"Scientific Wild-Assed Guess". Fast acting. Not ever if my BG wasn't elevated. R could drop me from 350 to 70 in like 1/2 an hour and Novolog works in a similar manner. I don't know for sure how it works. Perhaps there's data available since IV insulin is used in hospitals etc. but I haven't ever looked for it.
These days, I don't do it all that often. You're asking great questions but I only want to answer them guardedly...
I understand. I'm lucky enough to only rarely have a real high, and to be very sensitive to insulin so subcutaneous injection (plus if possible a walk or other mild physical exertion) brings my highs right down. So this isn't something I could see myself doing anytime soon, but I do find it fascinating.
I'm talking about what niccolo is talking about. :-)
Who seems confused? We're talking about IV, i.e. injecting insulin into veins.
But IM, which you mention, is interesting in this context too, because presumably it's a hybrid between subcutaneous and IV, because of the greater blood perfusion of the muscles as compared to subcutaneous tissues.
Interesting. And no kidding on fast acting insulins being a big improvement!
I used R and NPH from 1984 until 2008, when I got my pump and switched to Novolog.
I know IV works and have also heard of people using it, eg with a high BG and sports competitions coming up, when the insulin has to work really fast.
however, you guys have to know, we might do injections subcutaneously every day, but IV injections are a bit of a different shoe size.
first of all hygiene standards must be maintained much more religiously than with subcutaneous injections, as otherwise small amounts of wrong bugs are directly in the blood stream, with no barrier in between whatsoever. -> infections or food poisoning
also, IV injections are a bit harder to execute, as finding the vein and stuff isnt that easy, so it needs more schooling from health personnel in the beginning.
another point, patients doing IV injections need to be really aware of what they can do with that insulin, as it can kill way faster in a severe hypoglycemia. also, less insulin is needed, so miscalculations will be much worse with IV injections than with subcutaneous insulin delivery, just because all insulin comes into action at once.
and after all, you would have to know exactly when your food is digested, as any earlier insulin dosage would send you hypo immediately.
Those are all very good points Swiss and sort of why I'm leery of discussing too many details.
I am very fortunate to have huge veins, I keep my "works" in the fridge to keep it clean. I think there's also some danger that if you inadvertently shoot an air bubble in, you can end up with a potentially lethal air embolism.
yup, that embolism adds up. i am not saying IV insulin injections shouldnt be executed by patients, just trying to point out why it isnt widely spread and why doctors might hesitate to support this.
not sure wheter i will try this out or not, atm IV just scares me too much, but maybe, if i get a pro at IV once medschool progresses, i might try it too and will come to you for help ;)
Swiss, for those of us no longer blessed with youth, finding a vein (like on the back of the hand) is no problem at all :-)
This is one those discussions that prompts doctors to warn their patients to stay away from the big bad Internet…
I won’t consider IV injections because I think the danger of blood infections is too great. I have never done an IM injection but that article by Gary Scheiner makes me think I should try it. I don’t know if the syringes I own are long enough.
Agreed, IM injections are probably a good compromise, less risk but a lot of the benefits of IV. And even IM injections aside, the Gary Scheiner article is great, makes me want to order Think Like a Pancreas!
If you haven’t read Think Like a Pancreas, you should definitely order it. He also has a blog at his website and that is worth reading also: http://integrateddiabetes.com/blog/
I wouldn't recommend iv injection, there are so many issues and you have no idea how you will respond to it. Having something in your vein constantly is like having an iv line, which is very uncomfortable and which opens you to infections. The only time I've been given iv insulin was in dka at my diagnosis at which point my bg began swinging all over the place once from 240 to 40 in about 15-20 minutes. I was on iv insulin for 3 days and then began mdi when I was out of dka. I think you will only be put on iv insulin for dka or for other situations such as labor, severe illness and so on. There are also issues such as air bubbles and infections which have been mentioned. I personally don't think there is ever going to be a way of delivering insulin which mimics what the healthy pancreas does perfectly, you just can't compare what we do, even with pumps, to that response but I hope I'm wrong and that someone comes up with something better than what we have.
Agreed with most of what you write, and for me at this point it's a conceptual rather than practical issue, i.e. I have no intention, or need, for IV delivery. And IM seems like a safer alternative, with many of the same benefits, even if I did.
While I agree perfection is an elusive goal, at least in theory an artificial pancreas could actually improve on a real one. And even that hypothetical aside, no need for the perfect to be the enemy of the good, and almost by definition in ten years things will have improved relative to what we have today.
Blog looks great. I'm still working my way through Pumping Insulin, but I think Think Like a Pancreas will be next on my D reading list.
I would love to have the answer to this question... but I gotta say, I'm glad we do not inject intravenously. I had an awful needle phobia when my son was diagnosed and while I have managed to get past that, I'm not sure I could have done so if I had to learn to do IV injections.
I haven’t read all the posts. But an alternative safer approach to rapidly bring down blood sugar is to inject into muscle rather than fat. Enhanced further if 1 can then exercise that muscle.