INSULIN SHOTS AND DIABETES
Diet and exercise are important for everyone who has diabetes. For those with Type II they may be enough to bring the glucose levels into the right balance. But people with Type I diabetes must have injections of insulin to bring their condition under control.
Most people don’t like going to a doctor for shots, and the idea of having one or more injections every day (and giving them to yourself!) might seem scary. But people lose the fear of injections when they are given frequently, and daily insulin shots soon become routine.
Giving yourself an injection is really not too hard to do. First, you fill the syringe to the proper dose from the insulin bottle, taking care that no air bubbles remain in the syringe. Then wipe a spot on the skin with a cotton swab dipped in alcohol; this cleans the skin and kills any germs that might cause infection. Then, with the hand not holding the syringe, pinch up the skin into a bulge. (In a muscular area like the thigh, it may be better to stretch the skin out tight rather than pinch it.) Quickly insert the needle into the skin. (The quicker you are, the less it hurts.) Then push the plunger down, injecting all the insulin in the syringe; withdraw the needle carefully; and wipe the skin again with alcohol. Plastic disposable syringes are designed to be used once, then thrown away. (Bacteria could multiply on a dirty syringe, so reusing it could be dangerous.)
There are several new options available for taking insulin. Jet injectors, for example, deliver insulin without a needle, in a tiny pressurized stream that penetrates the skin. An insulin pen looks like a regular pen and contains an injection of insulin.
The belly, buttocks, thighs, and upper arms are the places most often used for insulin injections. (Unlike drug abusers, a person injecting insulin for diabetes does not want to inject the drug into a blood vessel. Injecting it into muscle or fatty tissues allows the insulin to be absorbed slowly, a little at a time, rather than in a big dose all at once.) It is a good idea to rotate the injection sites. Too many injections in the same spot sometimes cause the fat deposits under the skin to be absorbed into the body, producing an unsightly dent in the flesh. Deposits of fat under the skin may also form, causing raised lumps. These effects can usually be avoided by not injecting insulin into the same place more than once every few weeks. Both of these problems are also reduced with the human insulins available today.
Insulin shots twice a day are a rather unnatural way to keep the blood sugar level under control. Medical researchers have been working on devices to deliver insulin in a way that is more like how the normal pancreas releases it—in a small, continuous flow, which is increased when more glucose enters the bloodstream and can be adjusted as needed.
A major advance in this quest was the development of insulin pumps, first introduced in the late 1970s. Today more than 10,000 people with IDDM wear external insulin pumps. A needle is taped in place, and insulin is pumped from a storage container through a plastic tube. The pump delivers insulin continuously, in a tiny flow, which is set by the doctor and adjusted by the user on the basis of frequent blood tests and activities such as exercise. Before meals the user presses a button on the pump to get an extra squirt that will work on the glucose from the food.
Implantable pumps are surgically inserted under the skin of the abdomen. The size of a hockey puck, they include a pump and a reservoir containing enough insulin to last up to several months. The flow rate is set with a radio transmitter. Clinical trials involving 350 people with insulin-dependent diabetes are currently under way in the United States, Canada, and France.
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