The management of diabetes will depend on the type of diabetes. Since Type 1 diabetes is more common in childhood, this is primarily being discussed. In Type 1 diabetes since there is no insulin being produced, insulin has to be given. Insulin is only available as injections at present.
Aim of management:
- To feel well and ability to function normally
- Have blood sugars as close to normal as possible
- To avoid low blood sugars
- To avoid hospitalizations
- To reduce the risk of long term complications
Controlling diabetes is a balancing act. Good control of blood sugar level depends on a delicate balance between diet, exercise and insulin. Adjusting insulin, therefore, is only one of the ways to control diabetes.
Sources
of insulin:
There are 3 types of insulin that are available in the market:
- Porcine Insulin: produced from pancreas of the pig
- Bovine Insulin: produced from pancreas of cow
- Human insulin: Genetic alteration of bacteria or yeast is done to create human insulin.
- Insulin analogs: These are artificially modified molecules of insulin.
Human insulin is most popular amongst these insulin’s because the structure is exactly the same as the natural insulin produced in human beings.
Use of bovine and porcine insulin has decreased since human insulin became available, although porcine insulin is as effective as the human insulin.
All insulins can be classified according to the duration of action into:
Short
or Rapid Acting
or
Intermediate Acting
or
Long Acting
There are insulin mixtures available in the market, which
have a combination of the short and intermediate acting insulin’s
in different proportions. If the proportion of your dose is similar these
can be used.
Short
or rapid acting insulin
It is also called regular insulin.
There are 2 insulin analogs that are also short and rapid
acting and are available in India. These are the
- Lispro insulin
- Insulin aspart
These start acting almost instantly and can be injected just before the meal or immediately after the meal so that the dose can be adjusted according to the amount of food intake.
Intermediate Acting insulin: (NPH or Lente)
This is milky white in appearance.
Long Acting Insulin (Ultralente, Glargine)
Glargine
is an insulin analog that has become available in India recently. It has
no peak and its effect lasts for about 24 hours. It provides a basal insulin
level that resembles the natural pattern of insulin secretion between
meals. It has to be used with regular insulin before meals. It is usually
injected at night and cannot be combined with any other insulin in the
same syringe. It is not recommended for use in children less than 6 years.
The time of onset, peak effect and duration of action of the various insulin's
has been given in this table.
| Short Acting | Lispro/Aspart | Intermediate | Glargine | |
| Starts working | ½-2 hours | 15-20 mins | 2-4 hours | 2 hours |
| Best effect | 2-3 hours | 1 hour | 8-14 hours | no peak |
| Disappears | 4-6 hours | 4 hours | 14-20 hours | 24 hours |
Insulin Regimes:
Various
insulin regimes are used for managing diabetes and your physician would
help decide what regime is most suitable for you.
For better control of diabetes, flexibility in lifestyle and for
reducing the risk of complications 3-4 injections of insulin daily is
preferred.
One injection of insulin daily is not enough for good control of diabetes.
It increases the risk of long-term complications.
Controlling diabetes means controlling the blood sugar. To do this, you must balance insulin, diet and exercise. Diet increases blood sugar, while insulin and exercise both lower blood sugar.
Exercising muscles need a lot of energy. This energy comes from sugar or glucose. The muscles get this glucose from the blood stream. So, as sugar moves out of the blood stream to the exercising muscle, the amount of sugar in the blood stream goes down.
Why is exercise important?
There are several reasons:
- Exercise will help in the control of your diabetes.
- Exercise will build a healthier heart, lungs, muscles and body.
- Exercise will help in weight control by lowering the amount of fat in your body and decreasing your appetite.
- Exercise will make you look and feel better – maybe not while you are exercising, but after!
What kind of exercise is good for your diabetes?
Any exercise
you can do continuously for 20 to 30 minutes, and which makes your heart
beat faster and your lungs work harder. Some recommended activities are:
Swimming, jogging, bicycling, fast walking, jumping rope, skating, dancing
etc.
How
much should you exercise?
To get the most out of an exercise program for your diabetes and for your
whole body, you should do one of the suggested activities for 30 minutes
3 to 4 times each week. Try it for 2 weeks and just see how good you feel!
When should exercise be avoided?
- When your blood sugar is over 400. High blood sugar means the body is not able to use sugar very well. Your body must be able to use sugar during exercise.
- When blood sugar is 240 or more and ketones in the urine are moderate or large. Presence of ketones in the urine indicates that your body is burning fat for energy. Exercise can make this worse.
- When blood sugar is less than 80. Unless you eat a snack before you exercise, you could easily have an insulin reaction.
What should you watch out for?
- It is a good idea to check your blood sugar before and after exercise when starting an exercise program.
- Always; have a fast-acting sugar or fruit exchange with you when you exercise. Some examples: 3 sugar cubes, ½ cup unsweetened fruit juice.
- If you start to feel like you are having a low blood sugar reaction: shaky, weak, dizzy – stop exercising, rest and take a fruit exchange: if you feel better in 10 to 15 minutes, you can go back to what you were doing. If you continue to feel bad, eat another fast-acting sugar.
- If the activity will last more than 30 minutes, you should have a starch or bread exchange for every 30 minutes of exercise.
- Take your shot in the part of your body you will not be using during exercise. For example, if you plan to jog, take your shot in your abdomen or arm. An exercising muscle makes insulin go into the blood stream more quickly.
With these things in mind, you can exercise safely, get fit and have fun!
Things you need to do to take care of your diabetes:
- Test your blood sugar at least 2 times each day.
- Take you insulin every day at the correct time.
- Follow your meal plan.
- Get some kind of exercise every other day.
- Relax! You will do just fine. Stress can worsen control.