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Diabetes Type II PathophysiologyInsulin and hyperglycemia -
If you notice any of these symptoms, you should check your blood sugar. If your blood sugar is very high, you should also test for ketones in either your blood or urine. It is normal for patients with T1D to get hyperglycemia, and most of the time this is simply treated with insulin.
This produces chemicals called ketones, which make your blood more acidic. DKA is dangerous. Too much acid in your blood can make you pass out diabetic coma or even cause death. If you notice these or any of the other signs of hyperglycemia listed above, you are at risk of or may already have DKA.
You can use a urine test strip or blood ketone meter and ketone test strip to test for ketones at home. Testing either urine or blood is important, but when possible, a blood test is preferred because it gives you and your care team more precise information about your ketone levels.
Because urine may have been in the bladder for some time, the results from these tests may show levels that are either higher or lower than the ketone levels that are actually circulating in your body. It is also very important to know that urine test trips degrade over time, so if you are using this method, you need to look at expiration dates carefully.
At-home urine test strips will change color to show the level of ketones in the urine. The following ranges are generally used:. You should call your diabetes care team immediately if your urine test results show you that you have moderate or large levels of ketones or your blood ketone test shows 1.
You should go to the emergency room if you have high levels of ketones and have vomited at least twice in the last 4 hours. The first thing you should do to treat hyperglycemia is take insulin. If you take insulin by syringe or pen, and your blood sugar has not responded within 2 hours, you can take a second dose using the same correction dose.
Remember that insulin takes 20 to 30 minutes to work and will continue to work for 4 to 5 hours. If you get hyperglycemia often, talk with your doctor.
They might adjust your medication or suggest you talk with a dietitian about meals and exercise. Also, a CGM can help you keep track of changes in your blood sugar throughout the day.
Your body releases stress hormones when you are sick, which can cause hyperglycemia. Keep taking your insulin and other diabetes medications, even if you are throwing up.
They might also want you to call if:. Managing blood sugar during and after physical activity is important and is something that a lot of people with T1D have questions about. JDRF has a number of resources available for people with T1D and their families, many of which can be found here.
If you are using an insulin pump, talk to your diabetes team about how to best manage hyperglycemia. In general, be sure to check your pump first. Make sure all parts are connected and working correctly. Check your bolus history and temporary basal rate.
Also check your insulin to make sure it has not expired or gotten too warm. If you use a CGM, try not to react to it too often. Controlling blood sugar is very important in children with T1D. Long-term hyperglycemia damages the eyes, heart, kidneys, and nerves, so it is important to maintain good glucose control to minimize the chances of this damage.
Importantly, they should test their blood sugar before driving a car. Click here for a downloadable guide on causes, symptoms and treatments of hyperglycemia. We value your privacy. When you visit JDRF. org and our family of websites , we use cookies to process your personal data in order to customize content and improve your site experience, provide social media features, analyze our traffic, and personalize advertising.
See 'Site of injection' below. Insulin pen injectors — Insulin pen injectors may be more convenient to carry and use, particularly when you are away from home. Most are approximately the size of a large writing pen and contain a cartridge that contains the insulin, a dial to set the dose, and a button to deliver the injection figure 2.
A new needle must be attached to the pen prior to each injection. The needles are sold separately from the pens. Insulin pen cartridges should never be shared, even if the needle is changed. The injection technique is similar to using a needle and syringe.
See 'Injection technique' below. Pens are especially useful for accurately injecting very small doses of insulin and may be easier to use for people with vision or dexterity problems.
Pens are more expensive than traditional syringes and needles. A number of different insulin pens are available; each comes with specific instructions for use, and video tutorials are available online. Needle and syringe — Some people use a needle and syringe rather than a pen injector to give themselves insulin.
This involves drawing up insulin from a bottle using the syringe, then injecting it with the needle. Drawing up insulin — There are many different types of syringes and needles, so it's best to get specific instructions for drawing up insulin from your health care provider. The basic steps are listed in the table table 2.
See 'Insulin pen injectors' above. Before drawing up insulin, it is important to know the dose and type of insulin needed; if you use more than one type of insulin, you will need to calculate the total dose needed your health care provider will show you how to do this.
Some people, including children and those with vision problems, may need assistance. Magnification and other assistive devices are available. If you have difficulty drawing up your insulin, let your health care provider know, as there are ways to help with this.
One type of insulin, called U regular insulin, might come in a pen or a vial. When it comes in a vial, it requires a special U syringe; this syringe makes it easier to measure the right dose.
If you use this type of insulin, your health care provider can show you how to use the U syringe. It's very important to use this specially marked syringe only for U insulin. Using a U syringe with other insulins can cause a dangerous insulin overdose.
Because it can be confusing to figure out how to accurately measure the correct dose, U insulin and other concentrated insulins U lispro or degludec should be prescribed in an insulin pen device under most circumstances. Injection angle — Insulin is usually injected under the skin figure 3.
It is important to use the correct injection angle since injecting too deeply could deliver insulin to the muscle, where it is absorbed too quickly. On the other hand, injections that are too shallow are more painful and not absorbed well.
The best angle for insulin injection depends on your body type, injection site, and length of the needle used. Your health care provider can help you figure out what length needle to use and the angle at which to inject your insulin.
Injection technique — These are the basic steps for injecting insulin:. You do not need to clean the skin with alcohol unless your skin is dirty. Keep the skin pinched to avoid injecting insulin into the muscle. Hold the syringe and needle in place for 5 seconds for syringes and 10 seconds for insulin pens.
If you see blood or clear fluid insulin at the injection site, apply pressure to the area for a few seconds. Do not rub the skin, as this can cause the insulin to be absorbed too quickly.
Each needle and syringe should be used once and then thrown away; needles become dull quickly, potentially increasing the pain of injection. Needles and syringes should never be shared. Used needles and syringes should not be included with regular household trash but should instead be placed in a puncture-proof container eg, a hard laundry detergent bottle or a sharps container, which is available from most pharmacies or hospital supply stores.
FACTORS AFFECTING INSULIN ACTION. Dose of insulin injected — The dose of insulin injected affects the rate at which the body absorbs it. Larger doses of insulin may be absorbed more slowly than smaller doses.
Site of injection — It is very important to rotate injection sites ie, avoid using the same site each time to minimize tissue irritation or damage. When changing sites, it is important to keep in mind that insulin is absorbed at different rates in different areas of the body.
Insulin is absorbed fastest from the abdominal area, slowest from the leg and buttock, and at an intermediate rate from the arm. This may vary with the amount of fat present; areas with more fat under the skin absorb insulin more slowly figure 1. It is reasonable to use the same general area for injections given at the same time of the day.
Sometimes abdominal injections, which are absorbed more quickly, are preferred before meals. Injection into the thigh or buttock may be best for the evening dose because the insulin will be absorbed more slowly during the night. Smoking and physical activity — Any factors that alter the rate of blood flow through the skin and fat will change insulin absorption.
Smoking decreases blood flow, which in turn decreases insulin absorption. In contrast, activities that increase blood flow such as exercise, saunas, hot baths, and massaging the injection site increase insulin absorption and can result in hypoglycemia low blood sugar.
For these reasons, it is best to avoid injecting your insulin immediately after any of these activities. Your health care provider might also recommend taking a lower dose of insulin before or after exercise. Decreased potency over time — Most insulin remains potent and effective for up to one month after the bottle has been opened if kept in the refrigerator between injections.
However, the potency of intermediate-acting and long-acting insulin begins to decrease after 30 days. This can be a problem for people who require very small doses of insulin, for whom a vial might last two months or more.
If you use a needle and syringe, it is advisable to start a new vial at least every 30 days. Insulin pens come with specific instructions about how to store and use the device.
Unopened insulin pens are usually stored in the refrigerator. Once the pen is opened, most pen injectors can be kept at room temperature eg, in a purse or jacket pocket for up to 14 to 28 days, depending on the type of insulin premixed insulin loses potency more quickly.
It's important to avoid exposing the pen to extreme temperatures hot or cold. After the specified number of days, or if there is suspicion that the insulin has lost potency for example, if the pen was left in a hot car , a new insulin cartridge or pen should be used, even if there is insulin left in the old device.
Individual differences — The same dose of the same type of insulin may have different effects in different people with diabetes. Some trial-and-error is usually necessary to find the ideal type s and dose of insulin and schedule for each person. Insulin needs often change over a person's lifetime.
Changes in weight, diet, health conditions including pregnancy , activity level, and occupation can have an impact on the amount of insulin needed to control blood sugar levels. Your health care provider should be able to teach you to adjust your own insulin dose as needed, but this will depend on your specific situation.
See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics ". Several situations can complicate insulin treatment for a person with diabetes. With advance planning and careful calculation, these situations are less likely to cause major fluctuations in your blood sugar control.
Your health care provider can assist you in handling these situations. Eating out — Eating out can be challenging since the ingredients used, calorie and fat content, and portion sizes are usually different from meals prepared at home. If your insulin regimen involves injecting the same amount of insulin at the same time each day, being consistent about when and what you eat will help to improve blood sugar control.
If meal timing and content varies widely, blood sugar levels will fluctuate as well, making it less likely that you will meet your goal A1C level. When dining out, you can make healthy food choices by requesting nutrition information from the restaurant or referring to a web site, phone app, or reference book.
See "Patient education: Type 2 diabetes and diet Beyond the Basics ". Hypoglycemia and hyperglycemia can occur more easily in situations where you are eating new or different foods; thus, it's important to keep a fast-acting source of carbohydrates such as hard candy or glucose tablets as well as a blood glucose monitor with you at all times.
See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ". Surgery — If you need to have surgery or another procedure, you may be instructed not to eat for 8 to 12 hours before their procedure.
In this situation, a health care provider can help you determine the dose and timing of insulin to use before and after the procedure.
This is particularly important if you will be unable to eat a normal diet after the procedure. Infections — Infections such as a cold, sore throat, urinary tract infection, or any infection that causes fever can cause blood sugar levels to rise.
If you get sick, it's a good idea to talk with your health care provider, as you will need to carefully monitor your blood sugar levels and possibly increase your insulin dose. It is also important to drink plenty of fluids in order to avoid dehydration.
If you have nausea or vomiting, you may need medication to control your symptoms and avoid dehydration. Travel — Managing blood sugar levels and insulin treatment while traveling can be difficult, especially if you are traveling across multiple time zones.
In addition, activity levels and diet are often different while traveling, making it especially important to carefully monitor your blood sugar levels. If you are planning travel, talk with your health care provider to develop a plan for managing your diabetes.
See "Patient education: General travel advice Beyond the Basics ", section on 'Traveling with medical conditions'. STAYING MOTIVATED WITH TYPE 2 DIABETES. Living with diabetes can be very demanding, and some patients lose motivation over time.
Your health care provider can provide tips and encouragement to help you stay on track. Helpful information and support is also available from the American Diabetes Association ADA at -DIABETES and at www.
Your health care provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.
Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.
These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Using insulin The Basics Patient education: Treatment for type 2 diabetes The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Diabetic ketoacidosis The Basics Patient education: Hyperosmolar hyperglycemic state The Basics Patient education: Should I switch to an insulin pump?
The Basics. Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Type 2 diabetes: Overview Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics Patient education: Preventing complications from diabetes Beyond the Basics Patient education: Type 2 diabetes: Treatment Beyond the Basics Patient education: Type 2 diabetes and diet Beyond the Basics Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics Patient education: General travel advice Beyond the Basics.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.
Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Alpha-glucosidase inhibitors for treatment of diabetes mellitus Exercise guidance in adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus General principles of insulin therapy in diabetes mellitus Glycemic control and vascular complications in type 2 diabetes mellitus Pregestational preexisting diabetes mellitus: Antenatal glycemic control Inhaled insulin therapy in diabetes mellitus Initial management of hyperglycemia in adults with type 2 diabetes mellitus Insulin therapy in type 2 diabetes mellitus Management of diabetes mellitus in hospitalized patients Management of persistent hyperglycemia in type 2 diabetes mellitus Metformin in the treatment of adults with type 2 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus Thiazolidinediones in the treatment of type 2 diabetes mellitus.
Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Type 2 diabetes: Insulin treatment Beyond the Basics.
Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Author: Deborah J Wexler, MD, MSc Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures.
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