What is Diabetes?
► What Insulin does?
Insulin is a hormone produced in the pancreas by beta cells. Although insulin has innumerable roles throughout the body, there are five main actions. (See Table 1).
Table 1: Five major actions of insulin
|1||Drives glucose into cells|
|2||Drives potassium into cells|
|4||Blocks fat breakdown|
|5||Blocks protein breakdown|
The primary role of insulin is to facilitate the movement of glucose across cell membranes for use as an energy source. Additionally, it moves potassium into the cell, is anabolic and blocks the breakdown of proteins and fats.
Thus, lack of insulin results in hyperglycemia, hyperkalemia and a catabolic state where proteins are broken down into ketoacids, and fats are broken down into free fatty acids. All of these combined is what we know as DKA.
Journal of Medical Services 2018
► Different types of Insulin
Everyone with type 1 diabetes, and some people with type 2 diabetes, need to take insulin using an insulin pen or an insulin pump.
There are five different types of insulin which all work in slightly different ways to help manage diabetes.
Sometimes known as fast-acting insulin, it’s taken shortly before meals. It works quickly, and it’s usually taken alongside intermediate-acting insulin or long-acting insulin. The dose depends on how many carbohydrates are eaten.
This is similar to rapid-acting insulin but works slightly slower. Because of this, it needs to be taken about 25 minutes before eating.
This is a combination of short- or rapid-acting insulin. It’s taken twice a day before breakfast and dinner.
Also known as background insulin or basal insulin. This means it works throughout the day. It’s taken once or twice a day.
Long-acting insulin: Another type of background or basal insulin, it is slower acting than intermediate insulin but very similar in how the body processes it. It’s usually taken once a day.
Pen injectors are relatively easy to use, and there’s a whole range to suit different insulin. There are two main types: a disposable pen that already contains the insulin, which you throw away once empty; and a reusable pen with replaceable insulin cartridges.
An insulin pump gives people the insulin they need throughout the day and night. A pump can be an excellent alternative to injecting with an insulin pen and give people more flexibility when managing their diabetes.
There are two types of insulin pumps: a tethered pump and a patch pump. Both are attached to the body by a tiny tube called a cannula, which goes just under the skin. The cannula needs to be changed every two or three days and moved to a different place every time.
Tethered pumps: This is attached to the body by another small tube that connects to the cannula. The pump itself usually houses all
the controls and can be carried on a belt, in a pocket, or a body band worn under clothing if people don’t want it on show.
Patch pumps: These attach directly onto the body where the cannula is placed. Popular choices include legs, arms, or stomach. There’s no extra tubing, which means the pump sits directly onto the skin and is operated by a remote. Patch pumps are temporary, so the whole device needs to be changed when the pump sends an alert, not just the infusion set and location.
For further information click on link diabetes-uk-meds-and-kit-2020 and go to page 24 and 25.
As well as insulin, there are several medications available to help treat type 2 diabetes – two of them are sometimes used to help treat type 1 diabetes, too. They work in a variety of ways, so some people will use a combination of medications.
These are the different types and what they do:
Biguanide (metformin): This is usually the first diabetes medication prescribed if a healthy diet and physical activity alone hasn’t sufficiently helped to manage blood sugar levels.
Sulphonylureas: These are tablets that stimulate the cells in the pancreas to make more insulin, helping it to work better.
Alpha-glucosidase inhibitor (acarbose): Slows down the intestine’s absorption of starchy foods, which, in turn, slows down any rise in blood sugar levels after eating.
Prandial glucose regulators: Similar to sulphonylureas, this stimulates the cells in the pancreas to produce more insulin. They work more quickly than sulphonylureas but only last for a short time, so they need to be taken half an hour before each meal.
Thiazolidinediones (glitazones): Reduces insulin resistance and improves sensitivity, allowing the insulin that the body produces to work more effectively. It also helps to protect the cells in the pancreas, which enables them to produce insulin for longer.
GLP-1s (incretin mimetics): Increases the level of incretins in the body. Incretins are a type of hormone that help produce more insulin when it’s needed and reduce the amount of glucose production when it’s not needed. They reduce the rate at which the stomach digests food and empties, and can also reduce appetite.
DPP-4 inhibitors (gliptins): These work by blocking the action of DPP-4, an enzyme that destroys incretin.
SGLT2 inhibitors: This medication reduces the amount of glucose absorbed by your kidneys and your blood.
For more information click link diabetes-uk-meds-and-kit-2020 and go to pages 20-23 inclusive.
► Training for Glucose and Ketone Testing
It is important that all staff that are performing glucose or ketone testing are completing the annual training online and using their own barcode.
The training can be found here: Training – MKUH – Intranet under Glucose e-learning Module. If a barcode number is requested and you do not have one, please enter N/A.
The barcodes cannot be laminated, so we suggest once you get your barcode cover it with some sticky tape to preserve the print.
Useful Information and Resources
- Joint British Diabetes Societies (JBDS) for Inpatient Care Group | ABCD (Diabetes Care) Ltd
- DTN-UK Education | ABCD (Diabetes Care) Ltd
- ABCD (Diabetes Care) Ltd | Association of British Clinical Diabetologists
- Diabetes UK – Know diabetes. Fight diabetes. | Diabetes UK