Indications

When is insulin used for therapy? People with type 1 diabetes are dependent on externally supplied insulin because the body’s own insulin production and release is not sufficient. Type 2 diabetics are treated with insulin when dietary measures and oral medications (tablets) no longer have any effect and blood glucose control is unsatisfactory. In the case of gestational diabetes, oral antidiabetics must not be given, which is why the administration of insulin injected through hypodermic needles is used.

Insulin preparations

There are different types of insulin, which differ mainly in their time of action and therefore a separate administration scheme is necessary for each type of insulin. Human insulin (normal insulin) is one of the so-called short-acting insulins. It starts working after 30-45 minutes and is injected under the skin (subcutaneously).

It is a component in intermittent conventional therapy or insulin pump therapy and is also used in the initial treatment of newly diagnosed diabetes. It is important that the patient maintains an injection-eating interval of 15-20 minutes, so that an optimal effect of normal insulin is achieved. Short-acting insulin analogues, i.e. chemically modified insulin, are also applied under the skin, but it is not necessary to maintain an injection-eating interval due to the modified chemical properties: The onset of action is rapid and occurs after 15 minutes.

Another type of insulin used in diabetes therapy is long-term insulin with a duration of action of over 24 hours. Coupling insulin with another substance slows down the breakdown of insulin into its basic building blocks, so that the duration of action of the given hormone quantity is prolonged. NPH insulin, which is frequently used, is in the range of the average duration of action.

The analogues insulin detemir, glargin and degludec have the longest effect. Most of these drugs are ineffective when taken orally. This phenomenon is based on the fact that the protein chains of synthetic insulin are broken down in the gastrointestinal tract by the body’s own enzymes before the hormone can take effect.

In the course of insulin therapy, a distinction is made between two intake mechanisms.Patients are usually forced to take a so-called basal dose of insulin one to three times a day. Long-acting insulins are particularly suitable in this context. The basic daily requirement is covered by this basal dose.

The current blood sugar level should be determined before meals. In case of high values or sugar-rich meals, a bolus can be injected in addition to the basal insulin quantity. Bolus injections are particularly suitable for those insulins that act particularly quickly and briefly.

Normal insulin and
The short-acting insulin analogues.
The delay insulin. These preparations consist of insulin and an additive (protamine, zinc, surfing), which gives the hormone a longer duration of action. Delayed insulins are injected subcutaneously and can be further divided into intermediate insulins, the effect of which lasts for 9 to 18 hours and can be repeated in
Long-term insulin with a duration of action of more than 24 hours.
Coupling insulin with another substance slows down the breakdown of insulin into its basic building blocks, so that the duration of action of the given hormone quantity is prolonged.

Insulin-dependent diabetics are in many cases forced to take insulin injections on their own every day. This can be stressful for some people. In addition, the regular breaking through of the skin, which serves as a natural protective barrier, carries the risk of infections, inflammations and unsightly haematomas (bruises).

This is a particularly difficult situation for young people suffering from diabetes mellitus. Today, patients with diabetes have the possibility to use a so-called insulin pump. An insulin pump is a medical device that can be used for insulin therapy.

The regular injection of the required amount of insulin is replaced by the small, programmable pump. To apply an insulin pump, a catheter is placed under the skin of the affected patient. In most cases this is done in the area of the abdomen.

The actual insulin pump should be worn permanently on the body (for example on the belt). However, theoretically it is also possible to disconnect the device from the catheter system for a short period of time. The use of such an insulin pump is particularly suitable for people who suffer from type 1 diabetes.

The application principle of the insulin pump is similar to that of a conventional insulin injection therapy (ICT). The organism is regularly supplied with a so-called basal rate, which is intended to cover the basic requirement. In certain situations (e.g. when glucose intake is increased, such as with particularly carbohydrate-rich food), an individual insulin bolus can be delivered at the push of a button.

In most cases, a small amount of short-acting insulin is administered several times a day to cover basic needs. In contrast, the usual injection therapy uses long-acting insulin (e.g. NPH insulin). Despite the comparatively convenient use of an insulin pump, it should not be forgotten that it cannot replace a healthy pancreas.

A measurement of the current blood glucose level by the insulin pump is not yet possible and must still be carried out by the patient independently. The use of an insulin pump is a good alternative, especially for diabetics with the so-called dawn phenomenon. This refers to those patients whose blood sugar level rises sharply, especially during the night (usually around four o’clock).

The reason for this rise in glucose is an increase in the activity of liver cells, which release enormous quantities of sugar into the bloodstream at this time. With the help of the insulin pump, the patients concerned are no longer forced to get up during the night and administer an insulin bolus. The insulin pump can be precisely programmed to deliver an appropriate dose of insulin during sleep.

Thus, a typical adverse drug reaction of insulin, morning hyperglycemia, can be avoided. This advantage is highly relevant in this respect, as any metabolic derailment (whether it is a shift to hyper- or hypoglycaemia) can cause severe organ damage. Insulin Separating Food is a form of nutrition that depends on the insulin balance.

Insulin Food Combining aims to reduce the insulin level in the blood by selecting suitable foods.In addition to the choice of food, longer breaks between meals also play an important role in this form of diet. The physiological basis of the insulin separation diet is the fact that both fat breakdown (lipolysis) and glycogen breakdown are inhibited by high blood insulin levels. By lowering this level, the reduction of body fat should therefore be increased and the slimming effect improved.

The principle of the insulin separation diet is based on the physiological secretion and action patterns of the proteohormone insulin. In the morning, great importance is to be attached to the targeted intake of carbohydrates. A rich breakfast with bread, rolls and sugar-containing spreads should provide the organism with enough energy to be consumed throughout the day.

Furthermore, the hunger in the morning should be satisfied with muesli and plenty of fruit. According to the Insulin Separating Diet, there should be a break of about 5 hours between breakfast and lunch. At lunchtime, a balanced mixed diet with a high proportion of carbohydrates forms the ideal basis for keeping the body going.

Due to the already high insulin level at this time of day, the absorbed sugar can be metabolized without any problems. Also between lunch and dinner a break of five hours must be kept. According to Insulin Food Combining, an effective fat reduction is generally only possible during the evening hours and at night.

In the evening the body should be adjusted to the reduction of fat reserves. This means that the intake of carbohydrates must be completely avoided. Eating carbohydrate-containing foods in the evening would cause the B cells of the pancreas to produce too much insulin and release it into the bloodstream.

As a result, fatty tissue would not be broken down during the night. Especially in the evening, insulin food combining foods with protein suppliers such as fish and meat are suitable to optimize the success of the diet. In addition, salad and vegetables can be consumed without provoking a high insulin level.

From a medical point of view, compliance with the insulin separation diet should not be viewed uncritically. The German Society for Nutrition (short: DGE) even explicitly advises against this kind of diet. According to the DGE, the insulin separation diet and the associated separation of carbohydrates and proteins during food intake makes no sense. The society is of the opinion that (contrary to what has been assumed so far) it is quite possible for the organism to digest carbohydrates and proteins at the same time. In addition, the DGE emphasizes that carbohydrates are an important food component and a body cannot be kept healthy without them.