INSULIN FAST OR SLOW Part 1

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at http://www.dcp.ca

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? Good question. Well if you look way back you get the quote 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. Or you can go to the Latin origins of the word. 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

These answers were not leading me anywhere, so I started where many people start, I Googled “diabetes”. The second site listed was www.diabetes.ca and that is the web site of the Canadian Diabetes Association. A few more clicks and I found that 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.

Canadians have a proud history in the treatment of diabetes. 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. More recently, in 1999 Dr. James Shapiro and his team at the University of Alberta developed “The Edmonton Protocol”. They found a way to transplant the insulin producing cells from a person’s pancreas into the diabetic’s liver. Researchers had tried for more than 20 years to successfully transplant the cells that produce insulin from a healthy pancreas into the body of a person with diabetes. Yet of 405 attempts since 1970, 92 per cent of the recipients were back on insulin within a year. Dr. Shapiro and his team figured out the proper procedure and proper mix of anti-rejection drug and were successful. (See Canadians can be pretty smart, eh?)

What do Banting and Shapiro’s work have in common? Ways of getting insuling into diabetics. 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 microbes that have a tiny bit of human DNA implanted in them and is identical to the insulin that the human body produces (and you thought genetic engineering was in the future) 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.

Next time we will talk about how really fast and really slow insulins can be used to try to mimic the pancreas.

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