Microsoft word - insulin & type 2 for voice pdf.doc
Insulin has the most wonderful reputation among
aggressive over time. Initially, many people with
people with Type-2 diabetes. Many view it the
Type-2 diabetes can control their blood sugar
same way as moving to a nursing home (or
through exercise (which improves insulin
Florida retirement community)… just one short
sensitivity) and a healthy diet with limited
carbohydrates. Once this fails to achieve desired
blood sugar levels, oral medications are often
But nothing could be further from the truth. If
added. Some medications reduce the amount of
anything, taking insulin keeps you as far away
sugar produced by the body; some improve
from the mortician as possible. Despite recent
sensitivity to insulin; and some stimulate the
advances in medical therapy, insulin remains the
pancreas to produce as much insulin as possible.
most potent and effective treatment for elevated
Eventually, the oral medications (combined with
blood glucose. It is a more natural substance than
diet and exercise) are unable to the job, and
pills (chemically similar to the insulin produced
by the body), and lacks many of the potential
side-effects inherent to oral medications.
Oral medications really do have their limits.
Unlike insulin, which lowers blood sugar
Today, there are more than 15 million people
DIRECTLY by causing the body’s cells to absorb
with Type-2 diabetes in the United States, and
insulin from the bloodstream, oral medications
more than 3 million take insulin. But many more
work INDIRECTLY. They only work when the
people should probably be taking insulin. Here is
pancreas is able to produce sufficient amounts of
insulin. Once the pancreas is unable to keep up
with the workload, no amount of medication is
Nature of the DiaBeast
going to solve the problem. And it really can be a
problem. Elevated blood sugar levels cause
Type-2 diabetes is a progressive condition. It
gets worse over time. It usually starts out as a
infection/impaired healing, diminished mental
state of mild insulin resistance: the insulin
and physical abilities, mood changes) as well as
produced by the pancreas is not properly utilized
long-term complications (blindness, kidney
by the body’s cells. This result is a gradual
failure, nerve disorders, heart disease).
increase in the blood sugar level, which promotes
increased insulin production by the pancreas.
Insulin to the Rescue
Eventually, the pancreas is unable to make
enough insulin to overcome the insulin resistance,
Taking insulin is easier and safer than ever
and glucose levels rise high enough to require
before. Insulin syringes have short, super-thin
needles that you can barely feel. Insulin can also
be administered with an insulin pen: simply dial
All this time, the pancreas is working harder and
up and inject. Don’t forget… insulin is given into
harder to secrete as much insulin as possible. Just
FAT. Not muscle, not blood vessels, not into any
like a machine that is strained and overworked,
kind of sensitive tissue. Fat has no nerve endings,
the insulin-producing cells eventually burn out
so the injection procedure is virtually pain-free.
and cease to function. This is why the treatment
for type-2 diabetes tends to become more
Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC
In recent years, new insulin formulations have
come to the forefront. “Basal” insulin, which works slowly and gradually over an extended period of time (like a time-release capsule), may be enough to get your diabetes in control. Glargine (brand name Lantus) and detemir (brand name Levemir) are two such insulins. They are
usually taken once or twice daily, and do a good
job of controlling blood sugar levels overnight and between meals. Having insulin working all
the time helps to “rest” the pancreas so that it can
generate extra insulin at mealtimes. And because
Another effective option would be to use an
basal insulin does not have a pronounced peak, it
insulin PUMP. Insulin pumps are beeper-sized
rarely causes hypoglycemia (low blood sugar). In
and battery-operated. They deliver tiny pulses of
many cases, basal insulin is all that is needed to
rapid acting insulin throughout the day and night,
control the blood sugar throughout the day and
which effectively serves as the “basal” insulin.
The user programs a larger dose, called a “bolus”
dose, to be delivered at meal and snack times.
In some instances, even with the addition of basal
The insulin is delivered from the pump into a
insulin, the pancreas is unable to make enough
small plastic tube that sits just below the skin.
insulin at mealtimes. This results in large blood
sugar “spikes” after meals and snacks. Post-meal
spikes have been shown to damage blood vessels
and contribute to many of the complications of
In order to cut down on the number of injections
diabetes. To prevent the spikes, a number of
required with MDI or the complexity of using an
PREMIXED insulin. Premixed insulin usually
Perhaps the most effective solution is to take
consists intermediate insulin known as NPH (a
rapid-acting insulin at each meal, in addition to
cloudy mixture which peaks 4-10 hours after it is
the usual injections of basal insulin. This is
taken) combined with rapid insulin. Taken at
called an MDI (multiple daily injection) program.
breakfast and dinner, premixed insulin provides
Rapid insulin, including lispro (brand name
some basal insulin throughout the day and night
Humalog), aspart (brand name Novolog) and
(albeit with pronounced peaks and valleys), and
glulisine (brand name Apidra) is usually taken at
rapid insulin to offset breakfast and dinner.
the onset of each meal or snack. Rapid insulin
starts working in approximately 15 minutes, peaks (works hardest) in about an hour, and lasts for around 4 hours. The dose can be adjusted based on the amount of carbohydrate in the meal or snack. Rapid insulin, just like basal insulin,
Insuin activity from twice daily premixed insulin
Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC
Some physicians also recommend a combination of insulin and oral medications. For example, basal insulin is often combined with medications called MEGLITINIDES (brand names Prandin and Starlix) or DPP-4 INHIBITORS (brand name Januvia). These medications help the pancreas to secrete extra insulin specifically at mealtimes. Granted, insulin is not ideal for everyone with Type-2 diabetes. It requires some dexterity to administer the injections. If the doses are incorrect, it can cause hypoglycemia (low blood sugar). And if not balanced with sufficient exercise and a healthy diet, insulin tends to cause weight gain. But don’t lose sight of the fact that diabetes is a disease that requires aggressive treatment. If your blood glucose level is frequently above target or your HbA1c is above 7%, talk to your doctor about intensifying your therapy. Starting insulin, or taking your insulin program to a higher level, may give you just the results you’re looking for. Editor’s note: Gary Scheiner is a Certified Diabetes Educator with a private practice specializing in intensive diabetes management. He and his team offer consultations and self-management education via phone and the internet. For questions or more information, you may contact him at [email protected], or call 877-735-3648.
Voice of the Diabetic (Natl. Federation for the Blind): Winter, 2010 Copyright 2010, Gary Scheiner MS, CDE – Integrated Diabetes Services LLC
MEDICAID FRAUD November 2006 Hidden Camera at New York Nursing Reveals Neglect . . . . . . 1 Cases . . . . . . . . . . . . . . . . . . . . . . 2 Case Updates . . . . . . . . . . . . . . . . 13 Hidden Camera at New York Nursing Home Reveals Neglect Attorney General Eliot Spitzer announced on November 22 the arrest of nine employees ofthe Hollis Park Manor Nursing Home in Queens, where
Psychopharmacological Treatments in Persons with Developmental Disabilities Chapter 8 Psychopharmacological Treatments in Persons with Developmental Disabilities (DD) Chrissoula Stavrakaki, Ruxandra Antochi, Jane Summers, and Judy Adamson Learning Objectives Readers will be able to: 1. Identify the categories of psychotropic medications 2. Learn how to use psychotropic medications i