Insulin Basics

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

What is diabetes? Well most people in Canada think of Fredrick Banting and Charles Best who found a substance called insulin inside the pancreas’s of dogs that stopped people from dying from a strange wasting disease called diabetes. (See Canadian’s can be pretty smart, eh?) If you look at the words diabetes mellitus (the full latin name), you can paraphrase it to mean “sweet tasting urine”. It was literally diagnosed by “water tasters” who drank the urine of those suspected of having diabetes; the urine of people with diabetes was thought to be sweet-tasting. The Latin word for honey (referring to its sweetness), 'mellitus', is added to the term diabetes as a result. Doctors today should be very happy they have lab tests to use. One of my favorite quotes during my readings though was by Aretaeus the Cappadocian in the second century AD when he called diabetes as “being a melting down of the flesh and limbs into urine.” It is not really accurate, but very dramatic.

Diabetes is when your body has trouble storing and using glucose. Glucose is a simple sugar that fuels many processes in the body. There are 3 types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesn’t produce insulin. You must inject insulin or you will die. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells aren’t listening to the insulin signal. That means tissues like muscle and fat don’t suck the glucose out of the blood and use it. Type 2 diabetes can be treated with diet, exercise, pills or insulin, or often a combination of these. Gestational diabetes only occurs in pregnancy.

There are many types of insulin. The simplest is called R or Toronto insulin (Did I mention Banting and Best worked out of the University of Toronto?). It is produced by trained microbes and is identical to the insulin that the human body produces (and you thought trained seals were impressive). It is a short acting insulin. There are faster acting insulin in which the insulin molecule is changed a little to make it work faster. Other insulins with names like N, L and U are slow acting. They take R insulin and put it in a solution with other stuff to make the insulin release slowly. Insulin has to be injected because if it is taken orally, the stomach acid will destroy it.

Most people think of small syringes when they think of insulin. There also are insulin pens. Pens still have a needle, but many people find the fact you “dial up” the dose, instead of drawing up insulin into the syringe makes them easier to use. The pen needles also tend to be finer (in case you were interested, the finer the needle the bigger the gauge number) and shorter. Because of this, many people find the insulin pens more comfortable. The insulin pens give an audible “click” on each unit of insulin they dial up, so even those with visual impairments can use the insulin pens. Using a syringe with a visual impairment can be difficult.

There are also insulin pumps. These are expensive (in the thousands of dollars), they require a lot of training at first to learn how to use properly, but they are very interesting. Your pancreas releases a small amount of insulin into your body all the time (called basal insulin), and a pulse when you eat sugar (an insulin peak). Let’s say Jane is using an insulin pen and she uses short acting insulin at meal times (insulin peaks when they eat) and a long acting insulin at bedtime (this mimics the basal insulin). ( There are other ways of giving insulin. This was just an example. Don’t panic if you doctor has you doing something different.) So Jane’s injections are close to how a pancreas works but not exactly. With an insulin pump, the pump would release a small amount of short acting insulin all the time (basal insulin) and Jane could program the pump to release a pulse of insulin based on what she eats (an insulin peak). So insulin pumps more closely mimic what a pancreas does. They aren’t perfect, though. Jane would still have to poke her finger many times a day to check her sugar, and would have to become quite knowledgeable about how to use her pump in case of problems, clogs, etc.

As always if you have any questions or concerns about these or other products, ask your pharmacist.