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Helping the body do what it can't do naturally
What happens when you eat a piece of chocolate cake? The pancreas will release a bit of insulin to help break the sugar down quickly and regulate blood sugar levels. Insulin is a hormone that keeps complex sugar molecules (glucose) in check. In a healthy body, the sugar concentrations never get too high or too low to cause problems. But if your pancreas fails to do its job, you develop Type I diabetes. If insulin production becomes erratic because of health or lifestyle issues, you develop Type II diabetes. In either case, insulin must be injected or oral medications must be taken to keep blood sugars stable and avoid dangerous or life-threatening complications.
How to buy insulin at PlanetRx
To purchase insulin, please go to the Pharmacy page, click on the Fill Prescription link, and follow the instructions. PlanetRx can call your doctor for verification if you don't have a prescription; be sure to select the option "PlanetRx will contact my doctor," and supply your doctor's phone number.
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Why Do You Need Insulin?
Sugar in the blood comes from two sources: your diet and your liver. Your liver is capable of producing sugar from glycogen and protein. This is what enables you to have sugar in your blood even when you aren't eating (such as overnight). High levels of sugar in your blood, such as after eating, are lowered by insulin's action. You always need some amount of insulin in your body at all times.
Insulin is a hormone that works to lower sugar by addressing both sources of sugar. Whether or not you need insulin, and how much you need, has a great deal to do with what type of diabetes you have. Type I diabetics do not make any insulin. Thus the injected insulin takes the place of what the body cannot do naturally. Type II diabetics make some insulin, but not enough. Some Type II diabetics need to take insulin in order to supplement the insulin their body makes.
Together, you and your doctor should determine whether insulin therapy is right for you.
- In most cases, insulin treatment lasts a lifetime.
- For those who are insulin-dependent, it is absolutely essential that it be taken regularly.
- There are a number of lifestyle changes that can reduce the amount of insulin you require. However, do not make any reductions in your dosage without the consent and approval of your physician.
- A number of conditions can affect your insulin levels and needs. Please consult the warnings section and, of course, your doctor to learn more.
- NEVER embark on insulin therapy without the guidance of your doctor.
- NEVER alter your insulin therapy without the guidance of your doctor.
- The accuracy of the drug depends wholly on the individual and how accurately and efficiently he or she can assess the dosage needed.
Overview of What Affects Insulin Absorption
The type of insulin is a major factor.- Lispro, a fast-acting insulin analogue, is designed to be the most quickly absorbed.
- Regular insulin, another fast-acting insulin, has fast absorption, but not as fast as liapro.
- Neutral protamine hagedorn (NPH) and insulin zinc suspension (Lente) are intermediate-acting insulins, which are absorbed more slowly than fast-acting insulins.
- Extended insulin zinc suspension (Ultralente) are long-acting insulins, which are absorbed the slowest.
The site of injection causes absorption to vary.- The abdomen provides the fastest and most consistent absorption of insulin.
- The upper thighs, outer thighs, and back of the upper arms provide slower sites for insulin absorption.
- The buttocks provide the slowest absorption compared to the above sites.
- Injection depth at these sites also causes insulin absorption to vary. If you inject insulin into a muscle you will get very rapid absorption.
But there are less quantitative factors on insulin absorption.- An increase in blood flow to an injection site will increase the rate that insulin is absorbed. So, excercise will cause insulin to be absorbed more rapidly, because blood flow has increased to the exerted muscle groups. You will need to either inject less insulin or eat more carbohydrates after excercise. But also rubbing the injected area increases blood flow, and hence, absorption.
- Repeatedly injecting into an area can cause the skin to harden in response. This causes insulin absorption to be erratic. To avoid this, rotate injection sites.
- There are many other factors that can affect insulin absorption more subtly, such as body temperature and stress.
- THE MORAL: Insulin absorption varies, and the best way to find out how insulin is affecting your body--TEST YOUR BLOOD GLUCOSE LEVELS.
Getting Your Insulin
- Insulin is a nonprescription drug and should be available at most drugstores and pharmacies. Only U-500 concentrations require a physician's prescription.
- The U.S. is unusual in that insulin is available without a prescription. If you intend to travel outside the country, consult your doctor and get a prescription in case you need to obtain more insulin while travelling.
- Insulin prices vary from pharmacy to pharmacy. Be sure to check prices.
- Some insurance companies have special relationships with particular pharmacies. Check with your insurance company to see if such a program exists.
- Ask your pharmacist whether buying in large quantities lowers the price.
- Always check the expiration date of the insulin you are buying to make sure you will be able to use it all before it expires.
- You may want to find a pharmacy that delivers, particularly if you don't have access to a car or are home/bedridden.
- To make sure that you are always purchasing the right preparation of insulin, bring along a used, empty bottle to visually check and compare your purchase.
Lifestyle Choices Are Affected
- Weight gain is a common side effect of insulin use. This means that the insulin is working, but you may need to alter your diet by limiting calories or increasing activity.
- Alcohol can alter insulin response.
- Smoking can require a significant increase in insulin requirements. Consult your doctor and be absolutely honest about the number of cigarettes you smoke.
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How Insulin Regulates Blood Glucose Levels
- Sugar in the blood comes from two sources: your diet and your liver.
- Your liver is capable of producing sugar from glycogen and protein. For this reason, you can have sugar in your blood even when you aren't eating, such as at night while you are sleeping.
- Insulin works to lower sugar levels by addressing both sources of sugar in the blood.
- Insulin helps remove glucose in the blood by shuttling the sugar into cells so it can be used as energy.
- Insulin also shuts down the liver's sugar-producing activities, especially at night.
- However, insulin does more than just control blood sugar.
- Insulin tells the body to store extra sugar and carbohydrates as fat.
- Insulin helps shuttle amino acids, the building blocks of protein, to the muscles in the body.
Insulin, Once Inside the Body.
- Insulin is a naturally occurring substance that a normal human body makes in adequate amounts.
- Diabetics either do not produce enough insulin or do not produce any at all. Injectable insulin is used as a replacement for the body's own naturally produced insulin.
- After being injected into the body, insulin gets into the bloodstream.
- The effects of insulin are not immediately felt.
- Time to onset of effectiveness can range from 15 minutes to an hour, depending on the preparation.
- The injected insulin deals with sugar in your blood in exactly the same way that human-produced insulin from the pancreas does.
How to Store Insulin
- Regular insulin degrades most quickly at room temperature, lasting only one month.
- NPH and lente forms can last up to 24 months at room temperature.
- Expired insulin should never be used -- regardless of whether it has been opened or not, at room temperature or in the refrigerator.
- To get the most out of your insulin, store unopened bottles in the refrigerator, not the freezer.
- It is generally OK to store opened bottles of insulin at room temperature, as long as the bottles are used within a month.
- Bottles kept at room temperature beyond a month will begin to lose their strength and will risk becoming contaminated.
- If you need to use refrigerated insulin immediately, try to warm up the syringe by rolling it between your palms prior to injection.
- Cold insulin can be uncomfortable when injected.
- Do not leave insulin in excessive heat, light, or cold. Extreme heat could degrade the activity of insulin. Exposure to 100 degrees Fahrenheit will cause insulin to degrade. Extreme cold could cause insulin to precipitate and clump.
- Excessive shaking and jarring also has the possibility of degrading insulin activity.
When Should You Use A Different Vial of Insulin?
- Your insulin vial has changed color.
- Your insulin is clumping even after you mixed it.
- Your insulin vial looks frosted from protein crystallization.
- You use your insulin and do not notice the usual lowering effect of your blood glucose.
- During all of these events, it is wisest and safest to switch to a new vial of insulin to ensure you are receiving appropriate treatment of your diabetes.
Tips on Injection Sites and Techniques
- The site of injections can affect the absorption and time to onset of effectivity. Consult your doctor for the differences among injection sites.
- Insulin is injected into fatty tissue, ideally, at the same depth each time.
- Try to keep a consistent technique.
- Absorption is fastest when insulin is injected into the abdomen.
- Absorption is slowest when insulin is injected into the legs, arms, and buttocks.
- Exercise can quicken the time to onset of effectivity.
- If you have been exercising a particular limb, or plan to, keep in mind that injecting in that limb will quicken time to onset of effectivity.
- Using an injection site too much can cause the tissue in that area to scar. Scarred tissue can make it difficult for the body to absorb insulin.
- Alternate injection sites and space them approximately one inch apart.
Be Careful With Your Dosage
- Always carefully check that you are injecting the correct preparation of insulin before you begin.
- If you inject a large dose of insulin, eat appropriately! Large amounts of insulin in your body with no food to work on can send you into hypoglycemic shock.
- Try to observe how different dosages make you feel.
- The aim is to be able to know how many units you need almost intuitively.
Preparing Yourself for an Injection With a Syringe
- Inspect your insulin. Are there clumps? If so, use another vial.
- If you are using mixed preparations of insulin or intermediate acting insulin, you must first "mix" the preparation. But this does not mean you should shake it! Bubbles in the insulin can get into the syringe and produce inaccurate dosing and cause discomfort if injected.
- Roll the vial between the palms of your hands. You may use the same method to warm up recently refrigerated insulin, as cold insulin can be uncomfortable to inject.
- Wash your hands with soap and water.
- Because all insulin is in suspension (meaning not completely or evenly dissolved in the fluid), you must agitate the bottle gently. Failing to agitate the bottle before use can result in dosages of uneven strength. Wait until foam or bubbles subside after agitation.
- Clean the rubber stopper on the vial with alcohol.
- Touching only the barrel and the plunger, take the clean syringe and measure out an amount of air into the barrel that is equivalent to the volume of your dosage. Why? You want to prevent creating a vacuum in the vial, so by injecting an amount of air into the vial that is equal to the amount of fluid you will be drawing out, you can prevent the vacuum effect.
- Inject the air into the vial. Turn the vial upside down until the entire needle is covered by fluid.
- Draw out the correct dosage. Remove the needle from the vial.
- Tap the barrel of the syringe to loosen any air bubbles that might be clinging to the side of the barrel and expel the air bubbles.
Injecting Insulin
- With one hand, pinch a fold of skin at the injection site. Why? You want to pull the skin away from the muscle to avoid injecting the insulin into the muscle. Muscle absorbs insulin faster than tissue and you may become hypoglycemic.
- There are a number of suggestions when it comes to deciding at which angle to insert the needle. Some suggest holding the needle so that it stands perpendicular to your skin and then inserting. Others suggest pushing the needle at anywhere from a 45-degree angle to a 90-degree angle to your skin. Obese patients require an angle closer to 90 degrees, and thin patients require an angle closer to 45 degrees. Poke around --literally! Experiment and choose the position that is most comfortable for you.
- Before injecting the contents of the plunger, pull the plunger back slightly to make sure you haven't hit a blood vessel. If blood appears in the syringe, remove the needle and try another location. If not, proceed by depressing the plunger to complete the injection.
- When finished, remove the needle quickly.
- To avoid bruising, immediately apply pressure to the insertion site.
- Recap the needle carefully to avoid accidental sticking.
- Record the injection site so that you can effectively alternate your injection sites to avoid excessive soreness and scarring.
- Remember: Different injection sites produce different times to onset of effectivity. Consult the Insulin section for a brief description of the different sites.
Mixing Your Own Insulin
Before preparing your own insulin concoctions, you MUST seek the advice of your healthcare professional to see what ratio of the various insulins is best suited to your lifestyle and physical needs. But here is some information you should know before mixing:- Regular and NPH insulin can be mixed to any proportion desired, and lasts one month at room temperature or three months in the refrigerator.
- Regular and lente insulin should be used immediately if combined because lente will cause some of the regular insulin to crystallize.
- Lente and ultralente can be mixed in any proportion desired, and can last up to 18 months in the refrigerator.
- Remember: when drawing the different insulins into your syringe, always draw up regular insulin first. Then draw up the Lente or NPH. If you draw up the Lente or NPH first, you will contaminate the regular insulin and possibly change its rate of absorption.
- Even though insulin can have a long shelf life, it can also become contaminated within that time. And if one bottle of insulin is contaminated, mixing it with another will definitely contaminate that one as well.
- If the insulin mix is causing strange fluctuations in your blood glucose levels, or causing you to feel funny, see your healthcare professional. A change in your insulin mix may be required.
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Hypoglycemia Happens
Hypoglycemia, low blood sugar, may occur if you have diabetes. Don't immediately blame yourself for episodes of hypoglycemia; in managing your diabetes, you are attempting to control a very complex, intricate, and inconsistent system. Hypoglycemic episodes per week can be avoided. If you are experiencing hypoglycemic episodes, contact your healthcare provider to see how you can prevent hypoglycemia.
Generally, if your blood sugar drops below 50 to 55 mg/dl, you are considered hypoglycemic. Before you decide to treat your hypoglycemia with glucose tabs, gels, or other sugars, you must take (if possible) a blood glucose test to determine how much sugar you need. Symptoms will vary from person to person, but here are some hypoglycemia warning signs to watch out for:
- Rapid heartbeat
- Excessive sweating
- Muscle tremors
- Anxiety
- Hunger that can be extreme
- Irritability
- Vertigo
- Headache
- Blurred vision
- Confusion
- Convulsions in extreme cases.
- Unconsciousness in extreme cases
- Lethargy
- Fatigue
Hypoglycemia Unawareness
It is possible to have hypoglycemia and not experience any of the early warning symptoms. You may experience only the mental symptoms, and none of the physical symptoms. - Hypoglycemia unawareness was originally thought to be caused by nerve damage from living with diabetes for many years. This causes an absence of epinephrine release in response to low glucose levels.
- It is now thought that hypoglycemia unawareness may be caused by frequent episodes of low blood glucose, without pre-existing nerve damage. Episodes of hypoglycemia seem to lower the glucose levels at which epinephrine release, causing hypoglycemia without any of the physical symptoms.
- Hypoglycemia unawareness tends to affect people who control their glucose levels stringently. It also tends to affect pregnant women.
- An interesting comparison occurs in people who do control their blood sugars poorly. These people experience physical symptoms of hypoglycemia at much higher blood glucose levels than the average diabetic person.
If you have hypoglycemia unawareness, you need to consult your healthcare provider. Together you can develop a treatment regimen to ensure that you have adequate blood glucose levels and avoid situations where you might have low blood glucose. Keeping blood sugars at adequate levels to avoid hypoglycemia for days to weeks has been shown to restore sensitivity to hypoglycemia.How To Treat Hypoglycemia
- Get carbohydrates, "quick sugar," immediately. Carbohydrates can come from glucose tablets, non-diet soda, hard candy -- anything rich in sugar.
- Do not use carbohydrate sources that are also high in fat such as ice cream, chocolate, or cake. The excess fat can inhibit the absorption of carbohydrates.
- Keep your convenient glucose sources in your purse, pocket, car, or any other place that is quick and easy to access.
- Treat hypoglycemia correctly. Do not overeat carbohydrate sources or eat too little carbohydates.
- You should consume about 10 to 15 grams of carbohydates. Look at the nutritional labeling of the products you buy to determine how much you should consume to get 10 to 15 grams of carbohydrates. Do this ahead of time, not when you are experiencing hypoglycemia, because you might be tired and not thinking clearly.
- Below are some food equivalents for 10 to 15 grams of sugar:
6 large jellybeans (not the tiny gourmet kind)
4 to 7 LifeSavers
2 tablespoons of raisins
2 teaspoons of table sugar or honey
6 to 8 ounces of skim milk
Half a can of soda (not diet)
Note: "Quick sugar" is only a temporary solution. You should eat a small snack such as crackers or 1/2 a sandwich after eating "quick sugar" to maintain blood sugar levels. - Remember that it can take up to 20 minutes before carbohydates are efficiently absorbed into your bloodstream. If after 30 minutes you still feel symptoms of hypoglycemia, take another 10 to 15 grams of carbohydrate. Repeat this process until your symptoms are gone.
- If after two attempts of consuming sugar your symptoms have not disappeared, seek medical attention.
- It may be difficult but you must resist the temptation to eat more carbohydrates. Overeating can lead to hyperglycemia.
Educate Others
- Please educate your friends, family, and co-workers about what to do if you become unconscious.
- If you do become unconscious or so debilitated that you cannot ingest glucose tabs or food, you need glucagon, an injected drug that counteracts hypoglycemia.
- Instruct friends, family, and co-workers to take you to the hospital and/or call for an ambulance. Remind them that these are life-and-death situations.
- If you cannot receive medical attention immediately (in the case of a long ride to the hospital or a wait for an ambulance), instruct friends, family, and co-workers to place some glucose gel or cake frosting between your cheek and gums and to massage the outside of the cheek to help the gel or frosting dissolve.
- Make sure friends, family, and co-workers do not attempt to force sugar or food down your throat! You can choke!
- ALWAYS, no matter how well you manage your diabetes, carry glucose tabs, gels, or their food equivalent with you at all times and let those who are around you know exactly where they can find them.
Hyperglycemia Unawareness
Hyperglycemia, high blood glucose levels, is thought to be responsible for most of the chronic complications associated with diabetes. So you monitor your blood glucose levels diligently, and dutifully inject your daily regimen of insulin to prevent hyperglycemia. You should be aware of two phenomena that could cause hyperglycemia even though you are sticking to your insulin and testing routine. They are called the Somogyi Phenomenon and the Dawn Phenomenon.
Somogyi Phenomenon- The Somogyi Phenomenon can be thought of as hyperglycemia as an overresponse to hypoglycemia. As a consequence of low blood glucose levels your body will release counterregulatory hormones (cortisol, epinephrine, glucagon, and growth hormone), triggering your liver to release glucose into your bloodstream. This could lead to hyperglycemia.
- Often the Somogyi Phenomenon is due to a relative overdose of insulin which produces hypoglycemia, triggering a subsequent rebound hyperglycemia. This could either be from simply taking too much insulin, or from taking the normal dose of insulin, but not consuming enough food. A red flag is raised for the Somogyi Phenomenon if you cycle rapidly between low and high glucose levels, experience excessive hunger and food intake, in combination with weight gain.
Dawn Phenomenon- Before you wake up in the morning your body prepares itself by releasing counterregulatory hormones which causes the liver to crank glucose into your bloodstream. If you did not have diabetes, your pancreas (in the early morning) would release a surge of insulin to counter this rise in blood glucose. But without insulin you may become hyperglycemic from the rise in blood glucose.
- So the Dawn Phenomenon is due to lack of insulin.
Morning Hyperglycemia: Dawn or Somogyi?- You wake up in the morning and test your blood glucose levels, and they are high. What could be the culprit, the Somogyi or Dawn Phenomenon? It is important to know because the Somogyi Phenomenon requires that you take a lowered dose of insulin, while the Dawn Phenomenon requires that you take more insulin.
- The only way to know for sure is to test your blood sugar levels around 2 AM to 3 AM. If the levels are normal, you are most likely experiencing the Dawn Phenomenon. If the levels are low, you are most likely experiencing the Somogyi Phenomenon.
- Talk to your healthcare professional about your findings, and the two of you can determine the appropriate insulin dosing for your needs.
Insulin Allergy
It is not uncommon to develop an allergy to insulin. Insulin allergy is more common from beef or pork insulin than human, but any insulin can produce allergy. Allergy occurs when IgE antibodies (the same antibodies that are responsible for hay fever) are created against insulin or some component of insulin preparations.- Allergy is most likely from beef insulin because it is the most different from human insulin.
- Pork insulin differs less from human insulin, so there is less chance that it will produce an IgE response.
- Human insulin can even cause allergy (even though it is the least likely to cause allergy), because it is not exactly "human insulin." It comes from bacteria programmed with the human insulin gene, but it is still slightly different from insulin you would find in a human pancreas. So, it can trigger an IgE response.
- The noninsulin components of insulin preparations, such as protamine, can also cause allergy.
- Then there are the minute concentrations of contaminants that were not all removed during the insulin purification process. These slight contaminants could also cause allergy.
The symptoms of allergy come in two categories: local and systemic. Local symptoms only involve the site of injection and do not spread to the rest of the body. They are minor (though annoying), do not affect areas besides the site of injection, and are not life-threatening. These symptoms can last a few days to a couple of weeks.
Local Allergy Symptoms:- Swelling
- Itching
- Redness
Keep in mind that local inflammatory responses are not always due to insulin preparation allergy. They could also be the result of infection, allergy to some other product besides insulin (such as lotions), or trauma caused by less ideal injection techniques.
Systemic reactions are serious and could possibly be life-threatening. Systemic reactions spread beyond the site of the insulin injection and could affect the entire body. These are often seen in diabetic people who stop insulin therapy then resume it.
Systemic Allergy Symptoms:- Hives or rashes in areas beyond injection site, possibly spreading to the whole body
- Difficulty breathing
- Wheezing
- Rapid heartbeat
- Sweating
- Anaphylaxis leading to a potentially deadly drop in blood pressure
If you believe you or someone you know is experiencing a systemic allergic reaction, SEEK MEDICAL ATTENTION IMMEDIATELY. Epinephrine injection is required to prevent a deadly drop in blood pressure. Also, if you experience a severe allergic reaction to your insulin, you will need to undergo insulin desensitization treatment. Again, consult your health professional immediately.
Insulin Resistance
Insulin resistance is clinically defined as requiring 200 or more units of insulin per day to achieve glucose control. To understand how insulin resistance develops, you need to understand a few basics on how insulin works. Insulin (from injection or the pancreas) enters the bloodstream and finds insulin receptors on the surface of cells. You can think of insulin as a puzzle piece and the receptor is the other piece that fits insulin. The binding of insulin to its receptor causes the receptor to signal many things (many of which are not fully understood). But one thing for sure is that this insulin-receptor binding causes the cell to take up glucose from blood.
You MUST consult a healthcare professional if you find that you are requiring higher doses of insulin to regulate your blood sugars.
Insulin resistance can be thought of as anything that prevents insulin from signalling the cell to take up glucose. Resistance can be divided into three broad categories:
Prereceptor- Resistance could be caused by mutated insulin that is defective. It no longer can bind to the receptor. Think of mutation as changing insulin's shape. Now insulin is a shape that does not fit the receptor or does not fit well.
- Alternatively, antibodies called IgG could bind to insulin first, preventing insulin from reaching the receptor. This is an immune response. You can think of IgG as having a shape that fits onto a piece of insulin. A puzzle has many parts that fit onto different pieces; a part of insulin fits into the receptor and another part (but it could also be the same part) also fits onto IgG. The problem is that when you have an immune response, there is so much IgG floating around in the blood that almost all the insulin is grabbed by IgG before it can fit onto the insulin receptor.
Receptor- This could be due to a mutation in the insulin receptor that reduces or obliterates insulin binding. So you can think that the shape of the receptor has changed and no longer fits the shape of insulin well.
- Another cause could be that for some reason (usually obesity) the total number of receptors has been reduced. Imagine that there are 10 receptors on a cell, for some reason now there are only 5 receptors. This change in receptor number has cut the insulin response in half. This is an ideal example and in real life there are many other factors that come into play, but it illustrates the principle.
Postreceptor- In this form of insulin resistance the insulin could bind to the receptor (there were not fit problems), but the signal that was supposed to be produced did not occur or was very weak.
- The signal produced can be comparable to TV reception.
- You might have great reception or a strong signal: the TV picture is clear and crisp, the signal to take in glucose is strong.
- You might have fuzzy reception or a weak signal: the TV picture is intermittent and snow-covered, the signal to take in glucose is weak and only causes minimal glucose uptake.
- You have no reception or the signal is non-existant: all you see on the TV is a snow, there is no glucose intake in response to receptor bind.
Insulin Hypertrophy & Lipoatrophy
Injecting insulin repeatedly into your subcutaneous tissues can cause changes at these sites. Minor damage to blood vessels can cause bruising, which will heal and is not life-threatening. If you notice blood at the site of injection, apply pressure to the site to reduce the likelihood of bruising.
Of greater concern is insulin hypertrophy of adipose tissue and lipaotrophy. These two effects are also not life-threatening but can affect insulin absorption. Both of these effects may be avoided by rotating injection sites.
Insulin Hypertrophy- Insulin hypertrophy (also known as lipohypertrophy) results in adipose tissue enlargement near the site of insulin injection. This can result in fatty, lumpy areas.
- The cause is not known but is thought to be a consequence of insulin increasing glucose absorption and fat production.
- The fatty deposits are harmless, but you may find them cosmetically unacceptable.
- If you inject insulin into a site that has hypertrophied, avoid injecting into fatty lumps. Insulin may not be absorbed effectively through them.
- Hypertrophy usually disappears or diminishes when the injection site is rotated.
Lipoatrophy- Lipoatrophy causes the fat under your skin to disappear, leaving a slight, sometimes fibrous, depression. These effects can be thought of as the opposite of lipohypertrophy.
- The cause of lipoatrophy is unknown, but it is thought to be an immunological reaction to insulin that inadvertently damages the fatty tissue near the insulin. Another theory suggests that lipoatrophy is the result of damage from repeated injections at a site.
- To reduce the chance of an immunological reaction, you can switch to human insulin. Human insulin is less likely to produce an immune response than beef- or pork-derived insulin.
- As in lipohypertrophy, depressions from lipoatrophy are cosmetic and not life-threatening.
- To avoid lipoatrophy, rotation of injection sites and human insulin are recommended.
- To reverse lipoatrophy, human insulin is often injected near the border of the depression. The rationale is that insulin's fat deposition effect will help fill the depression with adipose tissue. This process can take months to complete.
- Never inject insulin into lipoatrophied depressions, because the absorption from these sites is unpredictable.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Books
- 1. American Diabetes Assocation.American Diabetes Association: Complete Guide to Diabetes. New York: Bantam Books 1996.
- 2. American Pharmaceutical Association. Handbook of Nonprescription Drugs. 11th ed. Washington., D.C.: American Pharmaceutical Assocation 1996.
- 3. Fauci, Anthony S. et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: MacGraw Hill 1998.
- 4. Saudek, Christopher D. et al. (Baltimore: JHU Press, 1997.The Johns Hopkins Guide to Diabetes for Today and Tomorrow. Baltimore: JHU Press 1997.
Find more books on health and wellness at  barnesandnoble.com.
Articles
- 1. American Diabetes Association."Buyer's guide to diabetes products '98 (Buyer's Guide).". Diabetes Forecast; Vol. 50 10/1/1997.
- 2. American Diabetes Association."All about insulin. (Diabetes Day-By-Day, part 13). Diabetes Forecast; Vol. 47 8/1/1994.
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