AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Learn about the function of insulin, proper insulin timing and dosage, and the role of Lantus insulin. Get expert tips on taking insulin during Ramadan. | Meri Sehat

Insulin Dose And Timings

Online Consultation

Iqra Mazhar

Insulin And Postpartum

Introduction

The postpartum period refers to the time after you give birth. Your hormonal levels will be fluctuating as your body recovers from the physical and emotional toll of the pregnancy. You&rsquo;ll probably be overwhelmed by all sorts of emotions during this period.

Besides mood, these changes can affect your blood sugar regulation, particularly if you had <a href="https://merisehat.pk/disease/diabetes-gestational">gestational diabetes</a>. However, you can have postpartum diabetes even if you did not have gestational diabetes. 
&nbsp;

Around 2-10% of all pregnant women in the US have gestational diabetes<a href="#accordion">[1]</a>. The condition often shows up during the middle of pregnancy when the placenta produces hormones that prevent the body from efficiently using insulin. Consequently, glucose concentrates in the blood rather than being absorbed by the cells.

The best thing to do after the diagnosis of gestational diabetes is to look after yourself as much as possible. It&rsquo;s crucial to monitor blood glucose during labor and birth. While eating healthy and staying active during pregnancy can help control blood sugar levels, you may need to take insulin as well to control your blood sugar levels and avoid complications, like preeclampsia and birth defects, for you and your baby. 
&nbsp;

Insulin can be injected via pen or syringe and it&rsquo;s generally safe to use as prescribed by your doctor. Using too much insulin or skipping a meal, however, may cause hypoglycemia which can be dangerous for both you and your baby.

Note: If you have type 1 or type 2 diabetes, refer to a professional doctor before getting pregnant as uncontrolled gestational diabetes is not safe for your baby. Moreover, several diabetes tablets are not safe to be taken during pregnancy so your doctor can guide you regarding insulin injections<a href="#accordion">[2]</a>. 
&nbsp;

Understanding the importance of insulin in pregnancy

If you were diagnosed with gestational diabetes, it&rsquo;s important that you get tested for diabetes after delivery. Your doctor will order regular glucose checking for a few days after delivery, usually before breakfast and two hours after meals, to ensure your glucose levels are within the normal range. An oral glucose tolerance test is recommended 6-12 weeks after birth<a href="#accordion">[2]</a>. 
&nbsp;

If your blood glucose level is:

<ul>
	<li>Normal &ndash; Get checked every three years</li>
	<li>Pre-Diabetes &ndash; Get checked every year; talk to your doctor about minimizing your risk of diabetes</li>
	<li>Diabetes &ndash; Consult your doctor and set up a treatment plan 
	&nbsp;</li>
</ul>

The symptoms of gestational diabetes usually disappear in the postpartum period as blood sugar levels return to normal after labor and any medications, including insulin, will be stopped after your baby is born. But it&rsquo;s also possible that it progresses to type 2 diabetes. Around 50% of women with gestational diabetes develop type 2 diabetes<a href="#accordion">[1]</a>. 
&nbsp;

Getting checked helps because type 2 diabetes presents few symptoms during the early stages of the disease. With a timely diagnosis, you can prevent or delay the development of type 2 diabetes by continuing with your treatment, eating healthily, and avoiding a sedentary lifestyle.

Note: For future pregnancies, make sure to inform your healthcare team about your history of gestational diabetes. 
&nbsp;

According to the American Diabetes Association, breastfeeding can help you manage your diabetes<a href="#accordion">[3]</a>.

For the baby, breastfeeding for the first six months at least means a reduced risk of developing type 1 diabetes, obesity leading to type 2 diabetes, and other health issues like eczema and respiratory disease. For the mother, benefits include a lower risk of developing health conditions like breast and ovarian cancers and type 2 diabetes in addition to a quicker recovery after birth. 
&nbsp;

That said, is it safe to take insulin while breastfeeding your newborn? Yes, it is<a href="#accordion">[3]</a>. This is because insulin molecules are large enough to not pass through the breast milk to the baby.

However, the dose needs to be adjusted accordingly after the pregnancy and, again, during breastfeeding. Ideally, the blood sugar level while breastfeeding should be between 90 and 180 mg/dL.

These levels may drop during breastfeeding, a condition known as hypoglycemia, so you should eat before each session to keep the glucose levels stable. And check your blood glucose levels every time before and after nursing. 
&nbsp;

Key Points

<ul>
	<li>Gestational diabetes goes away soon after birth in the majority of cases. This is because of a drop in pregnancy hormones and the insulin resistance associated with them.</li>
	<li>If you have had gestational diabetes or are at risk of postpartum diabetes, you should monitor your blood sugar regularly during the postpartum period.</li>
	<li>Breastfeeding may help reduce insulin and blood sugar levels after birth.</li>
	<li>If you started taking insulin during pregnancy, it may be stopped after childbirth. But, depending on your blood glucose levels, you may have to restart insulin again.</li>
	<li>If you were taking insulin before pregnancy, you will most probably continue to do so. However, the dosage and the type of insulin may be reviewed by your doctor.</li>
	<li>Lifestyle recommendations may further help prevent developing type 2 diabetes. 
	&nbsp;</li>
</ul>

[1] Gestational diabetes. Centers for Disease Control and Prevention.

[2] Department of Health &amp; Human Services. Diabetes - gestational. Better Health Channel.

[3] Diabetes and breastfeeding. Diabetes and Breastfeeding | ADA

Shermeen Zuberi

Importance Of Insulin In Diabetic Care

Nearly 463 million people in the world are diagnosed with <a href="https://merisehat.pk/disease/diabetes-a-complete-overview">diabetes</a>, out of which nearly 150-200 million people need insulin therapy for their health<a href="#accordion">[1]</a>.

If you have type 1 diabetes, you&rsquo;ll have to inject insulin on a regular basis to use glucose from meals and, basically, to survive. This is because your pancreas is no longer making any insulin or producing an insufficient amount of the hormone.

If you have type 2 diabetes, your body may be producing insulin, but due to the fact that you&rsquo;re overweight or inactive, it may not be utilizing the hormone properly. This is called insulin resistance. You may need insulin shots to help your body control high blood glucose levels or hyperglycemia.

About 5-10% of pregnant women develop gestational diabetes<a href="#accordion">[4]</a>&nbsp;If you have gestational diabetes, you may need to inject insulin as well to manage your blood glucose levels until the baby is born. 
&nbsp;

Understanding the importance of Insulin

Understanding the role of insulin therapy as part of diabetes treatment becomes a whole lot easier when you understand how the hormone typically works and what happens when you get diabetes. 
&nbsp;

<ul>
	<li>
	<h5>Regulating Blood Sugar Levels</h5>
	</li>
</ul>

When you eat or drink, your body breaks down the carbs into glucose, which is the primary source of energy for your body. This glucose enters the bloodstream, signaling the pancreas to release insulin. Insulin helps the blood sugar to enter the cells where it can be used as an energy source.

It also helps the blood sugar to be stored in the liver as glycogen for later use; in case of low insulin levels between meals, the liver releases this stored sugar, ensuring the blood sugar levels are within a narrow range. 
&nbsp;

As a result, the blood sugar levels in the bloodstream decrease and, accordingly, the insulin levels decrease, too.

The problem arises when there&rsquo;s a lot of blood sugar in the bloodstream. The pancreas either has difficulty keeping up with the rising blood sugar levels or the cells stop responding to all the insulin, which is why you need therapy. 
&nbsp;

<ul>
	<li>
	<h5>Preventing Diabetic Complications</h5>
	</li>
</ul>

Untreated high blood glucose can lead to various complications. This includes nerve damage, blindness, foot ulcers, kidney damage, heart disease, and stroke. There is lots of insulin in the bloodstream, too, instructing the liver and muscles to take up the excess blood sugar; when their capacity is full, the extra blood sugar is sent to fat cells and is stored as body fat, resulting in weight gain and increasing the risk of type 2 diabetes. Insulin therapy is crucial to managing blood sugar levels to reduce the risk of developing these life-threatening complications and also to maintain overall better health. 
&nbsp;

<ul>
	<li>
	<h5>Correcting Insulin Deficiency</h5>
	</li>
</ul>

Your body&rsquo;s immune system may mistakenly destroy the insulin-producing cells in the pancreas if you have type 1 diabetes. This leads to a complete deficiency of insulin. Some individuals with type 2 diabetes struggle when they don&rsquo;t have enough insulin or when other treatment options (e.g., oral medications) are not effective in controlling blood sugar. Insulin treatment supplements or replaces natural insulin with the aim to achieve normal blood glucose levels. 
&nbsp;

<ul>
	<li>
	<h5>Meal Scheduling</h5>
	</li>
</ul>

A lot of factors, including lifestyle and weight, influence your insulin therapy. Planning meals helps because you can then determine your insulin regimen (insulin pump therapy or multiple injections every day) according to the amount of carbohydrates you consume in a meal. It gives you the liberty to enjoy a varied diet along with better glycemic control. 
&nbsp;

<h5>Other Functions Of Insulin</h5>

Insulin is also involved in<a href="#accordion">[2]</a>:

<ul>
	<li>Modification of enzyme activity and the subsequent reactions in the body</li>
	<li>Management of the synthesis of lipids</li>
	<li>Uptake of potassium and amino acids by cells and regulate DNA replication and synthesis of proteins</li>
	<li>Management of the breakdown of lipids and proteins because of changes in fat cells</li>
	<li>Regulation of the excretion of sodium and fluid volume of urine</li>
	<li>Building muscle post-injury or sickness</li>
	<li>Enhance the memory 
	&nbsp;</li>
</ul>

Important!

<ul>
	<li>Starting insulin therapy can be frightening. Consult your doctor to know more about the type of insulin you need. Make sure you know how, when, and where to inject insulin, and also how to rotate your injection sites.</li>
	<li>Always keep a proper record of your insulin dose and your blood glucose levels.</li>
	<li>Insulin should be stored correctly for usage. Extreme (hot and cold) temperatures damage insulin.</li>
	<li>Proper disposal of syringes, lancets, pen needles, and cannulas is important.</li>
	<li>Inform a doctor if you need help adjusting your insulin doses. This change may be due to changes in diet, increased or decreased exercise, illness, medication, weight loss or weight gain, etc.</li>
	<li>Contact a doctor if you have any problems taking insulin or if you notice any side effects. 
	&nbsp;</li>
</ul>

Conclusion

Insulin is an important hormone that controls how tissues and cells absorb energy. Insulin shots are effective in counteracting the effects of insulin resistance or deficiency. While people with type 1 diabetes have to inject insulin for the rest of their lives, the majority of people with type 2 diabetes may not need it<a href="#accordion">[3]</a>. Regular blood sugar monitoring and close communication with healthcare providers are essential for optimizing insulin therapy and achieving optimal diabetes management. 
&nbsp;

[1] Buse JB, Davies MJ, Frier BM, Philis-Tsimikas A. 100 Years on: The impact of the discovery of insulin on clinical outcomes. BMJ Open Diabetes Research &amp; Care

[2] Smith Y. Insulin’s role in the human body. News.

[3] An overview of insulin. Medical News Today.

[4] Department of Health &amp; Human Services. Diabetes and insulin. Better Health Channel.

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Usage Of Insulin Pens And Pumps During Ramadan

The month of Ramadan is upon us and Muslims worldwide rejoice for it&rsquo;s officially the month of blessings! And unless you&rsquo;re exempted, you&rsquo;ve probably begun preparing for a month of fast and spiritual growth.

But, how do you fast if you&rsquo;re a diabetic? There&rsquo;s no denying that it can be a bit difficult as compared to fasting by otherwise healthy individuals. Then again, given the medical advancements, it is actually possible for you to successfully fast and keep your blood sugar levels under control.

Read on to find out for yourself! 
&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Understanding Usage Of Insulin Pens And Pumps During Ramadan

Using insulin pens during Ramadan is a practical option. They are a great choice for those who are fasting because they are portable and simple to use. The price of insulin pens differs based on the brand and style of the pen.

In Pakistan, the two common insulin pen types are NovoRapid FlexPen and Levemir FlexPen.

<ul>
	<li style="text-align:justify">Levemir FlexPen: It is a long-acting insulin pen that can help control blood sugar levels throughout the day.</li>
	<li style="text-align:justify">NovoRapid FlexPen: It is a rapid-acting insulin pen. It is usually taken before meals because it takes 10-20 minutes to lower your blood sugar levels.</li>
</ul>

NOTE: Change your injection site regularly. 
&nbsp;

Another choice for controlling <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes </a>during Ramadan is insulin pumps. They are especially helpful for those who need to administer insulin frequently or who struggle to control their blood sugar levels with insulin syringes.

The price of insulin pumps differs in Pakistan based on the type and features of the device. 
&nbsp;

Also accessible in Pakistan are patch devices, which can be attached to your skin to administer insulin through a tiny catheter.

&nbsp;

Managing diabetes during Ramadan requires careful planning and monitoring of blood sugar levels. Insulin pens and pumps are convenient and effective options for diabetics who are fasting during Ramadan.

However, it is essential to consult a healthcare professional before making any changes to insulin doses or medication schedules.&nbsp; Also, if you&rsquo;re concerned about hypoglycemia or low blood sugar levels during Ramadan, make sure to keep a supply of quick-acting carbohydrates, such as glucose tablets or juice, to avoid hypoglycemia. 
&nbsp;

[1] Ali S, Davies MJ, Brady EM, Gray LJ, Khunti K, Beshyah SA, Hanif W. Guidelines for managing diabetes in Ramadan. Diabetic Medicine. 2016 Oct;33(10):1315-29.

[2] Nawaz MS, Rafique HS, Malik T, Wahab MU, Chughtai AU, Nawaz MS, Butt MD. CURRENT TRENDS AND AVAILABILITY OF INJECTABLE THERAPY IN PAKISTAN FOR MANAGEMENT OF DIABETES MELLITUS. International Journal of Pharmacy & Integrated Health Sciences. 2023 Mar 1;4(1).

Syeda Qurat-ul-Ain

<a href="https://merisehat.pk/article/the-importance-of-a-checkup-before-ramadan-for-diabetic-patients-using-insulin">Insulin </a>is an important hormone that regulates the body&#39;s blood sugar levels. It is created by the pancreas and converts glucose into usable energy for the body. Doctors often prescribe insulin injections to diabetics struggling to maintain good blood sugar levels. Like all medications, it&rsquo;s important to follow the doctor&rsquo;s instructions to take insulin shots at the right time and with the right amount of insulin. 
&nbsp;

Understanding Insulin Dose And Timings

The dose of insulin that a person requires during a day depends on a series of factors, including:

<ul>
	<li style="text-align:justify">Diabetes Type:<a href="https://merisehat.pk/disease/diabetes-type-1-and-2"> Type 1 diabetics </a>usually require insulin injections several times a day. On the other hand, <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">type 2 diabetics</a> may be able to control their blood sugar levels with oral medications or an oral medication and insulin combo.</li>
	<li style="text-align:justify">Insulin Resistance: People who have type 2 diabetes require a higher dosage than people with type 1 diabetes. </li>
	<li style="text-align:justify">Weight And Body: The dose also depends on a person&#39;s weight and body composition. </li>
	<li style="text-align:justify">Exercise Routine: Diabetics who are active throughout the day usually require less insulin than those who&rsquo;re not.</li>
	<li style="text-align:justify">Nutrition: People who consume high amounts of carbohydrates need a high dose of insulin to control their blood sugar levels.</li>
	<li style="text-align:justify">Other Drugs: It&rsquo;s important to discuss any additional medications with the doctor as they can influence the amount of insulin required by the body. 
	&nbsp;</li>
</ul>

According to the type of insulin, the following are some basic recommendations for when an insulin injection should be scheduled throughout the day<a href="#accordion">[3][4]</a>:

<ul>
	<li style="text-align:justify">Rapid-Acting Insulin: This kind of insulin begins to function within 15 minutes and usually lasts 2-4 hours. It is usually consumed 15 minutes before meals to reduce the spike in blood sugar that follows meals. This type of insulin is frequently used with longer-acting insulin.</li>
	<li style="text-align:justify">Short-Acting Or Regular Insulin: This kind of insulin begins to function in 30 minutes and lasts 3-6 hours. It is usually consumed 30-60 minutes before meals to reduce the spike in blood sugar that follows meals.</li>
	<li style="text-align:justify">Intermediate-Acting Insulin: It takes 1-2 hours to begin working and lasts 12 hours. In other words, it covers the insulin needs for half a day or overnight. It is usually combined with short-acting or rapid-acting insulin.</li>
	<li style="text-align:justify">Long-Acting Insulin: It begins to function within 2-4 hours and lasts for up to 24 hours. It is usually taken once daily, for instance, it can be recommended first thing in the morning or before bed to control sugar levels all day. Depending on the type of diabetes, it may be used with rapid-acting or short-acting insulin. 
	&nbsp;</li>
</ul>

<ul>
	<li style="text-align:justify">While fasting, some individuals may need to take less insulin while others may need to take more before or after meals.</li>
	<li style="text-align:justify">During Ramadan, insulin timing may also need to be changed. To ensure that basal insulin coverage is sufficient during the fasting hours, for instance, individuals who typically take long-acting insulin in the morning may need to take it at night.</li>
	<li style="text-align:justify">It&#39;s crucial to carefully monitor blood sugar levels, particularly during the first few days of fasting when insulin requirements might be unpredictable.</li>
	<li style="text-align:justify">Refrain from overindulging at iftar. This may reduce the need for extra insulin<a href="#accordion">2</a>.</li>
</ul>

NOTE: Always consult a doctor who can guide you about insulin dosages during Ramadan. 
&nbsp;

[1] Humulin R, Novolin R (insulin regular human) dosing, indications, interactions, adverse effects, and more. Humulin R, Novolin R (Insulin Regular Human) Dosing, Indications, Interactions, Adverse Effects, and More n.d.

[2] Pathan MF, Sahay RK, Zargar AH, Raza SA, Khan AA, Ganie MA, Siddiqui NI, Amin F, Ishtiaq O, Kalra S. South Asian Consensus Guideline: use of insulin in diabetes during Ramadan. Indian journal of endocrinology and metabolism. 2012 Jul;16(4):499.