Therapy for diabetes

Insulin types

Different insulin types are now used to treat diabetes. These differ in

their origin: human or animal insulin, or the newly developed insulin analogues,
their concentration (effective strength): U40 (40 units per millilitre) and U100 (100 units per millilitre),
their activity: delayed, fast or very fast-acting,
their appearance: soluble (clear insulin solution) or cloudy (suspension with crystalline or amorphous insulin),
their packaging: insulin in bottles for withdrawal and self-injection; pre-mixed cartridges for pens and pre-mixed ampoules.

Insulin: storage of insulin

All these different types of insulin have one thing in common: they are sensitive to external influences. If they are to be stored for a long time, they should be kept at a temperature of 4 to 8°C (for example, in the vegetable crisper in the refrigerator), and should never be frozen, even for a short period. Bottles, cartridges and prepared syringes that are to be used should be stored at room temperature in order to reduce the stinging caused by the injection of cold insulin, but they must be protected from direct sunlight. Insulin retains its complete effectiveness for at least 4 weeks. If you are going to be outdoors for some time in hot or cold weather (when you are on holiday perhaps), you should store your insulin in an insulated polystyrene container. When insulin is stored correctly, its appearance should not change. Insulin that has an altered appearance has lost its full effectiveness for lowering blood sugar levels and should only be used in emergencies (if no other insulin is available). In this case it is essential to monitor your blood sugar level so that you can compensate for the loss of effectiveness by increasing the dose. This also applies when you spend your summer holidays in a warm climate.

Some tips:

Pens filled with insulin should be stored at room temperature, not in the refrigerator. Pumps filled with insulin should be carried on the body.
Cloudy insulin must be mixed prior to injection to ensure that the insulin works properly. This is done by gently tipping the pen back and forth at least 10 times or by rolling the insulin bottle in your hand. Violent shaking of the insulin must be avoided, as this causes it to foam.
If you withdraw the insulin yourself, you must make sure that the syringes or injection devices (pens or pumps) used are compatible with the stated concentration of the insulin in order to avoid serious errors in the dose (either overdosing when using U100 insulin with a U40 syringe, or under-dosing when using U40 insulin with a U100 syringe).

Insulin: injecting the insulin

It is not only the type and concentration of the insulin being used that affects the speed and duration of the effect of insulin. The choice of the injection site also plays an important role. Insulin injected into the skin on the abdomen is absorbed most quickly into the body and therefore has the most rapid effect. For this reason, this is the best injection site for peak insulin before meals and for regulating the blood sugar level. The effect of the long-acting insulin injected using a syringe or pen in the evening can be maximised by injecting it late in the evening into the subcutaneous fat (not in the muscle!) of the upper thigh or the buttocks.

In this context both the correct injection technique and the choice of suitable needle are important. You will find more detailed advice in the section on
"The correct needle length".

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