes accounts for around 10% of diabetes cases, while Type 2 makes up most of the remainder. The last few percentage points are attributed to rarer forms of diabetes that you can check out in the video description. Type 1 diabetes is caused by a lack of insulin production. In the pancreas, there are special clusters of endocrine cells called the islets of Langerhans. One type of endocrine cell in these islets is the beta cell, which produce and release insulin. In Type 1 diabetes, the beta cells are destroyed by the immune system. Therefore, the body can no longer produce insulin and blood glucose levels rise uncontrollably, leading to the symptoms mentioned earlier. Scientists believe both genetic mutations and environmental factors, such as infections, may play a role in triggering this autoimmune attack. An additional symptom of Type 1 diabetes is rapid weight loss, as fat cells, or adipocytes, begin to break down fats into another type of energy molecule known as ketone bodies. Large amounts of these ketone bodies are released into the blood, which can be taken up by other cells as an alternative source of fuel. However, ketone bodies are slightly acidic molecules, so excessive amounts of these molecules can acidify the blood. This is known as diabetic ketoacidosis, which is a life-threatening condition if untreated. However, when most people think of “diabetes”, they are probably imagining the more common Type 2 diabetes associated with obesity, ahigh sugar and fat diet, and a lack of exercise. These three lifestyle factors, as well as genetic factors, dramatically increase the risk of developing Type 2 diabetes. Unlike Type 1 diabetics, Type 2 diabetics continue to produce insulin. However, their cells have become resistant to insulin, meaning that more insulin is required to achieve the same effect of lowering blood glucose. 

To compensate for insulin’s ineffectiveness, beta cells will produce even more insulin. However, when insulin resistance becomes so severe that the insulin required by the body exceeds the maximum amount of insulin produced by beta cells, symptoms of high blood glucose begin to appear. Weight loss and diabetic ketoacidosis from fat breakdown also occur in some cases of Type 2 diabetes. Furthermore, in some cases the continued overproduction takes a toll on the beta cells, which eventually die and causes a lack of insulin production, further worsening the problem. The cause of insulin resistance is still not well understood; however, factors such as high insulin levels from excessive sugar consumption and fat around the liver and pancreas are being investigated as possible causes of insulin resistance. It is important to note that it is very difficult to “cure” diabetes as of now. Doctors are only able to make living with diabetes tolerable, as long as medications are taken and lifestyle changes occur. Current treatment depends on the type of diabetes. Since the high blood glucose of Type 1 diabetes is caused by a lack of insulin, simply administer insulin during periods of high blood glucose, such as after a meal. However, this is easier said than done. Insulin is a protein and will get degraded in the stomach if taken orally. Therefore, Type 1 diabetics must inject insulin directly into the bloodstream, usually just under the skin of their abdomen. The dose is also extremely important – too little and blood glucose levels remain high, but too much insulin will cause blood glucose levels to plummet, leading to coma or even death. On the other hand, decreasing high blood glucose in Type 2 diabetes is much more complicated. Insulin is only effective in around 30% of patients as cells are already insulin resistant, so other methods of decreasing blood glucose are required. Many diabetic drugs have been developed which target the mechanisms of blood glucose regulation mentioned in the beginning of this video. These drugs can decrease glucose absorption in the intestines after a meal, decrease synthesis of new glucose, or increase insulin sensitivity which leads to more glucose uptake by cells. For example, the drug metformin is the first line treatment to Type 2 diabetes because it can activate certain metabolic pathways to both decrease glucose synthesis and increase glucose uptake by cells by increasing insulin sensitivity. However, despite our best efforts, diabetes is the 6th leading cause of death worldwide, with 3 people dying from diabetes complications every minute. Therefore, the best treatment of diabetes is to prevent diabetes from occurring in the first place. Though no prevention method is known for Type1 diabetes, frequent exercise and a healthy diet drastically reduces the risk of the much more common Type 2 diabetes. Currently, it is estimated that 400 million adults, which is around 10% of the worldwide adult population, is living with diabetes, although this number is expected to increase in the future. If more people become aware of and avoid the lifestyle choices associated with diabetes, we can slow down or even reverse this trend. 

Furthermore, Type 2 diabetes in particular develops slowly and silently over time, leading scientists to suspect that almost half of the worldwide diabetic population is undiagnosed, which is why it is so important to educate the public about the causes and symptoms of this disease. It is also important to note that diabetes is an extremely complex and not fully understood disease that scientists are still finding new information about everyday. So if you want to learn more about diabetes, like new treatments and research, check out the links in the description below.

Thanks for reading.

TRAVELLING WITH DIABETES

I travel domestically and abroad and one thing you learn with that experience is you have to be prepared when you have Type 1 Diabetes. You have to sort of think forward a little bit and decide what would be problems you may have. For example, you might not always get to food when you need to have it or you might not be able to take insulin conveniently when they’re serving food, so you have to think those things through a little bit. There’s a few things you need to prepare if you’re going to travel if you have Type 1 Diabetes.

 First, you need your insulin and you need to have back up for your insulin. You need enough insulin to carry you not only for the trip but in case there’s an unanticipated delay. When I’m traveling I usually figure how many days I’m going to be gone. I figure out how much insulin I’ll need for those days and then I at least double it if not triple it. You never know when something is going to happen -- the plane doesn’t take off right.

 If you have Type 2 Diabetes, the same rule applies to you. You need to take your oral medications to control your diabetes, not only for the time that you’re going to be gone but have back up in case you don’t get home on time.  

Second, you need a way to assess your glucose. You need to check your control and know what your control is; that means you carry a meter and enough strips to carry you.

Third, you need a way to correct a hypoglycemic reaction, a low blood sugar.  That could either be a form of rapid acting you know carbohydrates or something to eat but make sure you have it.

Fourth, you need to have a form of identification. In case you get into trouble where you can't help yourself, you need the help of somebody else and they need to know that you have diabetes. When I’m taking a long plane flight where there’s going to be meal service, there’s three things I want on my person. I don’t want them overhead where I may not be able to get to them because of turbulence or something in the aisle. I don’t want them under the plane. I want my glucose tabs with me in case I get low. I want my insulin with me so I can't take it for the meal. And I want to have a meter with me so I can adjust and determine what dose to take. When you start traveling over large time zones, for example if you’re going over to Europe or Asia or someplace where the time really shifts a lot, you need to think a little bit about your diabetes and how your insulin works in terms of the timing of your insulin.  So if your insulin is good for four to six hours but you change the time zone, you need to account for that. When you’re thinking about traveling for pleasure, taking a vacation, sometimes you can really incorporate a lot of things into that vacation that are really good, sound practices for diabetes. You can take vacations that have physical activity built into them. Go to national parks, take hikes, go out into the wilderness a little bit and use your feet. You know, not a bad idea. Sometimes you can go to places where there’s pools and oceans and--and  the options for swimming or using a bicycle .It’s not a bad idea to  incorporate good diabetes care into having fun and into vacation.

 When you’re driving in your car, a couple of good rules: 

First, don’t put your insulin in the glovebox, leave it there, and forget because if the car gets too hot or gets too cold you ruin your insulin. Now you have nothing to work with and that’s a big problem.

Number two, make sure you have something to help you correct hypoglycemia. If you get low that means you need to have something that’s rapid and will correct it and you shouldn’t drive while you do that. You should pull over, correct it, and that brings us to the third rule: have a meter. You don’t know what’s going on unless you can check. So you need to find out when you’re safe to drive. If you have diabetes and you haven't traveled a lot yet, you can get excellent advice from your healthcare team. They can give you good sound tips about how to travel safely with diabetes.

If you’re living with diabetes, you can get excellent information, great educational support at a really wonderful website https://diabetesexperienceindia.blogspot.com/ I’m pushpender singh and my Type 1 Diabetes does not prevent me from traveling.  

DIABETIC FOOT PROBLEM: SYMPTOMS,CAUSES AND TREATMENT

Hi today we are going to discuss about the different kinds of foot problems can occur in people with diabetes. There are a number of problem that a diabetic may face:

• Two main conditions are  
• Peripheral artery disease (PAD) and Peripheral neuropathy, are responsible for the increased risk of foot problems in people with diabetes.
• Symptoms and signs of diabetic foot problems arise due to the decreased sensation from nerve damage as well as the lack of oxygen delivery to the feet caused by vascular disease.
• People with diabetes have an increased risk of ulcers and damage to the feet.
• Diabetic foot problems also include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails. These problems are not specific to diabetes, but may occur more commonly due to the nerve and vascular damage caused by diabetes.
• Treatment depends on the exact type of foot problem. Surgery or even amputation may be required for some cases.
• Gangrene (dry gangrene) is tissue death due to absence of blood circulation. It can be life threatening if bacterial infection develops (wet gangrene).
• Many diabetes-related foot problems can be prevented by good control of blood sugar levels combined with appropriate care of the feet.

How can diabetes cause foot problems?

Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes.

• Peripheral artery disease (PAD), sometimes referred to as peripheral vascular disease (PVD), means that there is narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain. This is sometimes referred to as "hardening" of the arteries. Diabetes is a known risk factor for developing peripheral artery disease. In addition to pain in the calves during exercise (medically known as intermittent claudication), the signs and symptoms of peripheral artery disease relate to a decreased delivery of oxygen to the lower legs and feet. In severe cases, the lack of oxygen delivery to tissues can result in ulcers and even gangrene (tissue death).
• Peripheral neuropathy refers to damage to the peripheral nerves directly as a result of diabetes. Symptoms of peripheral neuropathy include decreased sensation in the nerves of the legs and feet, making it difficult to perceive injuries due to lack of feeling. Peripheral neuropathy also causes a tingling, pain, or burning in the involved areas. It can also cause the muscles of the feet to work improperly, leading to misalignment of the foot that can put pressure on certain areas of the foot.

Peripheral Artery Disease (PAD or PVD) Symptoms

Peripheral artery disease (or peripheral vascular disease) symptoms include:

·        Intermittent claudication

·        Numbness in the extremities

·        Weakness of the calf muscle

·        Pain at rest

·        Hair loss

·        Coldness in the legs or feet

What are the symptoms of foot problems caused by diabetes?

In the most severe case, as mentioned above, due to a combination of decreased sensation and reduced blood flow to the feet, ulcers may develop. If the tissues continue to receive insufficient oxygen, tissue death (gangrene) occurs. Gangrene is a serious and potentially life-threatening condition. Other potentially serious problems that may develop include cellulitis (infection of the tissues beneath the skin) and osteomyelitis (infection of the bone); sepsis (the infection spreads to the bloodstream) also is possible.

People with diabetes are at increased risk for milder problems with the feet that are not specific to diabetes but may occur more frequently due to problems with the nerves and circulation to the feet.

Some of these conditions are:

Calluses and corns, that may develop due to abnormal alignment of the feet or abnormal gait

• Fungal infections of the nails, which can appear as thickened, discolored, and at times brittle nails
• Tinea pedis, or athlete's foot, a fungal infection of the skin of the feet
• Hammertoes, or bent toes due to muscle weakness.
• Bunions, or the angling of the big toe toward the second toe. The area of the bunion may become reddened and irritated, leading to callus formation.
• Ingrown toenails
• Cracking of the skin of the feet, especially the heels, due to dry skin

How are foot problems caused by diabetes treated?

Treatment depends upon the type of foot problem. For example, some problems such as corns may require wearing corrective shoes, while others such as mild infections may be treated with antibiotics or antifungals. Other problems may need surgical debridement and antibiotics. Gangrene, or tissue death, cannot be reversed, but treatments are available to prevent gangrene (often termed dry gangrene) from spreading or becoming infected (dry gangrene becomes infected and develops into wet gangrene). Surgical removal of the dead tissue is typically required, and antibiotics are given to prevent the development of life-threatening infections in the dead tissue. In severe cases of gangrene, amputation of the affected part may be necessary.

Other types of foot problems can be relieved by proper footwear, sometimes with orthotic devices, and splinting or bracing. For some conditions like hammertoes, bunions, and ingrown toenails; surgery may be necessary to correct severe cases.

Taking proper care of your feet (see Prevention section) can help prevent or relieve many common foot problems in people with diabetes.

Can diabetes-related foot problems be prevented?

Some diabetes foot-related problems can be prevented by taking careful steps to observe and care for your feet. Keeping blood sugar levels under control (in the ranges advised by your doctor), and following your recommended diet and exercise program are the best way to prevent all complications of diabetes, including foot problems. In addition to keeping your diabetes under control, you can take steps to care for your feet, including the following:

• Wear comfortable, closed-toe footwear at all times. Special shoes are available for people with bunions or foot deformities if these are necessary. Be sure no objects are trapped inside the shoes that could cut or injure your feet.
• Don't walk barefoot, even at home. Be sure your feet do not get burned by walking on very hot pavement in summer
• Always wash your feet with warm water and dry them well after washing.
• Check your feet daily for any sores or problems.
• Apply lotion to dry areas, especially heels, but don't use lotion between the toes. Corns and calluses can be lightly smoothed with a pumice stone. Never use scissors or razors to cut away corns or calluses.
• Trim toenails straight across, and do not cut the corners shorter than the rest of the nail.
• Be sure that your doctor checks your feet at every checkup.
• Stop smoking, if you are a smoker. Smoking further increases the risk of arteriosclerosis and poor circulation to the feet.

If left with any doubt or query you can comment in the comment section below.

ALL ABOUT INSULIN DELIVERY DEVICES- SYRINGE, PEN, PUMP.....

Hi today we are going to discuss about the various devices through which we can inject insulin in our body.

So let’s begin:

Insulin is a necessary part of the treatment plan for all people with Type 1 diabetes and many with Type 2. Insulin helps get glucose from the bloodstream into the muscle and fat cells to be used for fuel. It cannot be taken as a pill or a swallowed liquid, because it would be broken down by the digestive system before it reached the bloodstream, where insulin does its work. Instead, insulin is injected or infused into the fatty tissue under the skin.

There are a number of devices that can be used to deliver insulin, including syringes, insulin pens, jet injectors, and insulin pumps. No single device or type of device works well for everyone. The decision of which to use may be based on a person’s insulin regimen, ability to manipulate or operate a particular device, visual ability, insurance coverage or ability to afford a particular device and related supplies, occupation, and daily schedule or leisure-time activities. Discussing your needs and preferences with your diabetes care team is the best way to pick the device that will work well for you and get the training you need to use it correctly.

Syringes

The most common method of insulin delivery is by syringe. Medical syringes are relatively small, are disposable, and have fine needles with special coatings that make injecting as easy and painless as possible. To take insulin with a syringe, the user first pulls back on the plunger to draw in air equal to the amount of insulin to be drawn, inserts the syringe needle into a vial of insulin, pushes the air into the vial, pulls back on the plunger until the correct dose is drawn into the syringe barrel, then inserts the needle through the skin and presses down on the plunger until the barrel is emptied.

Syringes come in a variety of sizes, with different-size barrels, different needle gauges (thicknesses), and different needle lengths. The higher the gauge, the finer (thinner) the needle. Your diabetes care team will help choose the appropriate syringe for you based on the sizes of your insulin doses and your personal preference for needle gauge and length. While some people may prefer a shorter needle, insulin leakage at the injection site or worsening blood glucose control are signs that a longer needle may be necessary to deliver the insulin properly.

Reusing syringes is not recommended due to potential complications such as more painful injections as the needle dulls with use, infection, or tissue damage. The best practice is to use a new syringe for each injection.

It is important to be aware that insulin is manufactured in different strengths; however, U-100 (100 units of insulin per milliliter [ml] of fluid) is the most common strength. The syringes for administering insulin are specifically designed for each different strength. Therefore, a U-100 syringe should normally only be used with U-100 insulin.

While most insulin sold are U-100, people who are severely insulin resistant may use U-500 (500 units of insulin per ml). However, no U-500 syringes are manufactured, so people who are prescribed U-500 insulin must work with their diabetes care team to learn how to draw up the correct dose in a U-100 syringe.

Insulin pens

Insulin pens look similar to oversized ink pens, making them a potentially convenient and discreet way of carrying insulin. To use an insulin pen, the pen cap is removed and a pen needle is attached. The pen is then “primed” by dialing in a very small dose (exactly how much depends on the particular pen) and expelling the insulin into the air. Priming is done to ensure that insulin is flowing through the pen properly and that there is no air in the cartridge or needle.

After priming is completed, the actual dose of insulin to be administered is dialed in using a dial or dose knob. The needle is inserted into the skin, and the dose is delivered by pressing on the dose knob until it is fully depressed. It is important to hold the pen in place and to continue pressing the dose knob while counting slowly to five before removing the needle from your skin to ensure that no insulin leaks out. Pen needles are intended for one use only and should be removed and discarded after an injection.

Insulin pens should never be stored with the needle still attached because doing so may allow insulin to leak out or air bubbles to form in the insulin cartridge. Between uses, the pen’s cap should be put on to protect the insulin cartridge. In-use pens or pen cartridges should not be stored in the refrigerator because of the possibility that condensation will form in the insulin container. (As soon as an insulin cartridge is placed in a pen, it is considered “in-use” and should no longer be stored in the refrigerator, even if the pen is not actually used for an injection for several days.)

Most pens hold 300 units (3 ml) of insulin and deliver doses in one-unit increments, with up to 60 to 80 units per dose. The NovoPen Junior and the HumaPen Luxura HD deliver insulin in half-unit increments. One of the biggest advantages of insulin pens is accurate dosing. Ease of use is another advantage of pens over syringes because they require less manual dexterity and coordination, and they may be easier to use for people with low vision.

Like syringes, pen needles also come in a variety of needle gauges and lengths. However, pen needles may be slightly thinner and in some cases shorter than syringe needles, so injections may be more comfortable.

Some pens are disposable, while others use replaceable cartridges of insulin that are inserted into the pen.

Prefilled pens. Prefilled, plastic, disposable insulin pens have a self-contained insulin cartridge. Several different types of insulin are sold in prefilled pens. Once you have used all of the insulin in the cartridge (or the insulin has reached its in-use expiration date), you dispose of the entire pen.

Durable pens. Insulin pens that use replaceable cartridges of insulin are also available. Most reusable pens are made of metal but otherwise have about the same features as disposable pens and a comparable cost.

Jet injectors

Another option that has been available for several years is insulin jet injectors. Jet injectors use a mechanism to produce high-pressure air to deliver a fine spray of insulin through the skin. Once the appropriate dose of insulin has been loaded into the injector, it is placed against the skin and the trigger, or button, is pushed. The high pressure causes the insulin to vaporize and penetrate the skin so that it reaches the subcutaneous tissue. Some bruising may occur from injections using a jet injector, but bruising can be minimized by adjusting the pressure (setting) of the spray. The pressure may have to be adjusted differently for different injection sites.

It is extremely important to follow the manufacturer’s guidelines on the care and cleaning of the device to maintain sterility. Jet injectors are generally not recommended for people who take blood thinners, are undergoing dialysis, or have hemophilia.

If you are interested in using a jet injector, work with your diabetes care team to learn the proper technique. In addition, check with your insurer to determine whether the cost of the device is covered.

Inhaled insulin

Inhaled insulin was approved by the Food and Drug Administration in January 2006, but the only inhaled insulin to reach the market so far — Exubera — was discontinued in October 2007. Other drug companies are working to gain approval of their products by the Food and Drug Administration.

External Insulin Pump

Insulin pumps are becoming more popular as the technology improves and additional features are added. Some pumps are now available that work in conjunction with continuous glucose monitors that can alert the user to high or low blood glucose levels if programmed to do so.

Insulin pumps have traditionally been used primarily by people with Type 1 diabetes, but they are becoming a treatment of choice for many with Type 2 diabetes, as well. Most insulin pumps are small devices about the size of a cell phone. (The exception is the OmniPod, which is even smaller and is attached directly to the skin, with no tubing necessary.) The pump itself can be clipped onto the waistband of your pants or skirt or placed in a pocket. A length of plastic tubing connects the insulin reservoir within the pump to the infusion set, which is taped onto the skin and contains a small catheter (often called a cannula), through which insulin enters the body. The catheter is commonly inserted into the abdomen or buttocks and needs to be changed every 48 hours.

The pump user programs the insulin pump to deliver insulin at a slow, continuous (basal) rate as well as in supplemental (bolus) doses before meals and to correct for high blood glucose. Basal and bolus dosing most closely resembles how the pancreas releases insulin in a person without diabetes.

Using an insulin pump requires commitment and frequent blood glucose monitoring. According to the American Diabetes Association, people who demonstrate the following characteristics are more likely to do well with pump therapy:
• Strongly motivated to improve glucose control
• Willing to work with their diabetes care team
• Willing to assume substantial responsibility for their day-to-day care
• Able to understand and demonstrate use of the insulin pump
• Willing and able to frequently perform self-monitoring of blood glucose
• Knowledgeable about using their blood glucose monitoring data to make dose adjustments

Many people are willing to put in the work necessary to use an insulin pump because it gives them more flexibility with respect to food choices and the timing of meals and activities, while helping to achieve tighter control of their blood glucose.

Disposal of needles

Most states require that used needles and other “sharps” (such as lancets) be disposed of in a way that reduces the risk of accidental needle sticks. Once you’ve used a needle or lancet, place it in a puncture-resistant container such as a liquid detergent bottle or a sharps container purchased at your local pharmacy. (When traveling, carry a small container with you.)

Some communities offer a sharps disposal program that allows you to drop off your sharps at particular locations such as hospitals or pharmacies. If your area does not have such a program, discard your puncture-resistant sharps containers by placing the lid securely onto the container, taping it shut, and marking it “USED SHARPS.” Place the container in the trash, not in a recycling container. Other options for disposing of sharps include sharps mail-back programs and home needle destruction devices.

Cost considerations

Always check with your insurance company to determine whether and which insulin injection devices and supplies are covered by your plan and what out-of-pocket costs are involved. If you do not have insurance coverage (or do not have prescription coverage), many pharmaceutical manufacturers offer patient assistance programs, which offer free or low-cost drugs and supplies to individuals who are unable to pay for their medicine.

Making your choice

The basic purpose of all insulin delivery devices is the same: to deliver the desired dose of insulin into the body to keep blood glucose levels under control. The device you choose should be one that’s easy for you to use and to afford. But picking one insulin delivery device now doesn’t mean you can’t switch to another — or to a combination of devices — in the future. If your needs, lifestyle, or fortunes change, you may decide that a different device might work better for you in your new situation.

So I think you all will be familiar with all types of devices which can be used for injecting insulin.

If left with any doubt or any query feel free to comment in comment section below.