Long–acting (ultralente) insulin takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. It stays in the blood between 20 and 24 hours. Some insulins come mixed together. For example, you can buy regular and NPH insulins already mixed in one bottle. They make it easier to inject two kinds of insulin at the same time. However, you can’t adjust the amount of one insulin without also changing how much you get of the other insulin. All insulins have added ingredients to keep them fresh and help them work better. Intermediate–and long–acting insulins also have ingredients to make them act longer. Today’s insulins are very pure. Allergic reactions are rare.
Tips for taking Insulin
Using cold insulin can make your shot more painful. You can keep the bottle of insulin you are currently using at room temperature or warm the bottle by gently rolling it between your hands before you fill the syringe. If you buy more than one bottle of insulin at a time, store the extra bottles in the refrigerator until you start to use them. Never store insulin at very cold (under 4 °C) or very hot (over 40 ° C) temperatures. Extreme temperatures destroy insulin. Do not put your insulin in the freezer or in direct sunlight. Insulin may lose some potency if the bottle has been opened for more than 30 days. Look at the bottle closely to make sure the insulin looks normal. If you use regular, it should be perfectly clear–no floating pieces or color. If you use NPH or lente, it should be cloudy, with no floating pieces or crystals on the bottle. Do not use insulin past the expiration date.
Treatment and Prevention of Nephropathy
Strict blood glucose control may delay progression of kidney disease and other diabetic related complications in type 2 diabetics as well as type 1.
Control of existing high blood pressure is extremely important not only for heart disease stroke and heart failure but also for preventing progression to kidney failure. ACE inhibitors beneficial effect kidneys and delay the progression of kidney failure.
Treatment of Neuropathy
Tricyclic antidepressant amitriptyline commonly used for neuropathy pain. The anti–seizure drug gabapentin may be an effective alternative to amitriptyline. If foot pain, numbness or tingling is worse at night, diphenhydramine (Benadryl) may help. Delayed stomach emptying caused by neuropathy may be relieved by erythromycin or metoclopramide.
Treatment and Prevention of Retinopathy
Tight insulin control is also proving to help prevent retinopathy in patients with either type 1 or 2 diabetes. Once damage to the eye develops, eye surgery may be needed. Argon or diode laser photocoagulation is proving to be particularly effective in reducing severe visual loss from retinopathy.
Prevention of Infections
Everyone with diabetes who is at risk for complications should have annual influenza vaccination and a vaccination against pneumococcal pneumonia.
