Medical Blog

Insulin

Insulin must be replaced to maintain life. As the insulin molecule is a peptide (a small protein), it would be broken down in the stomach if swallowed – just like any protein food. Insulin has to be injected into the fat layer under the skin.

This may be done using a disposable syringe with insulin drawn from a vial, or by using a pen injector. Insulin is usually advised to be injected through the skin into the fatty tissue of the abdomen, the upper thighs or hips.
There are two basic types of insulin regime. A combined injection of shortacting insulin and intermediate acting insulin may be given before breakfast and before the evening meal. This has the advantage of simplicity, but the disadvantage that meals have to be eaten at fairly fixed times and
in fairly fixed quantities.
The second regime tries to mimic the normal situation, with a low background of insulin being provided by a single daily injection of longer-acting insulin, together with the use of very short-acting insulin taken at a time when it is convenient to eat a meal, and in an amount corresponding to the size of that meal. Although this may involve three or more injections per day of very short-acting insulin, these can be given using a convenient pen device.

Food


People with diabetes can eat normally, with a few modifications. Overall, the pattern of eating advised is merely that of a healthy lifestyle – not too much sugar, avoid fatty foods, and plenty fruit and vegetables. Carbohydrate foods such as bread, pasta, potatoes and biscuits need to be considered in determining what dose of insulin is required. Since the 1930s carbohydrate has been ‘counted’ as 10 g exchanges. For instance, an apple, a small potato or a digestive biscuit each can be counted as a 10 g exchange of carbohydrate. A person with diabetes is trained to assess how many carbohydrate exchanges would be in a meal.

Hypoglycaemia

This word merely means ‘low blood glucose’ and is usually shortened to ‘hypo’. Hypos occur when the balance of injected insulin and food eaten is not correct. If, for instance, only a small meal had been taken despite a dose of insulin appropriate for a larger meal having already been injected, then the insulin would have too great an effect upon blood glucose and the level will fall.
A hypo causes sweating, shakiness, a feeling of great hunger and eventually muddled thinking. If it is not treated by eating some sugary food, the muddled thinking will get worse, and eventually consciousness will be lost. There is a great risk that a person may be assumed to have drunk too much alcohol because of the uncoordinated movements and confusion.
Especially after many years of type 1 diabetes, awareness of the early symptoms of hypos becomes blunted. There is then a risk of loss of consciousness without warning. The treatment of hypoglycaemia is administration of any sugary drink. A hypoglycaemic person may be uncooperative. Treatment from
a doctor or paramedic would involve intravenous administration of glucose, or subcutaneous injection of glucagon. Glucagon is a hormone which has an opposite effect to that of insulin and causes the liver to produce glucose.

Ketoacidosis

If a person with type 1 diabetes did not take insulin, glucose could not be used by the body and fat (the main alternative fuel) would be mobilized excessively. High levels of ketones would be present in the blood and urine. As ketones are weak acids, the blood becomes slightly acidic. Nausea and then vomiting occurs. Once vomiting starts the condition is likely to be fatal within one to two days unless treated.
Anyone with type 1 diabetes who is ill is advised to test their blood glucose frequently and also to test their urine for ketones. The insulin dose always needs to be increased during illness, even if no food is eaten (because the body becomes resistant to ordinary levels of insulin). It is vital that expert medical
help is obtained. Hospital admission is necessary for established ketoacidosis.