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What Is insulin? 
     รู้จักกับอินซูลินรักษาเบาหวาน

Type of Insulins for 
     treatment
     ชนิดและประเภทของอินซูลิน

 -
The warning signs of a 
   low blood glucose level
 -The signs of high blood 
   glucose
 - "Pen" injectors
 
-
Pump Therapy
 -
Pump Therapy FAQs
 


เบาหวาน
     Diabetes Mellitus

ทบทวนความรู้และเทคนิค
     การดูแลรักษาโรคเบาหวาน

     Diabetes type II  or
     Non insulin dependent
     diabetes mellitus  
     (NIDDM) Disease 
     and Care

ภาวะน้ำตาลในเลือดต่ำ
     Hypoglycemia

เครื่องวัดระดับน้ำตาลจาก
    เลือดปลายนิ้ว

แถบตรวจระดับน้ำตาลจาก
    ปัสสาวะ
ชุดน้ำยาตรวจระดับกลูโคส
    จากพลาสม่า / ซีรั่ม

   

Health Navigation






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เบาหวาน Diabetes Mellitus


ลักษณะทั่วไป
เบาหวาน พบได้ประมาณ 3.5 เปอร์เซ็นต์ของคนทั่วไป พบได้ในคนทุกวัยแต่จะ พบมากในคนอายุ 
มากกว่า 40 ปีขึ้นไป และคนที่อยู่ในเมืองมีโอกาสเป็นโรคนี้ มากกว่าชาวชนบท คนอ้วนและหญิงที่มี
ลูกดก มีโอกาสเป็นโรคนี้ได้มากขึ้น

ประเภทของเบาหวาน เบาหวานสามารถแบ่งออกเป็น 2 ชนิดใหญ่ ๆ ที่มีอาการ สาเหตุ  ความรุนแรง
 และการรักษาต่างกัน ได้แก่
1. เบาหวานชนิดพึ่งอินซูลิน (Insulin-dependent diabetes mellitus/ IDDM) 
เป็นชนิดที่พบ ได้น้อยแต่มีความรุนแรงและอันตรายสูง มักพบในเด็กและคน อายุต่ำกว่า 25 ปี   แต่ก็อาจพบ
ในคน สูงอายุได้บ้าง  ตับอ่อนของผู้ป่วยชนิดนี้จะ สร้างอินซูลินไม่ได้เลย หรือได้น้อยมาก เชื่อว่าร่างกายมี
การสร้างแอนติบอดี ขึ้น ต่อต้านทำลายตับอ่อนของตัวเอง จนไม่สามารถสร้างอินซูลินได้ ดังที่เรียก ว่า
"โรค ภูมิแพ้ต่อตัวเอง" หรือ "ออโตอิมมูน (autoimmune)" ทั้งนี้เป็นผลมา จากความผิดปกติทาง 
กรรมพันธุ์ ร่วมกับการติดเชื้อ หรือการได้รับสารพิษ จากภายนอกผู้ป่วยจำเป็นต้องพึ่งพาการฉีดอินซูลิน
เข้าทดแทนในร่างกายทุก วัน จึงจะสามารถเผาผลาญน้ำตาลได้เป็นปกติ มิเช่นนั้น ร่างกายจะเผาผลาญ 
ไขมัน จนทำให้ผ่ายผอมอย่างรวดเร็ว  และถ้าเป็นรุนแรง จะมีการคั่งของสาร คีโตน (ketones)  ซึ่งเป็น
สารที่เกิดจากการเผาผลาญไขมัน สารนี้จะเป็นพิษ ต่อระบบประสาท ทำให้ผู้ป่วย หมดสติถึงตายได้รวด
เร็ว เรียกว่า "ภาวะคั่งสาร คีโตน หรือ คีโตซิส (Ketosis)"
2. เบาหวานชนิดไม่พึ่งอินซูลิน(Non-insulin-dependent diabetes mellitus /NIDDM)
 
เป็น เบาหวาน ชนิดที่พบเห็นกันเป็นส่วนใหญ่ ซึ่งมักจะมีความรุน แรงน้อยมักพบในคนอายุมากกว่า 40 ปี
ขึ้นไป แต่ก็อาจพบในเด็กหรือวัยหนุ่ม สาวได้บ้าง 
ตับอ่อนของผู้ป่วยชนิดนี้ยังสามารถสร้าง อินซูลินแต่ไม่เพียงพอ กับความต้องการของร่างกาย จึงทำให้มี
น้ำตาลที่เหลือใช้ กลายเป็น เบาหวาน ได้ ผู้ป่วยชนิดนี้ยังอาจแบ่งเป็นพวกที่อ้วนมาก ๆ กับพวกที่ไม่อ้วน  
(รูปร่าง ปกติ หรือผอม) สาเหตุอาจเกิดจากกรรมพันธุ์ อ้วนเกินไปมีลูกดก จากการ ใช้ยา หรือพบร่วมกับ
โรคอื่น ๆ ผู้ป่วยมักไม่เกิดภาวะคีโตซิส เช่นที่เกิดกับ ชนิดพึ่งอินซูลิน การควบคุมอาหาร หรือการใช้ยา
เบาหวาน ชนิดกิน ก็มักจะ ได้ผลในการควบคุมระดับน้ำตาลในเลือดให้ปกติได้ หรือบางครั้งถ้าระดับ น้ำตาล 
สูงมาก ๆ ก็อาจต้องใช้อินซูลินฉีดเป็นครั้งคราวแต่ไม่ต้องใช้อินซูลิน ตลอดไป จึงถือว่าไม่ต้องพึ่ง อินซูลิน

Causes and Prevention of Diabetic Neuropathy
High blood sugar in diabetes patients can lead to diabetic neuropathy. Learn more about how diabetic neuropathy can cause damage to the nervous system, and how a healthy lifestyle can prevent diabetic neuropathy in diabetes sufferers.
                  Causes and Prevention of Diabetic Neuropathy

Diabetic Nephropathy Causes and Prevention
Often, high blood pressure from diabetes can cause diabetic nephropathy, and this can lead to kidney failure. A healthy lifestyle will help to prevent kidney damage and diabetic nephropathy.
                  Diabetic Nephropathy Causes and Prevention

Keeping your blood sugar on the level

When insulin was first discovered and made available for people with diabetes, there was only one kind of short-acting insulin. This required several injections a day. As time went on, new insulins were developed that lasted longer, requiring fewer injections, but requiring strict attention to timing of meals. Now, there are different types of insulin available, made from different sources. This gives more flexibility in the number and timing of injections, making it easier to maintain target blood glucose levels, based on your lifestyle. One to four injections a day may be suggested to you for optimal control of your blood glucose. Ask your health care team about the best insulin plan to meet your needs.

Insulin works differently in different people depending on factors such as: injection site, amount of insulin, etc. The following are general guidelines only.

Injecting in Leg Injecting in Arm Blood Glucose Testing


Type of Insulins for treatment 

TYPE NAME STARTS TO WORK IN PEAK ACTION DURATION
Rapid-acting insulin Humalog® 5 - 15 minutes ½ - 1 ½ hours 3 ½ - 4 ½ hours
Short-acting insulin Regular (R), or Toronto 30 - 40 minutes 2 - 4 hours 6 - 8 hours
Intermediate-acting insulin NPH (N), Lente (L) 1 - 3 hours 2 - 12 hours 18 - 24 hours
Long-acting insulin Ultralente (U) 4 - 6 hours 12 - 18 hours 24 - 28 hours
Premixed insulin (%R %N) 10/90, 20/80, 30/70,
40/60, 50/50
½ - 1 hours 2 -12 hours 18 - 24 hours
Premixed insulin analog Humalog® Mix25™ 5 - 15 minutes ½ - 12 hours 18 - 24 hours

 


What do I need to know about blood glucose levels?

The Canadian Diabetes Association's Clinical Practice Guidelines for the Management of Diabetes in Canada provide people with diabetes with definite goals for levels of glucose control. They are as follows:

Levels of glucose control for people with diabetes
(adults and adolescents)

  OPTIMAL
(target goal but may be hard to achieve for some people)
SUBOPTIMAL
(action may be required - not low enough to prevent complications)
INADEQUATE
(action required - at increased risk for long-term complications)
"MY TARGET RANGE"
(ask your doctor)
Glucose before meals 4 - 7 mmol/L 7.1 - 10 mmol/L Over 10 mmol/L  
Glucose 1 - 2 hrs after eating 5.0 - 11 mmol/L 11.1 - 14mmol/L Over 14 mmol/L  
HbA1c (depending on lab) Less than 0.07% 0.07 - 0.084% Over 0.084%  

The above information serves only as a guide.
You need to know what your own blood glucose target ranges are, so be certain to discuss this with your doctor.

 

How to test your blood glucose level
You can purchase a meter from your local pharmacy. Checking blood glucose requires obtaining a small drop of blood to place on a blood glucose strip. Talk to your diabetes educator or pharmacist about the various methods, and which one is right for you. When you decide, make sure you receive the proper training.

Ask about:

  • The size of the drop of blood and the type of blood glucose strips to use
  • How to clean you meter
  • How to check if your meter is accurate
  • How to code your meter

Your province or territory may subsidise the cost of injection and monitoring supplies. Contact your local Canadian Diabetes Association office to find out if this applies to you.

Why you should test your blood glucose level?

  • Blood testing is a quick measurement of your blood glucose level at any point in time.
  • Blood checking shows how your blood glucose levels are affected by your food intake, insulin, stress levels, illness and physical activity.
  • Blood checking is a quick method to identify high and low blood glucose levels.
  • Blood checking will help you, your doctor and diabetes health care team, to make the necessary changes in insulin, meal planning or exercise to achieve good blood glucose control.
What causes a low blood glucose level or hypoglycemia?
A low blood glucose level can occur when your blood glucose drops below a certain level (usually less than 4 mmol/L).

This is caused by:

  • Not eating enough food
  • Missing or delaying a meal
  • Exercising without taking the necessary precautions
  • Taking too much insulin
  • Drinking alcohol.

Low blood glucose can happen quickly, so it is important to take care of it right away.

The warning signs of a low blood glucose level
Note the symptoms you are feeling, and this will help you to identify low blood glucose in the future.

You may feel:

  • Hungry
  • Shaky or light-headed
  • Nervous or irritable
  • Sweaty
  • Weak
  • Your heart beats at a faster rate
  • Confused
  • A numbness or tingling in your tongue or lips.

Other signs of low blood glucose levels
You may also:

  • Have a headache
  • Be unusually sleepy
  • Experience mood changes

Remember: Some people do not have early warning signs of hypoglycemia. These individuals must check their blood glucose levels more often to avoid this condition. It is especially important for all people with diabetes to check before driving a car.

How to treat low blood glucose

  • Check your blood glucose. If you do not have your meter with you treat the symptoms anyway. It is better to be safe.
  • Eat or drink a form of sugar such as:
    • 3 B-D Glucose Tablets™ or 5 Dextrose Tablets™
    • 6 Life Savers TM
    • 3/4 cup (175mL) of juice or regular pop
    • 1 tablespoon (15mL) of honey.
  • Wait 10 to 15 minutes, then test your blood glucose again.

If it is still low:

  • Treat again.
  • If your next meal is more than one hour away, or you are going to be active, eat a snack, such as half a sandwich or cheese and crackers (something with starch and protein).

Severe Low Blood Glucose:
If your blood glucose drops very low you may:

  • Become confused and disoriented
  • Lose consciousness
  • Have a seizure

You will need assistance from another person. Make sure you always wear MedicAlert® identification. Talk to your doctor or diabetes educator about prevention and emergency treatment for severe low blood glucose.

 

What causes high blood glucose?
High blood glucose can result when food, activity and insulin are not balanced.
High blood glucose may happen when you are sick, pregnant or under stress.

The signs of high blood glucose
You may be:

  • Thirsty
  • Urinating more often
  • Tired
If you think your blood glucose is high, check your blood glucose levels
If you have type 2 diabetes, call or see your doctor. If you have type 1 diabetes, test your urine for ketones. Seek medical advice immediately if ketones are present.

VDO : Types of Insulin Delivery
Many people who suffer from diabetes take insulin to stabilize their blood sugar levels. Learn more about the different types of insulin delivery.

What Is insulin?

Insulin is a hormone made by a gland called the pancreas. Insulin helps the sugars obtained from the foods we eat get into the cells of the body to provide energy.

People develop diabetes when the body no longer makes any insulin; enough insulin; or is unable to utilize properly the insulin it makes.


Why do we need injected insulin?
For persons who do not have diabetes, the production of insulin by the pancreas varies according to the level of sugar in the blood. Each time we eat, our blood glucose, or sugar rises, an appropriate amount of insulin is produced and the blood sugar returns to normal within a couple of hours. For the person with diabetes whose body is not making any insulin or not enough insulin, insulin injections are necessary to maintain this proper balance of sugar in the blood and in the cells.

Insulin cannot yet be given by mouth because the acids in the stomach destroy it before it can begin to do its work. Insulin must be given by injection.

Types and amounts of insulin
Each person with diabetes is unique - an individual. The development of an insulin therapy schedule is thus dependent upon how much insulin each person's pancreas is still making; how sensitive they are to the insulin; their lifestyle; their activity level; and their eating pattern. Capillary blood sugar monitoring, through a finger prick, provides the person and his or her management team with very concrete information to assist in determining the type, amount, and timing of insulin injections.

The various insulin programs can range from one or two injections of insulin per day up to three or four injections.

The main goal of insulin therapy is to keep the blood sugar levels as close to the target range as possible (4 to 6 mmol/L before a meal, 10 or less two hours after a meal).

The Diabetes Control and Complications Trial (1993) reinforces the importance and the benefits of good blood sugar control in preventing or reducing the progression of long term complications of diabetes.


Characteristics of insulin
There are three distinct characteristics:

Onset: the time it takes the injected insulin to reach the blood stream and begin to work.

Peak: the time period in which the insulin is working its hardest to lower the blood sugar.

Duration: the length of time the insulin will be working in the bloodstream.

It is important that each person have a clear understanding of the characteristics of each type of insulin that he/she is taking. When blood sugar levels are not well controlled at certain times during the day, or if reactions are occurring, the knowledge of the action and characteristics of each insulin being taken will help to determine where changes need to be made.

Injection sites
Insulin absorption can be affected by the injection site, exercise, the accuracy of the dosage measurement, the depth of injection and by environmental temperatures.

To obtain consistency in daily insulin absorption and action, you should vary injection sites within the same anatomical region.

The abdomen provides an excellent area for consistent absorption of insulin, whereas the leg and arm areas are often affected more by exercise.

Repeated injection in the same area may cause a delay in absorption whereas massaging the site of injection may lead to an increased rate of absorption.

Insulin should be injected at a 90-degree angle using an insulin syringe (25 unit, 30 unit, 50 unit, or 100 unit size) or with an insulin pen. If redness, pain, or lumps are noted at the injection site, this area should be avoided until the problem goes away. Notify your doctor if it persists.

Preparing a syringe with two types of insulin
If you are preparing an injection drawing up two different types of insulin it is extremely important to measure dosages accurately and not to accidentally inject insulin from one bottle into the second bottle that holds a different type of insulin. You would not want to get intermediate-acting insulin into your bottle of short-acting insulin, thus altering the characteristics of the short-acting insulin.

Most people today are taught to draw up the short-acting insulin first then the longer-acting type. Air bubbles that occupy space in the syringe where there should be insulin must be cleared before the longer-acting insulin is drawn up. These air bubbles will not harm you directly but will result in an inaccurate dosage of insulin.

Premixed insulins
Premixed insulin are a combination of specific proportions of short-acting (R) and intermediate acting (N) insulin in one bottle or an insulin pen cartridge.

The premixed combinations include 10/90, 20/80, 30/70, 40/60, and 50/50. These different combinations, for example 30/70, mean that 30 percent of the insulin is short acting (R) and 70 percent is intermediate-acting (N).

These premixed insulins work well for individuals whose insulin requirements are quite set and who may be having difficulty with measurement of their dosages.

Premixed insulins do not, however, allow flexibility in dosage adjustment. You are not able to give yourself more N without also getting more R.

The increased number of premixed insulin on the market over the last three years makes the possibility of finding the appropriate ratio of R and N insulin in the one bottle or cartridge much more likely.

"Pen" injectors

The pen is the newest way of giving your insulin. It is convenient, quite portable, accurate, easy to use, and great for taking to work or when travelling.
•

Delivery: Audible and tactile unit "clicks"

•
LED Display: Large, easy to read display
•
Volume: 315 units (3.15 ml)
•
Dosage range: 1-80 units, one unit increments
•
Needle: Standard luer needle 27 or 30 gauge
•

Accepts plastic or glass cartridges that fit your H-TRONplus or Dahedi pumps

 

All insulin types with the exception of L (Lente) and U (Ultralente) are available in cartridges. The various premixed insulins are also available for use with the pen. If your insulin treatment plan requires taking N and R insulin and the amounts do not fall into the proportions of one of the premixed insulins, then you would be required to take two injections.

If you are interested in learning more about the pen, speak to your doctor or diabetes educator for more information.

Storage
The insulin vial you are using each day is quite stable at room temperature (25 C/77 F) for one month. Cartridges are stable for 21 days. Extra insulin stored in the refrigerator is good until the expiry date. Never store extra insulin in the freezer. Freezing can damage insulin and the insulin should not be used if this has occurred. Keep insulin away from heat and strong light. Never store your insulin in the trunk or in the glove compartment of your car.

Always check your insulin solution to ensure that the appearance is normal.

All cloudy insulin should appear uniformly cloudy when mixed by rolling between your hands. If particles are floating in the insulin solution or adhering to the bottom or sides of the bottle, do not use this insulin. If the short-acting insulin solution is no longer clear and colorless, discard the bottle.

Blood sugar monitoring
In order to establish an insulin treatment plan that will be effective, it is essential that the blood sugar levels be checked at various times during the day to determine how each component of the treatment plan is working. The blood sugar results help you identify the need for adjustments to the timing or amount of insulin, food, or exercise in order that better control will be achieved.

Discuss the times and the frequency of testing with your doctor or diabetes educator.

It is beneficial to test your blood sugar several times during the day (ideally before each meal and at bedtime) so that a pattern of your blood sugar control for the day can be determined. These patterns of blood sugar levels help you and your management team identify problem areas and make the necessary corrections to promote good blood sugar control.

If you have more questions or you are interested in learning more about insulin adjustment based on your blood sugar monitoring results, contact your doctor or diabetes educator. Your management team is there to work with you, to help you live a full healthy life with the best possible control of your blood sugar levels and thus your diabetes.

 

 

Pump Therapy

Armed with this new knowledge, your next step is to visit your Doctor and/or Diabetes Educator and discuss switching your therapy program to an insulin pump. Since using an insulin pump does require more effort on your part, some Doctors and Diabetes Educators will want to test your resolve to determine if you are ready.

Once you and your medical advisor have agreed that an insulin pump is right for you, you will begin learning the basics of using a pump. This includes learning to count carbohydrates, monitor your blood glucose levels, adjusting insulin doses and understanding the different bolusing options.

As you begin to better understand the basics of pump therapy, you can investigate which pump is right for you. Your Doctor or Diabetes Educator may only recommend a single brand or model of pump, but take the time to explore all of your choices. The pump that is best for you may not be the pump your medical advisors recommend, so take charge—you'll be the one using it everyday.

Once you've selected a pump, your Pump Trainer will meet with you to explain how the pump works. That person will take you through every function and scenario to make sure you understand exactly how to operate your pump safely and efficiently. Most pumps, such as the D-TRON™, come with free training materials (like an interactive CD-ROM) to assist you. Your Pump Trainer may ask that you begin using a pump containing a non-active, NaCl (saline) or salt water solution to monitor your progress, before switching you to pump delivered insulin (you must continue your current insulin therapy while using the NaCl solution).

The entire process of switching from your current therapy to pump therapy can take as little as a month, depending on your involvement. Once the change is made, the benefits will be immediate—more control, greater flexibility and more personalized insulin matching.

Of course, this is only a general outline of what's involved in switching to an insulin pump. Your situation may differ, but will include all of these steps in combination with others, as determined by your Doctor and Diabetes Educator.

*Prior to beginning pump therapy, you will have to become competent in the use of injection therapy for controlling your diabetes. This assumes that you understand the basics of insulin treatment, before moving on to more advanced programs

 

Pump Therapy FAQs

Whether you use insulin pump therapy to manage your diabetes or are considering it, rest assured that it's normal to have questions. To help you, we have compiled a list of some of the most common questions people ask.

How long have insulin pumps been available?

Insulin pumps have been available in the U.S. since the late 1970s. Today's insulin pumps, however, are much more advanced than early models. Modern pumps use the latest microchip technology to regulate insulin delivery and provide safety checks.

How safe are insulin pumps?
Insulin pumps are proven to be safe. They have been used by thousands of people around the world for years with few complications. And today's technology makes them even better. The computer systems on today's pumps perform continuous safety checks.

What are the advantages of an insulin pump?
The biggest advantage of an insulin pump is that it can help you better manage your blood glucose level. In addition, it can provide you with lifestyle flexibility-you can travel, exercise, work or eat without worrying about injections and when the insulin will take affect. Health advantages may include lower HbA1c, fewer low blood glucose (hypoglycemic) reactions, the reduced likelihood of diabetes-related complications (heart and kidney disease, vision loss and nerve damage), and improved physical and psychological well-being.

What are the disadvantages of an insulin pump?
Some people say a disadvantage of an insulin pump is that you are attached to the device 24 hours a day. Others say that pump therapy can be demanding because you have to change insulin cartridges and infusion sets. Another disadvantage for some people is that insulin pump therapy requires blood glucose testing at least four times every day.

What is it like wearing a pump 24 hours a day?
Because today's pumps are about the size of a personal pager and weigh only a few ounces, many pump users forget they're wearing an insulin pump. During the day, you can clip it to your pant or skirt waistband or put it in a pocket. Some women even wear the pump in their bra. You have choices at night, too. Some people clip the pump to their pajamas, while others put it in a pocket or under their pillow. Many people simply lay the pump next to them.

What type of insulin is used with a pump?
Your health care professional will prescribe the insulin that is appropriate for you. Some important points to remember about insulin pumps and insulin include:

  • Insulin pumps use only short-acting insulin.

  • People using long-acting insulin will no longer will need it after they begin using an insulin pump.

  • Why? An insulin pump delivers a continuous supply of fast-acting insulin.

  • Short-acting insulin has more predictable absorption than intermediate or short-acting insulin, so your blood glucose levels are better controlled.

If I use an insulin pump will I automatically have good control of my blood glucose level?
Good control (or "tight" control, as you'll hear many people say) requires a balanced approach. An insulin pump certainly will help you control your blood glucose level, but eating properly, monitoring your blood glucose and exercising regularly are equally important. The pump doesn't take care of your diabetes, you do.

Besides a pump and insulin, what other supplies does pump therapy require?
You'll need infusion sets, cartridges for the insulin, batteries, skin cleansers, and blood glucose monitoring supplies.

How much do supplies cost?
If you have traditional insurance, which typically pays 80 percent of expenses (i.e., an 80/20 plan), you'll pay approximately $30 every month for supplies (the insulin itself is extra).

 


 

  
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