NEWSLETTERS CLINICIAN SITE

Diabetes Type 1 Diabetes

What Is Insulin?
Types of insulin, ways of administering it (needle? pump? pen?), why insulin is so
expensive, and more

Feb 15, 2022

Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES, Certified Diabetes Educator and Transitional
Program Coordinator
Lisa Jaffe, Freelance Medical Writer
Medical Reviewer: Jessica Rodriguez CNP

ON THIS PAGE

• Definition • Glucose Management

• Causes • Insulin Drawbacks
• Types of Insulin • Looking Ahead
• Administering Insulin • FAQs
• Storage • Fast Facts
• Alternatives to Insulin

What does insulin do? Help your body turn food into energy, for starters. When you have
diabetes, and you’re either not producing insulin or your insulin function is off, all sorts of
things can go wrong. From needles to pens to pumps to types of insulin, we’re here to
empower you with clear answers to all your pressing questions.
Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta
Our setările
Pro implicite.
Panel Politica de stocare a datelor
Gestionați preferințele
Alvin Powers, MD Acceptați tot Mihail Zilbermint, MD
Professor of Medicine Assistant Professor in the
 Professor of Medicine Assistant Professor in the
Vanderbilt University Division of Endocrinology,
Diabetes and Metabolism
Johns Hopkins School of
Medicine
Irl B. Hirsch, MD
Physician and Professor of
Metabolism, Endocrinology
and Nutrition
University of Washington
Medical Center-Roosevelt

DEFINITION

What Is Insulin?
Insulin is a hormone created by your pancreas that controls the amount of glucose in your
bloodstream at any given moment. It also helps store glucose in your liver, fat, and muscles.
Finally, it regulates your body’s metabolism of carbohydrates, fats, and proteins. Sound
important? That’s because it is.
“Without proper insulin function, your body can’t store glucose in your muscles or liver, but
neither can it make any fat. Instead, the fat breaks down and produces, among other things,
keto acids,” says endocrinologist Irl Hirsh, MD. If the levels of these acids grow too high, the
imbalance can trigger diabetic ketoacidosis, a potentially fatal condition.
When you eat, your blood glucose levels rise, and this leads a typical person’s pancreas to
release insulin, so that the sugar can be stored as energy for later use. Without that
pancreatic ability, as a person with either type 1 diabetes or advanced type 2 diabetes, your
blood sugar levels may rise dangerously high, or drop too low.

Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
putețiInfographic by Lauren
accepta setările HunterPolitica de stocare a datelor
implicite.
Gestionați preferințele
CAUSES Acceptați tot
 What Causes Someone To Be Prescribed Insulin?
If your body doesn’t make insulin or doesn’t make enough, you are eventually diagnosed with
type 1 diabetes. It used to be called juvenile diabetes, but new estimates show that as many
as half of people with type 1 diabetes are not diagnosed until adulthood. On the other hand, if
your body doesn’t use insulin properly, you have type 2 diabetes.
INSULIN RESISTANCE

While people with type 1 diabetes need to take insulin to survive, many people with type 2
are able to stave off insulin use or even avoid it altogether by exercising, losing weight,
adapting healthier eating habits, or using other prescription medications.
TREATING DIABETES

TYPES OF INSULIN

What Are the Different Types of Insulin?

The American Diabetes Association (ADA) characterizes insulin by how fast it works. But
everyone’s body is different. If you have diabetes, you should expect deviations in the amount
of time any medication takes to reach your bloodstream. Here are a few useful terms related
to how fast and how long insulin acts in your body:
• Onset is defined as the length of time before insulin hits your bloodstream and begins to
lower blood glucose.
• Peak is the time during which insulin is at its maximum effectiveness at lowering your
blood glucose levels.
• Duration is the length of time insulin continues to lower your blood glucose levels.
These are the five main types of insulin that doctors prescribe:
Rapid-Acting Insulin

This type of insulin begins to affect blood glucose approximately 15 minutes after injection. It
Acestpeaks
site webin stochează
about andate
hour,prinandintermediul
then continues to workpentru
fișierelor "Cookie" for a few more.funcționalitatea esențială a site-
a permite
ului, precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta setările implicite. Politica de stocare a datelor
Short-Acting Insulin Gestionați preferințele
Acceptați tot
Short acting insulin reaches your bloodstream within 30 minutes of injection It peaks in the
 Short-acting insulin reaches your bloodstream within 30 minutes of injection. It peaks in the
2- to 3-hour range and stays effective for 3 to 6 hours.
Intermediate-Acting Insulin

This category includes NPH insulin (neutral protamine hagedorn) which helps control glucose
for 10 to 12 hours. A protamine is a type of protein that slows the action of this insulin.
Long-Acting Insulin

This insulin type enters the bloodstream 1 to 2 hours after injection and may be effective for
as long as 24 hours. An advantage to long-acting insulin is there is no pronounced peak, and
it works more like typical pancreatic insulin.
Premixed/Combination Insulin

Premixed, or combination, insulin contains a mix of rapid- or short-acting insulin combined

with an intermediate-acting insulin. This eliminates the need to draw insulin from more than
one bottle.
ADMINISTERING INSULIN

How Do You Take Insulin?

Many people with diabetes who use insulin self-administer it by injecting it with a syringe.
The outside of the syringe is marked with lines denoting the amount of medication in the
needle. There are different size syringes that you can choose from with the help of your
doctor.
How Do You Choose the Right Syringe for Injecting Insulin?

If your highest dose is near the syringe's maximum capacity, consider buying the next size up
in case your dosage increases
1 If you measure your doses in half units, be careful to choose an appropriate syringe
that has the right measurements
Acest 2site webWhen you’rdate
stochează e traveling, make sure
prin intermediul to match
fișierelor "Cookie"your insulin
pentru strength
a permite with the correct
funcționalitatea esențială size
a site-
ului, precum șisyringe if you purchase
din considerente new personalizare
de marketing, syringes in an unfamiliar
și analize. Putețiplace
modifica setările în orice moment sau
puteți accepta setările implicite. Politica de stocare a datelor
Just as there are different sizes of syringes Gestionațiforpreferințele
administering insulin, there are also varying
sizes of insulin needles. Shorter needlesAcceptați usually mean
tot less sting when injecting. The
downside is that the shallower the injection is, the longer it takes for the insulin to work. Your
 downside is that the shallower the injection is, the longer it takes for the insulin to work. Your
doctor will help you find the balance that’s best for you.
How Do You Take Insulin Without a Syringe?

There are several options:

• Insulin pens look like large writing pens and can help prevent under- and overdosing. They
also don’t require refrigeration, are conveniently prefilled, and are more durable than
syringes.
• Insulin pumps are attached to a thin tube that’s implanted under your skin. Pumps are
computerized or motorized, and some models also act as glucose monitors. They deliver
insulin before each meal along with small amounts through the course of the day. In the
US, about 60% of people with diabetes use some form of insulin pump.
• Jet injection devices are a good option if you hate needles. A jet injector holds several
doses of insulin. After placing it against your skin, you press a button, and the insulin is
pushed through.
• Inhaled insulin comes in a pre-measured inhaler and was first approved in 2014. It’s short-
acting and usually not covered by insurance, which makes it more cost prohibitive than
other types of insulin for most people with diabetes.
Unless you have an insulin pump that also works as a glucose monitor, insulin dosing is based
on self-monitoring your blood glucose levels. You can check them by doing finger pricks or
wearing a device that continuously monitors them for you.
STORAGE

How Should I Store My Insulin?

• Keep “current” insulin (like a few days or a week’s supply) at room temperature to help
alleviate injection discomfort.
• Insulin can usually be stored at room temperature for about a month. Once in use, insulin
pens should be stored at room temperature. Expiration dates of insulin pens can vary
depending upon the type of insulin. For disposable pens, you should discard the entire
device when empty or when you reach the expiration date.
• Store extra insulin (such as a 2–3-week supply or more) in the refrigerator.
• Don’webt expose
Acest sitesunlight.)
insulin to excessive cold or heat. (Don’t store it in the freezer or in direct
stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta setările implicite. Politica de stocare a datelor
Gestionați preferințele
Acceptați tot
 ALTERNATIVES TO INSULIN

What Are Alternative Medications for People With

Diabetes That Aren’t Insulin?
Non-insulin medications that may be prescribed to people with diabetes include:
• Metformin – a pill that stops sugar production in the liver
• Glitazones – pills that remove sugar from the bloodstream
• Sulfonylureas and glinides – pills that increase the release of insulin from your pancreas
• Starch blockers – pills that slow starch absorption
• Incretin therapies and amvlin analogs – pills and injections that reduce sugar production in
the liver and slow food absorption. Types of the former include DPP4 inhibitors (such as
Januvia) and GLP1 analogs (like Victoza).
• SGLT2 inhibitors – pills that are taken before meals that prevent the reabsorption of
glucose
GLUCOSE MANAGEMENT

What Else Can I Do To Manage My Blood Glucose

Levels?
Food, sleep, and exercise are all of vital importance for regulating your blood sugar when you
have diabetes.
1 Get enough sleep. Evidence shows that lack of sleep can lead to increased secretion
of the hormone cortisol, which is inflammatory and can cause greater insulin
resistance. Endocrinologist Al Powers MD of Vanderbilt University notes that when
you’re deprived of sleep or your sleep is disrupted, your glucose levels tend to go up,
whether you have diabetes or not.
Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
2 șiExercise
ului, precum regularly.
din considerente During exercise,
de marketing, insulin
personalizare sensitivity
și analize. Putețiismodifica
increased,
setărileand muscle
în orice cellssau
moment
puteți acceptausesetările implicite. Politica de stocare a datelor
available insulin more efficiently. When your muscles contract during exercise,
they also absorb glucose andGestionați use it forpreferințele
energy.
3 Follow an eating pattern that is healthful Acceptați for
tot you, as recommended by your doctor,
such as the DASH diet or the Mediterranean diet Both have been shown to help
 such as the DASH diet or the Mediterranean diet. Both have been shown to help
stabilize blood sugar levels.

INSULIN DRAWBACKS

What Are the Drawbacks to Insulin Treatment for

Diabetes?
The biggest issue with insulin right now is lack of affordability. “A box of rapid-acting insulin
can cost $400 without insurance. As so many people continue to lose their health coverage,
it’s becoming an enormous problem,” Dr. Zilbermint says.
Consistently rising costs have led some patients to ration their insulin, which can be
dangerous and even deadly. The cost of testing strips is also an issue, and both have led to a
black market in testing strips and insulin. “It’s illegal,” says Dr. Zilbermint, “but it’s happening.”
Where Can I Find Help Acquiring or Paying for Insulin?

The American Diabetes Association (ADA ) has a dedicated page for helping people who
need insulin get it, regardless of finances.
The type 1 diabetes research and advocacy group JDRF has a page with a variety of
links to organizations who also supply insulin assistance.
Can I Have a Negative Reaction to Insulin?

One complication facing people with diabetes who use insulin is the potential for severe
hypoglycemia, also known as “insulin shock,” which involves using too much insulin and
causing your blood sugar to drop extremely low. “This can cause coma, seizures, and heart
attacks,” says Dr. Powers. It requires treatment in a hospital but thankfully is highly treatable
once you are there.
What Severe Complications Can Occur Because of Rationing
or Running Out of Insulin?
Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, Diabetic
precum și din considerenteisdeanmarketing,
ketoacidosis personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta setările implicite. Politicaemergency
de stocare acondition
datelor that results if you don’t have enough insulin
to regulate your blood sugar. DKA causes yourpreferințele
Gestionați body to break down fat for energy in the
absence of insulin. This leads to a dangerous accumulation of acids known as ketones in your
blood that can cause your brain to swellAcceptați and yourtotbody to go into shock.
 Signs of diabetic ketoacidosis include:
• Thirst or a very dry mouth
• Frequent urination
• High blood sugar levels
• High levels of ketones in your urine
• Fatigue
• Dry or flushed skin
• Nausea, vomiting, or stomach pain
• Difficulty breathing
• A fruity or acetone odor on your breath (yes, just like nail polish remover)
• Confusion or acting “drunk” while sober
DKA is so common and can come on so quickly that it is the first sign of type 1 diabetes in
20% of cases, and the way many people with type 1 diabetes are first diagnosed with the
condition. If you go into diabetic ketoacidosis, don’t try to hide it or make light of it. Treat it as
the emergency it is and get to a hospital as soon as possible to recover.
“I’ve had people tell me they’re tired of taking insulin, or that they’re rationing it due to cost. In
type 1 diabetes, that’s all it takes to end up in a life-threatening situation,” says Dr. Zilbermint.
The good news? Once you get to a hospital, doctors can stabilize the condition quickly, so
take it seriously, and make sure your friends and family are educated about your diabetes.
Your chosen support network should know how to spot the signs and get you to medical help
immediately if you need it and aren’t feeling well enough to advocate for yourself.
LOOKING AHEAD

What Will Insulin Be Like in the Future?

Pharmaceutical companies are working on very long-acting versions of insulin that could last
for a week. There is also an ultra-fast version of insulin under development that will act in less
than 15 minutes.
AcestAnother
site web group
stocheazăof researchers is looking
date prin intermediul at glucose
fișierelor "Cookie" responsive
pentru a permite insulin (GRI), whichesențială
funcționalitatea woulda site-
ului, react
precumtoși the needs of your
din considerente bodyde instocare
de marketing, real time.
personalizare“It would
și analize.have
Puteținanosensors bound
modifica setările to the
în orice insulin
moment sau
putețisoaccepta setările implicite. Politica a datelor
that when insulin is needed, it releases, and when it isn’t, it stops,” according to Dr. Hirsch.
Gestionați preferințele
Acceptați tot
 FAQS

Frequently Asked Questions

1. Why is insulin so expensive?

Though reforms are underway in many parts of the US, insulin costs are still prohibitively high
for many people with diabetes. Reasons include the complexity of the pharmaceutical supply
chain and lack of generic substitutes. The American Diabetes Association has advocated for
policy changes that would stop the trend of rising insulin costs and improve affordable
access to insulin; read their policy statement on the issue here.
2. What is sliding scale insulin?

Sliding scale therapy is a regimen that prescribes a progressive increase in insulin doses
before meals and at bedtime, based on your blood sugar levels.
3. What is an insulin index?

The insulin index gives foods a rating based on how much your blood insulin concentration
rises in the two hours after consumption. This index is not used much in the US, however.
4. What is an insulin resistance diet?

An insulin resistance diet is often recommended for people who have insulin resistance, a key
component of type 2 diabetes. It incorporates foods that will help maintain your body’s
balance of insulin and blood sugar. Think nourishing calories from veggies, fruit, lean proteins,
and healthy fats.
FAST FACTS

Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, Insulin Fast Facts
precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta setările implicite. Politica de stocare a datelor
Gestionați preferințele
• 7.4 million people in the US use insulin Acceptați tot
• 60% of people with type 1 diabetes use an insulin pump
 p p yp p p

• Insulin use in the US varies by race and economic status: 14% of white people with
diabetes use insulin, compared to 17% of Latinx people with diabetes and 20% of Black
people with diabetes. 24% of people with diabetes who live below the
poverty line use insulin.
• A single box of insulin can cost $400 without insurance
• Inability to afford insulin is the main cause of diabetic ketoacidosis

MORE ON THIS TOPIC

• Type 1 Diabetes
• Type 2 Diabetes
• Diabetic Retinopathy
• Diabetes Treatment
• Hyperglycemia
• Prediabetes
• Intermittent Fasting for Diabetes
• Gestational Diabetes
• Hypoglycemia

REFERENCES

Notes: This article was originally published April 29, 2014 and most recently updated February 15,
2022.

Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES

Certified Diabetes Educator and Transitional Program Coordinator
Kovler Diabetes Center
Acest site web stocheazăAmy
dateHess-Fischl, MS,fișierelor
prin intermediul RD, LDN, BC-ADM,
"Cookie" pentruCDE is a program
a permite coordinator
funcționalitatea for the
esențială a site-
ului, precum și din considerente de marketing,
Teen andPolitica
Adolescent personalizare
Diabetes Transition Program at the University of Chicago’saus
și analize. Puteți modifica setările în orice moment
puteți accepta setările implicite. de stocare a datelor
Kovler Diabetes Center. She is also a certified diabetes educator, nutrition
specialist, and certifiedGestionați
insulin preferințele
pump trainer.
Acceptați tot
 Freelance
Lisa Medical Writer
Jaffe

Lisa Jaffe has been a writer and editor for more than 30 years. Most of her work
is related to healthcare, the healthcare industry, and health policy, but she has
also written about topics as diverse as pets, parenting, and policing.

RELATED

Diabetes Nov 18
What Is Automated Insulin Delivery?
Alexis M. McKee, MD, CDCES

Diabetes Nov 18
Type 1 vs. Type 2 Diabetes: What’s the Difference?
Lisa Jaffe

Diabetes Nov 16
What to Expect If You Develop a Diabetic Eye Condition
Jeanine Barone

Diabetes Nov 16
What Is the Life Expectancy for Type 1 Diabetes?
Margaret M. Burke, PharmD, BCPPS

Acest site web stochează date prin intermediul fișierelor "Cookie" pentru a permite funcționalitatea esențială a site-
ului, precum și din considerente de marketing, personalizare și analize. Puteți modifica setările în orice moment sau
puteți accepta setările implicite. Politica de stocare a datelor
Gestionați preferințele
Acceptați tot