Rapid or Regular Activity: Onset is within half an hour and activity peaks during a 2 to 5 hour period. It remains in the bloodstream for about 8 to 16 hours. These fast-acting, short-lasting insulins are useful in special cases: accidents, minor surgery or illnesses, which cause the diabetes to go out of control or whenever insulin requirements change rapidly for any reason. These are also being used more and more in combination with a long-acting insulin or alone (prior to meals and at bedtime).

Semilente: A special type of short-acting insulin that takes 1 to 2 hours for onset, peaks 3 to 8 hours after injection and lasts 10 to 16 hours. Intermediate-Acting: Reaching the bloodstream 90 minutes after injection, intermediate-acting insulin peaks 4 to 12 hours later and lasts in the blood for about 24 hours. There are two varieties of this type of insulin: Lente (called L) and NPH (called N).

Long-Acting: These insulins, which take 4 to 6 hours for onset, are at maximum strength 14 to 24 hours after injection, lasting 36 hours in the bloodstream. Long-acting insulin is referred to as U (for Ultralente).

Please be aware of the following problems that exist with insulin intake:

Hypoglycemia (low blood sugar) is sometimes called an insulin reaction or insulin shock. It can occur suddenly in people using insulin if too little food is eaten, if a meal is delayed or in the case of extreme exercise. Symptoms include feeling cold, clammy, nervous, shaky, weak or hungry, and some people become pale, have headaches or act strangely.

Hyperglycemia (high blood sugar) occurs when too much food is eaten or not enough insulin is taken. The warning signs are large amounts of sugar in the urine and blood, frequent urination, great thirst and nausea.

Ketoacidosis (in its most severe form - diabetic coma) develops when insulin and blood sugar are so out of balance that ketones accumulate in the blood. Symptoms include high blood sugar or ketones in the urine, dry mouth, great thirst, loss of appetite, excessive urination, dry and flushed skin, labored breathing, fruity-smelling breath and possible vomiting, abdominal pain and unconsciousness.

In addition to daily injections of insulin, regular physical activity and a controlled diet are essential. Following these daily dietary guidelines would help a great deal:

Up to 70 percent of all calories should be obtained from carbohydrates and unsaturated fats. These carbohydrates should be mainly complex carbohydrates and naturally occurring sugars (similar to those in milk and fruits). Examples of unsaturated fats are vegetable oils and margarine.

Between 10 and 20 percent of calories should be obtained from protein.

Less than 10 percent of all calories should be obtained from fat. Saturated fats are found in animal products and in some vegetable oils (such as coconut, palm, and palm-kernel oils).

- Eat 30 to 35 grams of fiber.
- Eat no more than 300 mg of cholesterol.
- For Type I diabetes, the meal plan should be tailored to the person's individual needs and is likely to include three meals and two or three snacks a day. A person with diabetes must eat these meals and snacks at set times each day to properly balance insulin.

Management of Type II Diabetes
The recommends diet (see guidelines stated above) and regular physical activity as the first line of treatment for Type II diabetes. If normal glycemic levels are not achieved within three (3) months, drug treatment is recommended.

Currently there are four (4) classes of prescription drugs available for the treatment of Type II diabetes:

  1. Sulfonylureas (Diabinese, Dymelor, PresTab, Orinase, Tolinase, Micronase, DiaBeta, Glynase, Glucotrol, Glucotrol XL and Amaryl), which stimulate the pancreas to release more insulin.
  2. Biguanides (Glucophage and Metformin), which keep the liver from releasing too much glucose.
  3. Alpha-glucoside inhibitors (Precose), which slow the digestion of some carbohydrates.
  4. Thiazolidinediones, which control glucose levels by making muscles more sensitive to insulin and reduce the amount of glucose that the liver produces.
Clinical trials suggest that oral antidiabetic agents - particularly the new noninsulin secretagogues (including Troglitazone and Metformin, which act on the liver and skeletal muscle) - may be useful in delaying or preventing development of Type II diabetes. Both agents, acting primarily by different mechanisms of action, also have demonstrated potential beneficial effects on serum lipid profiles.

Although these oral medications work in different ways, they can be combined to work more effectively to manage Type II diabetes. When these combinations of oral treatments are no longer effective (for about 60 percent of people with Type II diabetes), the doctor will start a regimen of insulin alone or in combination with an oral medication.

(Women) Should there be a concern about taking menopause-based medicine with insulin.

Prevention of Diabetes
There is no foolproof way to prevent diabetes, but steps can be taken to improve the chances of avoiding it:

Exercise. Studies of both men and women have shown that vigorous exercise, even if done only once a week, has a protective effect against diabetes. Exercise not only promotes weight loss but lowers blood sugar as well.

Lose weight. There is evidence that both men and women who gain weight in adulthood increase their risk of diabetes. A study conducted at Harvard showed that adult women who gained 11 to 17 pounds since the age of 18 doubled their risk of diabetes; those who gained between 18 and 24 pounds almost tripled their risk. Fact: 90 percent of diabetics are overweight.

Diet. The use of a diet low in calories and in saturated fat is an ideal strategy for preventing Type II diabetes. (See the ADA guidelines stated in the TREATMENT section).

Stop smoking. Smoking is especially dangerous for people with diabetes who are at risk for heart and blood vessel diseases.

Use alcohol in moderation. Moderation for men means no more than two drinks a day; for women, one drink is the limit. Choose drinks that are low in alcohol and sugar such as dry wines and light beers. If you use mixers, try to select one that is sugar free, such as diet drinks, club soda, seltzer or water. If you take diabetic pills or insulin, alcohol can drop blood glucose levels too far. Have the drink with a meal or snack.

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