Diabetes Insulin Treatment

Diabetes Insulin Treatment

Insulin treatment is essential for people with Type 1 diabetes. They have insulin-dependent diabetes mellitus (IDDM), the former, descriptive name for this form of the syndrome. They require what is, in effect, insulin replacement therapy because by the time they are diagnosed, they are producing no insulin of their own. In these circumstances, insulin treatment is both life-saving and necessary throughout life. As we have seen, people with Type 2 syndrome (non-insulin dependent diabetes mellitus, NIDDM) may manage successfully with other forms of treatment but a significant proportion eventually require insulin. Often, this is simply a reflection of the progressive nature of Type 2 syndrome, in which effective insulin activity within the body tends to decline to a low level. In other cases, glycaemic control with antidiabetic drugs may have been poor for some reason, or there may be complications present such as liver or kidney disease which necessitate the use of insulin.

Sometimes, people with Type 2 diabetes are managed with a combination of tablets and insulin. It is important to realize that a partial or complete change to insulin does not mean that Type 2 diabetes is getting worse or that the person has somehow 'failed' with other treatments. Most of those who change to insulin feel a great deal better, find it much easier to cope with than they expected, and are happy to continue with the treatment. Insulin therapy can only be successful if the person receiving it feels secure and confident about every aspect of their treatment. There is always plenty of time allowed for discussion and explanation at the diabetes clinic so that all concerns (such as 'needle phobia') can be addressed. Support and encouragement are considered to be very important and part of the ongoing work of the diabetes clinical care team. Before discussing insulin treatment in more detail, it is useful to look more closely at the nature of the insulin itself.

The Nature of Insulin and How insulin works?

There are four main types, or species, of insulin, according to the (mammalian) source from which each is obtained.

• Beef or bovine insulin is obtained from the pancreas of cattle and is one of the earliest forms of insulin to be used in human treatment. Its structure differs from that of human insulin in three amino acids (proteins) and it is now more or less obsolete. It is still produced for people who have used this type of insulin for many years and for whom change is unsuitable, for one reason or another. However, it is no longer prescribed for people newly diagnosed with diabetes.
• Pork or porcine insulin is derived from the pancreas of pigs and it differs from human insulin in only one amino acid in its structure. Semi-synthetic porcine insulin, which is chemically modified in the laboratory, is also available. Porcine insulin continues to be used by a minority of people with diabetes.
• Human insulin is produced in the laboratory by genetic engineering:
• from a proinsulin (a precursor insulin molecule);
• from a proinsulin precursor made by genetically modified yeast organisms (labelled 'pyr' on insulin bottles);
• from some other method of genetic engineering (labelled 'ge' on insulin preparations). Hence no human insulin used in treatment is in any way taken from human bodies, either living or dead.
• Human insulin analogues are copies of the human insulin molecule and are substances not found in nature but ones that have been recently developed by genetic engineering. There are two types:
• insulin lispro, in which the position of two amino acids (lysine and proline) have been changed (lys + pro = lispro);
• insulin asparte, in which aspartic acid has been substituted for the amino acid, proline, at position B28 on the insulin molecule.