Insulin is a hormone produced in the pancreas. Where exactly ? It is secreted from the beta cells. Insulin is not just another hormone. No, it’s the most important hormone in our bodies. Let that sink in…This is not only true for diabetics, this is true for every human being. Without insulin we will die.

Our bodies produce insulin naturally, but in the case of type 1 diabetics, our immune system attacked our pancreas and destroyed the insulin producing cells. In the case of type 2 diabetics, the body struggles to produce or use its own insulin due to insulin resistance.

Back in 1921, Frederick Banting and Charles Best discovered a way to extract insulin from the islet cells of cows and pigs. Before that, people couldn’t live long lives due to diabetes complications. Nowadays, we have synthetic insulin and it is not extracted from pigs and cows. This makes living with diabetes much easier.

So what is insulin’s main job ?

In case you forgot, insulin is that key or “doorman” that unlocks the cells and allows the glucose (foods we eat) to enter the cells so our bodies can use it as energy/fuel. Insulin regulates the level of glucose in the bloodstream. Without it, the glucose stays floating around in our blood and this is what causes high blood sugar levels.

How does Insulin regulate the level of glucose in the bloodstream ?

One way it does so is by regulating the liver and muscles. Insulin instructs the liver and muscles to produce and store glycogen (a starchy substance the body uses when blood sugars start falling too low).

When blood sugars start falling too low which could be caused by physical activity or fasting, the alpha cells of the pancreas will release glucagon (a hormone involved in the regulation of blood sugars).

Glucagon will send a signal to the muscles and the liver to convert the stored glycogen back into glucose in order to raise blood sugars back to normal levels.

Glucagon raises blood glucose. It is basically anti-insulin. Insulin lowers blood glucose.

Remember this process happens automatically for a person with a full working pancreas. In our case diabetics; by injecting insulin, we need to manually make our pancreas work so it does the same exact job.

I don’t want you to get confused with all of this, here’s the most important thing to know: Insulin is a hormone produced in the pancreas that regulates the level of glucose in the bloodstream. That’s it.

Types of Insulin:

Just like everything in life, we move forward and insulin has evolved. Both; the types of insulin available and the methods to deliver it have changed.

Insulin is injected, subcutaneously (under the skin) from a syringe (injections) using an insulin vial or from a pump or pod (these last two are the newer methods). There are also insulin pens.

There’s another method; inhaled insulin (afrezza), which is absorbed through the lungs.

Let’s explain very briefly the different types of insulin:

Older Insulins:

These insulins are cheaper than newer insulins but they don’t provide the same benefits as newer insulins. This type of insulin makes it harder for blood glucose management because it requires a more strict or rigid lifestyle when it comes to the type of food you eat, the amount of food and timing of meals.

–Regular insulin (short-acting insulin):

This is the insulin you take in order to cover your meals, but this insulin takes longer to start working in your body. It also stays in your body for a longer period of time so there’s a risk of low blood sugars throughout the day.

Brand Name	Generic Name	Manufacturer	Effect Onset	Peak	Duration
Humulin R	Regular	Lilly	30 to 60 min	2 to 4 hrs	6 to 8 hrs
Novolin R	Regular	Novo Nordisk	30 to 60 min	2 to 4 hrs	6 to 8 hrs

–NPH (intermediate-acting insulin):

Background or basal insulin, this insulin stays active in your body for about 14 hours. It has to be taken twice daily and it begins to peak after about 4 hours. Again, it requires a more strict routine with scheduling meals, the amount of food and the type of food. Not flexible compared to the new insulins available.

Brand Name	Generic Name	Manufacturer	Effect Onset	Peak	Duration
Humulin N	NPH	Lilly	1 to 3 hrs	6 to 10 hrs	14 to 24 hrs
Novolin N	NPH	Novo Nordisk	1 to 3 hrs	6 to 10 hrs	14 to 24 hrs

Newer Insulins:

-Prandial (Mealtime) 

-Rapid-Acting (Lispro, Aspart, Glulisine)

-Ultra-Rapid-Acting Insulin (fiasp)

This is the insulin you take for meals and to correct high blood sugars. It starts working within 15 minutes.

This insulin starts working quickly in your body so there is less risk of low blood sugars in the hours after a meal. It is easier to control and allows better blood sugar management and more flexibility than older insulins.

Brand Name	Generic Name	Manufacturer	Effect Onset	Peak	Duration
Novolog	Insulin aspart	Novo Nordisk	15 min	1 hr	2 to 4 hrs
Humalog / Admelog	Insulin lispro	Lilly	15 min	1 hr	2 to 4 hrs
Admelog	Insulin lispro	Sanofi	15 min	1 hr	2 to 4 hrs
Apidra	Insulin glulisine	Sanofi	15 min	1.5 hr	2 to 4 hrs
Fiasp	Insulin aspart	Novo Nordisk	15 min	1.5 hr	5 to 7 hrs

–Basal or long-acting insulin (Glargine, Detemir and Degludec):

This is the “background” or basal insulin that is working in your body over a period of 24 hours. In a non diabetic person, the pancreas is providing a constant supply of insulin. This long-acting insulin is replicating or doing the same job. This insulin is injected once or split in two doses, morning and night.

Brand Name	Generic Name	Manufacturer	Half-Life	Peak	Duration
Basaglar	Insulin glargine (U-100)	Lilly	12 hrs	Minimal	24 hrs
Lantus	Insulin glargine (U-100)	Sanofi	12 hrs	Minimal	24 hrs
Toujeo	Insulin glargine (U-300)	Sanofi	19 hrs	No significant peak	36 hrs
Tresiba	Insulin degludec	Novo Nordisk	25 hrs	No significant peak	42 hrs
Levemir	Insulin detemir	Novo Nordisk	5 to 7 hrs	Minimal	24 hrs

Premixed Insulins:

This type of insulin is a mix or combination of long-acting and short-or rapid-acting. They are not the preferred insulin since they come already with a fixed ratio of shorter and longer-acting insulin so this makes it harder to use more or less doses of either type and therefore blood glucose management is harder to control. To me this insulin looks like a fucking mess lol, diabetes is already hard man… but you know, it exists for a reason. The doctor and diabetes care team will suggest the best option for you.

Inhaled Insulin:

This insulin (afrezza) is absorbed through the lungs.

It is used along with long-acting insulin in people with type 1 diabetes.

It is not yet approved for children.

Brand Name	Generic Name	Manufacturer	Effect Onset	Peak	Duration
Afrezza	Inhaled insulin	MannKind	12 min	35 to 45 min	1.5 to 3 hrs

Insulin delivery methods:

Older insulins are available only through multiple daily injections (MDI). This is a syringe and an insulin vial.

Newer insulins are available through multiple daily injections (MDI), insulin pens and pen needles.

Insulin pumps/pods use only one type of insulin (rapid-acting).

The last one: (afrezza) is absorbed through the lungs through a small, purple, handheld inhaler.

Where to inject insulin?

This applies to diabetics who use multiple daily injections (MDI) and insulin pens.

Diabetics who use insulin pumps or pods will not use this type of injections.

Insulin is injected, subcutaneously (under the skin) so it can be absorbed into the bloodstream.

This will be explained by your doctor and diabetes care team. But here I will explain the most common places where to inject insulin:

–Abdomen: it is recommended to inject in your stomach, 2 inches away from the belly button. Insulin should be injected into fat tissue and not muscle. 

–Buttocks: upper portion, avoid lower.

–Thighs: It is recommended to inject one hand’s width below the top of the leg, and one hand’s width above the knee (upper outer thigh).

–Arms: back part of the arm. Back part of the biceps.

It is very important to rotate injection sites because injecting in the same site can cause swelling or hardening in the fat below the skin and this will affect the absorption of insulin into the bloodstream.

How do insulin pumps/pods work?

Insulin pumps are programmable devices that will automatically inject or infuse insulin under the skin. This is the newest technology in insulin delivery methods. The pump consists of an infusion set, which is a little tube carrying insulin to a cannula which is inserted under the skin with a needle. This little device is providing the constant drip of insulin (rapid-acting type) to the bloodstream.

This pump is attached to the body 24 hours and it is changed every 2-3 days. It also needs to be manually programmed by the user. The user needs to input the amount of insulin to be given according to the type of food eaten and other factors like physical activity. Insulin doses may change depending on low or high blood glucose levels.

Pumps work together with a sensor or continuous glucose monitoring (CGM). This little device is also inserted under the skin and reads glucose levels so the pump knows when to give or stop insulin delivery. This sensor also needs to be changed every week or so. This system is called a hybrid closed-loop system.

Anyone using a pump needs to be instructed by their doctor and diabetes care team on how to use it. Not everyone qualifies or is approved to use insulin pumps.

Which insulin delivery method should you use?

Remember I said that your diabetes and my diabetes are different ? Same applies here. This depends on what’s the best way for you to control your sugar levels. Remember this is not a one size fits all type of thing, no. You will work with your doctor and care team in order to find the best treatment plan for you.

You can test and try insulin pumps, multiple daily injections, or insulin pens. See what works better for your blood glucose management and do that.

Whatever you choose… remember the main goal ? To maintain normal, in range glucose levels.

What do I personally prefer?

I check my blood glucose with finger pricks and put blood in a glucose meter to get my sugar level readings. I do this 4 -6 times or as many times as needed depending on my activity throughout the day.

I use insulin pens for both; long-acting (basal); and rapid-acting (insulin to cover meals or correct high blood sugars).

In my case, and all type 1 diabetics who use multiple daily injections (MDI) or insulin pens; need to use both types of insulin: long-acting (basal) and rapid-acting.

In the picture below you can see:

On the top: long-acting (basal) TRESIBA

On the bottom: rapid-acting (insulin to cover meals or correct high blood sugars) FIASP

I don’t like to have anything attached to my body, why? Because when I work out; I jump, I lay on the floor, I sweat a lot, I just don’t like having anything attached to my skin. I’m very minimalistic, the less the better.

I don’t have anything against the new technology of insulin pumps and sensors. But here’s what I have read from different online communities and peoples opinions. Again, this is my personal opinion.

Some people have been able to manage better glucose control with the pump and sensors. That’s awesome. For other people all I hear are complaints:

-My sensor came off 

-My sensor is not reading accurate sugar levels 

-My pump stopped working

-My skin itches or is irritated due to changing or replacing my sensor

-My pump is not working so my sugar is now out of control  in the 300’s – 400’s 

-My pump is not programmed so it is giving me a false alarm 

-I ran out of sensors/pods and I won’t see my doctor until xxx weeks. What do I do now ? 

-I spent 2-3 hours fighting with my pump/ insurance provider so I can get new supplies so I don’t have to pay for new replacements.

After reading these comments, here’s my personal opinion: fuck that!!!

I don’t have time for that bullshit, I do value my time so I’m going to use what’s better for me and avoid all this fucking drama.

I’ve heard from people that they have been able to manage diabetes for 40+ years using multiple daily injections. Again, choose what works best for YOU.

Do your own research, try different methods. But whatever you choose, remember the main goal? I’m pretty sure you do…

@dieabeast