Diabetes: Choosing the right Insulin

Choosing the right insulin

Teenager Obesity Risk over developing type 2 diabetes 

Diabetes is seen as a global health problem that usually troubles the elderly at 60 or above.  However, in Hong Kong, we are experiencing the tendency of people to suffer from obesity at a younger age.  Diabetes is happening at a younger age as well.   Obesity and diabetes have a solid correlation because when the body fat inside the body continues to accumulate, it affects insulin sensitivity and the ability to control the blood sugar level.

Although diabetes is not a terminal disease, it is still a chronic one.  People who suffer from diabetes need to have long term medication or insulin injection to control their blood sugar level.  If the sugar level is out of control (constantly at the high side or fluctuating), this increases the risk of developing complications such as cardiovascular diseases, diabetic neuropathy, kidney failure, vision loss and diabetic foot that in certain cases would need amputation etc.

Even when society is aware that obesity is one of the leading causes of different types of chronic disease, people are still unable to maintain a healthy diet and lifestyle.  Once diabetes has been diagnosed at the age of 20, and 30’s, controlling the blood sugar will become their life mission.


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How to know if I am diabetic?
How to know if I am diabetic?

How to know if I am diabetic?

People are now more conscious about their health and are willing to conduct health assessments periodically and many incubating chronic diseases can be discovered early.

A person can run a fasting glucose test or Hemoglobin A1C(HbA1c) to determine whether they have diabetes.  Suppose the result of HbA1c (reflects the latest 3-month average blood sugar level) exceeds 6.5% while fasting glucose index reached 7.0mmol/L, or glucose level after a meal (usually measured 2 hours later) reached 11.1mmol/L, in that case, it can be concluded that patient is diabetic.

People who have mild diabetes can try to control the condition by losing some weight by adjusting their diet and lifestyle.  However, the success rate varies; for elder patients, as their physical condition have gradually deteriorated, if they do not receive appropriate medication early, their condition will only get worse.

Administering Insulin before meal leads low sugar level?
Administering Insulin before meal leads low sugar level?

Insulin before meal leads to low sugar levels?

Due to impaired pancreatic function, diabetic patients cannot secrete insulin normally to regulate their blood sugar. When patients cannot control blood sugar by improving their diet and living habits alone, to prevent blood sugar from rising, taking medicine or administering insulin injections are the recommended solutions.  However, traditional insulin injections can easily cause hypoglycemia in patients.

Hypoglycemia risk in Diabetes patients
Hypoglycemia risk in Diabetes patients

Hypoglycemia in Diabetes patients

Usually, patients must take hypoglycemic drugs or inject insulin before meals to regulate the rapid rise of blood sugar levels after meals. However, if the intake of drugs or injection doesn't match the time of eating, or the patient took his meals a long time after his medication, the patient is prone to hypoglycemia (Too low in blood sugar).  The symptoms of hypoglycemia include hunger, a fast heartbeat, shakiness and weakness.  For those more severe cases, confusion, dizziness, fainting would happen.

Nocturnal hypoglycemia

The most worrying is when hypoglycemia happens at night while sleeping, serious problems might occur.  For an elderly or a person living alone, if they administer the injection before sleep and once the drug effect kicks in, this is extremely dangerous. Patients are unlikely to recognize the symptoms or awaken during an episode.  When they go to the restroom in the middle of the night while having a nocturnal hypoglycemia episode, they might faint or fall without anyone noticing.  Even if the patient lives with the family, the patient might already have suffered from a fracture, such hip fracture that would impair their daily life.   

Traditional intermediate-acting insulin and its risk
Traditional intermediate-acting insulin and its risk

Traditional intermediate-acting insulin have a higher risk of hypoglycemia

Some patients felt inconvenient while using the traditional intermediate-acting insulin, which requires two injections per day. They are facing the risk of hypoglycemia that is caused by the peak action time.  Suppose a patient is using the short/rapid-acting or premixed type, doctors usually need to remind the patient to make sure their three meals a day are regular in time and portion.  However, in reality, patients need to eat outside. Sometimes, the surrounding environment or the public restroom hygiene is unsuitable for administering the injection. While for those who need to work in shifts or go overboard, the irregular working schedule or jet lag also leads to unstable injection.

One challenging issue to patients is to maintain an average intake of three meals a day.  In addition, when they are experiencing mild hypoglycemia, they will take extra sugar to regulate their blood sugar level, which would affect the overall blood sugar control.   As the patient condition worsens, the dosage of insulin will also be increased. As a result, hypoglycemia will be more likely to occur in the future, which forms a vicious cycle over time.

Type of work might not be suitable for traditional insulin injection

Certain types of patients find traditional insulin injections unsuitable, such as workers who need to work in high-altitude scales on construction sites. Their all-day work and lunchtime are on the scales in mid-air. Further, scaffolding workers who need to climb high and low all the time find that injecting traditional intermediate and long-acting basal insulin also risks hypoglycemia. For them, not only they might suffer from psychological stress, but having hypoglycemia would also pose a life-threatening risk. For this type of patient, they are recommended to try out the ultra-long acting basal insulin analogue which only requires one injection per day and avoid having peak action time of the drug that minimizes the chance of having hypoglycemia.

Ultra-long acting basal insulin analogue
Ultra-long acting basal insulin analogue

The benefit of ultra-long acting basal insulin analogue

The benefit of ultra-long acting basal insulin is that it can provide steady insulin for a long time with no fluctuating peak effect. Thus the chance of having hypoglycemia is low. In addition, this drug is only required once per day. The time for administration is also flexible. It only requires 8 hours apart between two injections. With the mentioned benefit, almost any patient that requires insulin medication is a suitable candidate.

Understanding Hypoglycemia
Understanding Hypoglycemia

What is hypoglycemia?

If a person finds their glucose level lower than 4mmol/L, it means they are currently suffering from hypoglycemia.  However, the symptoms are not necessarily the same among people.

For example, elderly with diabetes who have recurrence hypoglycemia, even though their blood sugar level is below 4mmol/L, might not show any symptoms such as palpitation, hand tremors, cold sweats etc... Still, they might go directly into a coma, and this situation is actually more critical. On the other side, for some patients, even their sugar level is above 4mmol/L, they might experience low blood sugar symptoms, such as hunger or sweating in cold.  Under this situation, patients are recommended to take candy, fruit juice, sweeties to regulate their blood sugar level quickly.


What type of insulin should I choose?
What type of insulin should I choose?

What type of insulin should I choose?

Different brands of insulin vary in onset, peak time and duration, even if they are the same type such as rapid-acting.  Always check the drug information and follow your doctor instructions.

Insulin Type Onset Peak Time Duration Method
Rapid-Acting 10-20 min 1 - 1.5 hours 3 - 5 hours Usually taken right before a meal. Often used with longer-acting insulin.
Short-acting 15-30 min 1 - 2 hours 3 - 5 hours Usually taken 30 to 60 minutes before a meal.
Intermediate-acting 1 to 2 hours 4 - 10 hours 10 to 16 hours Covers insulin needs for half a day or overnight. Often used with rapid- or short-acting insulin.
Long-acting 1.5-4 hours

6 - 8 hours (relatively flat)

20 - 24 hours Covers insulin needs for about a full day. Often used, when needed, with rapid- or short-acting insulin.
Ultra-long acting 1.5 hours Flat 42 hours Provides steady insulin for long periods.

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For any enquiry, please call +852 3420 6622, Whatsapp +852 5228 0810, or info@marinamedical.hk

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