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In 1922, A teenager, Leonard Thompson, was laid up gravely perilous state with diabetes when DRs.Frederick Benting and Charles Best injected an extract, obtained from panceas of an animal and surprisingly showed improvement, and finally, within a few days of treatment, was able to gain his strength and weight. This way, a new hope come to light for the despaired multitude of diabetics. The discovery of insulin extract was a medical miracle and wonder which was hailed as a miraculous discovery in the realm of medical world-a potent vehicle in the hands of doctors to treat their diabetic patients with insulin injections. Since it was miracle, both Dr. Banting and Dr. Best were, rightly bestowed with a noble prize-a well recognized honour.

After 75 years of constant and progressive use, insulin has come to stay. Since the discovery of insulin, experts have worked out and still continue to work relentlessly, a wide variety of insulins of meet needs of their diabetic patients. Now a variety of insulins have been introduced for use by certain types of patients, depending on an individual patient’s requirement as to quantity & frequency of use of insulin. Following types of insulin are available:-
11) Rapde-acting or short-acting Insulins :-
a) Regular
b) Semi-Lenten

2) Intermediate acting Insulin :
a) Globin
b) NPH (150 PHANE)
c) Lente
3) Long acting Insulin
a) Protamine Zinc
b) Ultra-Lente

Concentration of Insulin: There main concentrations viz. U-40 (Red label), U-80 (Green label) and U-100 (Black label) are available in the market, whose labellings have been done to pin point quantity and concertratin of insulin under each variety, or to put in differently we can discern form each label as to how much (“Pure insulin”) liquid volume each preparation has or what is the concentration of or how much pure insulin a preparation contains. Following points will further clarify what has been said heretofore:-
1. U- 100 Preparations – In such a variety each CC of the liquid contains 100 units of Insulin.
2. U-80 Preparation – In these preparations each CC of the same liquid contains 80 units of insulin.
3. U-40 Preparation: Herein each liquid CC contains 40 Units of insulin.

Availability of the above mentioned preparations in different insulin concentrations, enables the doctor to determine as to what quantity and at which intervals in a day, a diabetic patient will require insulin, taking into consideration all the relevant factors. Previously, insulin syringes either U-40 or U-80, were used by the patients but there was enough room for confusion-the patients has been using though by mistake or under confusion the wrong scales and injecting themselves with ‘half’ or, still worse, twice the prescribed dose. In the latter stage, such patients had to undergo an ‘Insulin shock’.

To rule out possibility of any danger fear of overdose and confusion in the use of insulin, preparations and syringes in U-40 and U-80 concentrations are being gradually phased out. U-40 and U-80 are being substituted, rather have already been by U-100 reusable and disposable syringes in which only the desired and needed doses are actually delivered, dispelling and ruling out possibilities of inaccuracy and overdose or any other confusion. Due to decimal system, U-100 syringes and preparations the patient won’t have any confusion. Use of such U-100 syringes and preparations will be useful for the physician also, because the doctor can have no danger in shifting his patient to highly purified U-100 product. Mere reduction in liquid volume will do, instead of affecting an actual change in insulin dosage required by a patient. It will also ensure proper control in the administration and management of IDDM patients.

Now 1-CC (100 units) disposal syringes, 1-CC (100 units) glass syringes and the 0.5 0 CC (50 units) disposable syringes, 0.35 CC (35 units) glass syringes are available. Out of which the patient can pick up any type of syringe to commensurate with insulin dosage. Diabetics of IDDM type are scared of the phobia that needles would break, bend or twist, but all such fears are baseless because, with proper care and caution, the patient cannot encounter any one of such problems.

Fears & Myths: It may be pointed out that refrigeration of insulin is not, at all necessary, because insulin does not deteriorate at room temperature hence there is any necessity for the diabetics to carry thermos or ice-bags. Ice-boxes to store insulin while proceeding on tour or travel.

2. People are scared of air bubbles which rise in the syringe and they are neither harmful nor dangerous. Such apprehension, like any other, is an off-shoot of patient’s lack of proper education. There is another fear, in the minds of patients and their relatives, that extra insulin should be the syringe. There is no need, at all, to give a second ‘small short’. In fact, there is no danger from air (whether a single bubble be avoided in the syringe. It is better to be informed and trained how to avoid air and bubbles in the syringe. It due to fear of an air bubble, an extra dose, though neither called for nor required, is given in smaller than the normal dose, then (in the case) there is no cause for alarm but if the extra dose exceeds or even matches the prescribed dose, in that eventuality, the physician of the patient must be consulted without delay, because injected extra insulin dose may cause hypolycaemia and other fall-out symptoms and complications.

3. The diabetes patient should himself learn the art of injecting himself. If he is dependent on any family member, nurse or doctor, for this purpose the chances are that, when he himself is required to take an insulin dose, there may not be any one near him, thus losing time of dose of insulin injection. Hence, the IDMM patient should himself learn and practice how to inject. Dependence, in such matters, is not good. Moreover, if the patient develops the latter practice, he will make sure that there is no chances of injection vials from a reliable chemist and, that too, manufactured by some reputed and established pharmaceutical company only.

Caution: Heat destroys effectivity and medicinal value of insulins, hence they should be always stored in a cool place. But, if at all, it is required to be kept in a refrigerator, it should be stored at a temperature where it does not freeze. If it is necessary to carry it during journey it should be wrapped with a water-soaked piece of cloth or in a pro-cooled thermos flash, so that temperature remains the same. It is very essential in hot climates, though moderately cold room temperature will suffice to preserve it, even though, some deviating opinion might have been expressed earlier, in this regard. The whose modus operandi is to keep insulin away from heat and heat conditions. In cold regions even normal room temperature will serve the purpose.

Note: No diabetes patients should himself adjust his done of insulin, simply in accordance with the above table, as it can prove fatal. Hence, always seek proper guidance from your physician who is the best judge to decide as to how much dose you require and after what gap/duration.

In order to determine precise dosage for a particular patient, initially it should be started on error and trial methods which will finally point no near-precise dose of insulin required to be prescribed to a patient. Once a particular dosage has been determined and prescribed, the reaction thereof, on the patient, or its acceptability should be closely watched & monitored, leaving no room for any ‘chance’ or ‘slip’ or ‘miscalculation’. In order to switch over to long-acting insulin, no undue haste should be exercised before giving it a fair trial.

Higher doses of insulin may be needed in disordered condition, like infective fevers, pregnancy, cortico-steriod therapy, excessive dietary intake, hyperthyroidism, presence of ketone bodies, obesity etc. on the contrary, tapered doses of insulin are required after taking to physical exercise, on reduced dietary intake, on using anti-diabetic drugs are also given in addition to insulin to augument the effect of insulin or when insulin is required to be given in lower doses/concentrations, but oral tablets are also required to be used.