What is the role of insulin in your body?

Insulin’s main role in the body is to regulate blood sugar levels and energy metabolism. Presence of insulin signals to cells in the body to take up glucose from the bloodstream and use it for energy. After a meal, your body breaks down carbohydrates into glucose and is then absorbed into the bloodstream spiking blood glucose levels. Pancreas responds to it by producing insulin which allows glucose to enter the cells in your body to provide energy and also to store the excess glucose to be used as an energy source in between meals. 

What are the 2 types of diabetes?

There’s 2 main classifications of diabetes: Type 1 and type 2. For type 1 diabetes or insulin-dependent diabetes, the pancreas is unable to produce insulin and thus an external source of insulin is needed to replace the natural production from the pancreas. If the insulin is not replaced, glucose can’t get into the cells and can’t be used as an energy source, causing the cells to shift to an alternative pathway to generate energy which can lead to a serious and life-threatening complication called diabetic ketoacidosis. 

For type 2 diabetes, the pancreas is able to produce insulin but cells in the body have become insulin resistant, thus they do not initially need insulin replacement therapy. Typically, in the early to mid stages of type 2 diabetes, oral medications that increase insulin sensitivity and/or increase insulin production are able to provide adequate blood sugar control.

However, overtime there can be progressive decline of pancreatic function and pancreas becomes unable to sustain the high amount of insulin production that is being required, and ultimately in the later stages of type 2 diabetes, patients end up also needing insulin replacement therapy to bring their blood sugar under control. 

What is the difference between human insulin and analog insulin

Human insulin or Regular insulin is engineered in the lab to be identical to our natural insulin, however when injected into the skin, it tends to clump together and take a longer time to get absorbed.

Human insulin typically has onset of action of 30-60 mins, max effect in 2-3 hours and duration of effect of up to 6.5 hours. So human insulin has to be injected an hour before you intend to eat. 

Analog insulin is insulin that is slightly altered such that is more rapidly absorbed when injected, produces higher peak concentrations in blood to help lower blood glucose levels quickly and has a shorter duration of action than human insulin.

They typically have onset of action of 10-15 mins, max effect in 1-1.5 hours and duration of effect of 3-5 hours. They are also known as rapid acting insulin analogues and are preferred over human insulin as they provide better control of meal time blood glucose levels than human insulin. Analog insulin can be injected 0-15 minutes before a meal, thus allowing for greater flexibility and the higher peak provides for better blood glucose control.

Why do some people require both a long-acting insulin and insulin injections with each meal?

Your body requires a baseline level of insulin throughout the day so that the cells in your body are able to take up glucose to use for energy. After you eat and get a blood glucose spike, you need a spike in your insulin levels so that the body can take the excess glucose from the blood and store it to be used later. Insulin is classified into 3 main types depending on their duration of action: rapid or short acting insulin (meal time insulin), intermediate-long acting and biphasic insulin.

The intermediate-long acting insulin provides the baseline level of insulin that your body requires and is typically taken once or twice daily. The mealtime insulin provides the insulin spike that your body needs to control the blood glucose spike after a meal.

If you have type 1 diabetes, you will need both types of insulin from the start as your body is unable to produce its own insulin. If you have type 2 diabetes, typically you will be started on a long acting insulin to be taken once daily if your blood sugar is not controlled by oral medications. If your blood sugar is still not controlled after starting the long acting insulin, meal time insulin will be added to your regimen.

What are some challenges with insulin?

One of the biggest challenges can be the stigma of being on insulin. The days of the syringe and vial to inject insulin are mostly gone, nowadays the pen-based insulin injectors are very discrete and easy to carry and use. If you are on mealtime insulin, the insulin has to be timed according to your eating schedule. Using the newer rapid acting analogues instead of human insulin makes timing meals easier as they can be taken right before eating.

Obesity puts you at a higher risk of type 2 diabetes and one of the side effects of insulin is weight gain, which may further exacerbate the problem. These patients may benefit from a newer treatment option for type 2 diabetes: Ozempic, which can help improve blood sugar control and clinical trials have shown a significant “weight loss with ozempic”