I was writing the same book at the same time. We were both typing and both came up with IV administration independently.
You just hit the reply button first !
I have experience in such matters but Its frowned upon to talk of it. It is a great option but its the whole messy vein issue that gets in the way of regular use. As far as insulin pumps there is the portal vein i think that is near the liver that is best for inserted devices for insulin if I remember correctly.
Hmm, I find I’m spending most of my time reading your posts. We have very similar interests.
Commonly known? By whom? Between 4 and 5 hours is complete action time with peak effect at 1 to two hours, at 5 hours the half life is reduced to zero and it ends. You may want to recheck that, even nph wears offbin 6 hours, of course you may be different but those are the standard deviation. The only thing she is misinformed with is that many of us after 40 years of injecting insulin have delyed onset. The problem is quite well known in people who have this disease for a very long time and many doctors must wait until a paper is written on the subject to ‘know’ it. Where we have seen it decades before because we live with it.
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That’s right.
I have been in the advocacy section stuck on the idea their are 7.5 million of ‘us’ in the US alone and we don’t need ‘them’.
Organizing people is not an easy task. My brain hurts. I got to go chill.
LOL…for arguments sake. Approximately 1.25 million type 1’s in the US and about 30 million type 2’s and an untold amount prediabetic.
The amount of type 1’s did vary depending where you looked, but most have settled on this number now. The type 2 figure can is still very much all over the place. These were pulled from the ADA.
I know nothing about Im or intravenous, I just know Fred was having an issue with it taking a long time and now Edward. I think Fred really liked Afrezza, hopefully it is still working for him. My suggestion because of that is to try Afrezza and see if it works for you.
I will quietly step out now…
to IgotT1,
IV admin of insulin may occur in hospitals but not commonly. IM admin of insulins I am not familiar with.
Let’s say a case is a hypothetical Pt BG = 950 POC with Kussmaul compensation for metabolic acidosis with blood gases showing base excess that is severely negative and a low partial pressure of CO2 in conjunction with low bicarbonate because of a forced increased respiration (blowing off the carbon dioxide, in other words) and thus the invol urge to deeply breathe (air hunger), and the daignosis is obviously osmotic diuresis resulting in hypovolemia and subsequent underperfusion of the tissue, then it’s likely treated by:
(1) fluid replacement (lactated Ringers or 0.9% saline then later changed to 0.45% saline to match losses due to osmotic diuresis was the common protocol); and (2) You never give this Pt bicarb, 3. use either fast-acting insulin given SLOWLY as replacement ONLY AFTER initial volume resuscitation is complete, probably not as a bolus, but given all or mostly all by adding to a new IV for slower drip. (4) Probable supplement K and also add a little dextrose to IV when glucose falls to 200 mg/dL to stabilize and prevent a glucose crash downward.
This scenario is one every T1 ought to know because it’s very common. Emerg Dpt staff know it well. DKA normally ends up well.
Loop should autocorrect a low without sugar injection. It just kinda backs off on the insulin to bring things back up into range. But, you should get used to a pump before trying Loop. Pumps have certain dangers, like severe drops in BG. Pumps take some getting used to. You have to use a sensor first. You could inquire about a Dexcom sensor as a starting point. No danger there.
IM is said to be good for corrections. Poor for bolus, because of the uneven predictability of absorption. A predictable 2 hour onset may be prefered.
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Interesting. i’ve never heard before.
The guy I used to know who was super knowledgeable about this disappeared…maybe 4 or 5 years ago. His name was Dave-something-or-other if anybody sees him over at Fu, you should let me know. He once was gonna experiment with IV insulin and we started posting literature back and forth and then a troll threatened to sue me for copyright infringement and I might have gotten kicked off the forum for a period. I’ve never seen him since. He was hardcore.
I have been type 1 since 1958 (age 15) and somehow survived NPH Lente once a day for many years. I am now using a Dexcom G6 and Fiasp (injected with a Medijector, remember those?) and Afrezza as bolus, and Tresiba (10u/day) as basal. I inject Fiasp (4u) in the abdomen as I start breakfast at ~ 7:00am (27 carbs, 550 calories, 19gr fibre) with a BG usually about 100 to 120, and that peaks at about 140 around 10am.
For lunch (usually 23 carbs, 550 cal at noon) the bolus is 4u cartridge of Afrezza (it actually seems to correspond to a 2u dose) and that keeps me fairly flat with a bit of snacking, which is fine by me, until light dinner at 7 or 8pm that usually comprises 8 to 10 carbs (usually fish or chicken) and 700 to 1200 calories. I cover dinner with a Fiasp dose of 1 or 2 units, followed by the daily dose of Tresiba. I occasionally get a declining glucose level at 2 or 3am, but the Dexcom receiver wakes me below 80 and a glucose tablet or two gets me back to sleep quickly.
The occasional rapid rises (usually caused by overcorrecting declining glucose levels below 70, which happen) are addressed by Afrezza, which really does have an effect within 15 minutes.
Just my experience.
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Nessus1, wow that is complicated. It seems you have worked out a paradigm to keep control. Kudos to you!
Aeonn Good information. It emphasizes the point that insulin absorption is easily influenced by hydration.
IV insulin was/is used for what is called insulin clamp studies for dose distribution, insulin sensitivity studies etc. in normal and T1 patients. One iv would be for insulin and the other iv would be glucose or glucagon. I don’t know if iv insulin is used in the ICU for T1. And don’t forget iv insulin was used for shock therapy in mental institutions.
I was diagnosed in 1964 - November it will have been 55 years. I don’t recall what insulins I was on, certainly Regular and either NPH or Lente. And I remember that you had to draw them up in a syringe in a specific order. I started MDI in 1980 along with home glucose monitoring when I read Bernstein’s article in NEJM. It was the beginning of being in control. I have been pumping for some 25 years now, and it was a significant upgrade along with CGM. So that is my background.
What everyone is discussing here is not how fast the insulin is working, but absorption in different sites. That is why spritzing in the nose is so great, a lot of blood vessels and the nasal epithelium absorbs the insulin very quickly. The big improvement made in the genetically engineered insulin was structuring the molecules so they did not for hexamers, which would slow absorption and binding to the receptor. The regular insulin of old is much slower acting than todays regular insulin. The half life or how long the insulin hangs around in the body is a characteristic of the insulin molecule, complicated by absorption differences.
Injection into the muscle works faster because of circulation, and degree of insulin resistance. Also body fat can complicate absorption. If you would bolus your insulin by subQ injection instead of the pump it will be absorbed faster. The insert may go into fat, form a fibrotic clot, be bent to prolong infusion, etc.
So these are some things to think about. More later.
Mike
The myth I believe is thinking that for us TID and Lada on insulin that we can ‘catch’ the BSL rise reliably with ‘fast-acting’ insulin. We have courses like DAPHNE which seem to promise a method to work out what we want to eat (rather than need to eat) and then just dose for it. And the insulin profile picture you can google show the curve effect of each insulin type’s onset, peak action and duration (. But… these are just averages). So for one person a particular short-acting insulin may start working in say 30 minutes, 45 minutes in another person and 55 minutes in someone else. No wonder we get disappointed and try to either take insulin maybe 40 minutes or more before the meal in some cases or like the OP, try to take the bSL rise by going the intramuscular route or look at using Affrezza which might work quickly but will it last the distance?
What about trying rather to match the type of food and its bsl effects to the insulin in question. (or choose another insulin to get that match?0
This is precisely what the low carb diet approach of Bernstein offers. Little amount of carb and more protein, part of which the liver converts slowly to glucose, to appear as a lower, drawn out bsl rise nearer 3 hours plus. As Bernstein and his adherents find Regular insulin is the go for that. Or on a pump or with split doses via MDI with perhaps the quicker acting insulins.
And you only need to look at Pediatrics May 2018 Management of Type One Diabetes with Very Low Carbohydrate Diet Authors Lennerz and Ludwig to see the absolutely great HBAICs, minimal BSL variations and low hypo rate.