Diabetes Management With Insulin Injections example essay topic

Diabetes Mellitus is a serious disease shared by 16 million Americans (PharmInfoNet 1). It is a disease characterized by a failure of the pancreas to produce enough if any insulin. Insulin is the chemical in the body that turns sugar into usable energy. "While it is treatable, diabetes is still a killer. The fourth leading cause of death in America, diabetes claims an estimated 178,000 lives each year. So the treatment is aimed at holding the disease in check, reversing it where possible, and preventing complications" (Hingley 33).

Due to the life threatening nature of diabetes, the necessity of controlling it is absolutely imperative. Philip Cryer, M.D., president of the American Diabetes Association and a professor at Washington University School of Medicine in St. Louis, believes that people don't understand how much of a problem diabetes can be. He says, "Diabetes is an increasingly common, potentially devastating, treatable yet incurable, lifelong disease. It's the leading cause of blindness in working aged adults, the most common cause of kidney failure leading to dialysis or transplants, and is the leading cause of amputations" (Hingley 33). For decades since its discovery in 1920, injectable insulin has been the standard treatment for diabetes. In fact, it is the only treatment for insulin-dependent diabetes.

And the standard method of administering it has remained injection with a syringe. But in recent years, there have been enormous advances made in the development of new and better ways to administer insulin. By far the best, most effective way to administer insulin that exists today - the way that most closely mimics the way the human body releases insulin into the bloodstream - is no longer through injection with a syringe, but rather, through the insulin pump. To understand diabetes, it is important to first understand how a non-diabetic body functions to process the normal presence of glucose in the bloodstream. Everything a person consumes is converted to glucose, at different rates depending on exactly what was consumed, and ultimately deposited into the bloodstream. There it circulates, waiting to be called to action.

When the body perceives that energy is running low, glucose in the bloodstream is ushered into the various cells of the body where it is converted into energy as needed. The pancreas, a large gland found in the abdomen, contains Beta cells that create insulin. The job of insulin is to regulate the amount of glucose in the blood at any given time. It does this by allowing glucose in the bloodstream to enter the cells of the body as needed for energy. Insulin holds the key that unlocks the cell door. Without it, the cell door stays closed and glucose cannot enter.

At this point, the cells of the body cannot produce the energy required to function properly and they literally starve to death (American Diabetes Association). Glucose, having nowhere else to go, builds up in the bloodstream, increasing to dangerous levels. There are two types of diabetes. Type I diabetes is sometimes called juvenile diabetes, or insulin dependent diabetes. With type I diabetes, the pancreas, for reasons unknown, ceases to produce insulin altogether.

This usually occurs over the course of a week or two, leaving a person with no other choice but to inject insulin daily for the rest of their lives. Only ten percent of all diabetics have this type. Type II diabetes is far more prevalent. Its onset is usually much more gradual, occurs later in life, and is most often the result of heredity. It is exacerbated by a sedentary lifestyle and obesity. With type II diabetes, the pancreas does not stop producing insulin as it does in type I. Rather, insulin production might decrease or, more often, the body's ability to utilize the insulin it does produce becomes severely diminished.

In most cases, however, this situation can be improved and often controlled with diet, exercise, and oral medication. Those with type II diabetes have considerably more opportunity to govern the course of treatment required to manage their condition than do those with type I. Where insulin injections are a last resort for type II diabetics, they are a life sustaining necessity for those with type I diabetes right from the very day the disease is diagnosed. There are many classic symptoms associated with diabetes, especially with type I. They include: unexplained weight loss, the frequent and urgent need to urinate, extreme hunger and thirst, difficulty seeing, overwhelming fatigue, severe headache, and overall feeling of flu-like illness. Left undiagnosed and untreated, these symptoms will lead to coma and, ultimately, death. Because type I diabetes comes on fast with a rapid presentation of extreme symptoms, the diagnosis is generally an easy one.

These symptoms have one common cause - the extraordinary build up of glucose in the bloodstream referred to as 'high blood sugar. ' Once the diagnosis is made, treatment with injected insulin begins immediately. Because type II diabetes has a much slower and more protracted progression of symptoms than type I, it is often not clearly apparent that a person is indeed developing the disease. It is not unusual for someone to walk around for months or even years unaware of the permanent damage being done by elevated blood sugar levels that have risen insidiously over time. Often, by the time the diagnosis is made and treatment begun, the complications of type II diabetes have already become a monumental problem.

Blindness, kidney failure, and nerve damage resulting in the need for amputation are all common complications of diabetes that is poorly managed over time. It is critical for everyone, but most especially those at high risk, to have their blood glucose levels checked by a doctor on a regular basis. Until the discovery of insulin in 1921 by Frederick Banting, a Canadian surgeon, and his assistant, Charles Best, there was no way to treat diabetes. The discovery of insulin by these two pioneers in the field of research has saved many lives and is said to be one of the most revolutionary moments in the history of medicine. It was determined late in the nineteenth century that diabetes was a direct result of a malfunction in the pancreas. With this information confirmed and refined in the early 1900's, John J.R. Macleod, head of the department of physiology at the University of Toronto, spent a great deal of time studying glucose metabolism and diabetes.

In 1920, he was approached by Frederick Banting who had a new idea. Banting believed that he could find not only a cause, but also a treatment for the so-called "sugar disease", and he wanted the use of Macleod's laboratory for his work (A Science Odyssey 1). Banting and Best figured out how to isolate and extract the material from the cells of the pancreas that they suspected was responsible for lowering sugar in the blood. After six weeks of profuse testing on diabetic lab dogs, Banting and Best were given the green light by Macleod to try it on a human for the first time. The first ever insulin injection given to a human was administered to a fourteen year old boy dying of diabetes.

His blood sugar was lowered and his urine was clear of any signs of the disease (A Science Odyssey 1). The introduction of insulin in the treatment of diabetes seemed truly like a miracle. What had been an automatic death sentence before 1921, became a treatable, manageable disease that did not necessarily have to shorten the lives of those afflicted with it, thanks to the perseverance of these great men (A Science Odyssey 2). Since the introduction of insulin in diabetes treatment, diabetics have been receiving the life saving hormone through injections. With insulin injections, a diabetic normally gets two kinds of insulin in one shot at least twice daily. Before breakfast, a diabetic will test his blood glucose level and draw a certain amount of short acting insulin into the syringe based on the blood sugar results and the size of the meal about to be consumed.

This insulin will serve to bring the current blood sugar under control, as well as act on glucose produced by breakfast. Along with this short acting insulin, the diabetic will also draw long acting insulin into the syringe before injecting. This insulin peaks in four to six hours and lasts eight hours or more. When a diabetic does this before every meal, there develops an overlap of insulin types, dosages, and peaks and valleys of potency. This can cause hard to predict and even harder to manage swings in blood sugar. For the diabetic who is treated with insulin injections, it is critical to maintain a regular schedule of eating.

It is very important that they eat as close to the same times as possible every day, eat as close to the same number of carbohydrates as possible each day, and never skip meals (American Diabetes Association 3). For many years, injecting insulin through a syringe was the only method of administering it. But thanks to extensive research and development, improved methods of administering insulin have been devised in recent years. The method that most closely resembles the way in which the pancreas produces and releases insulin is a device called the insulin pump. The insulin pump offers diabetics a form of control that is miles ahead of all the rest. It was developed from technology acquired for the Viking Mars Lander.

Originally, Dr. Robert Fischell, Chief of Technology Transfer at Hopkins Applied Physics Laboratory, developed the concept of an insulin pump in 1976 while he was on vacation. He made some drawings of his idea and filed them away when he returned home. Then two and a half years later, Dr. Fischell was asked by a medical scientist if he thought the idea of an insulin pump was possible. He replied, "You mean a pump like this" (Ledger 3)?

Then, the research took off. Today, the insulin pump looks something like a pager. It is really a little computer that can be programmed to deliver insulin automatically and manually based on the individual patient's insulin requirements. Insulin is delivered from the pump and into the body through a device called an infusion set.

The infusion set is a thin plastic tube, twenty-four to forty-two inches long. These tubes are fixed at the end with a small, soft cannula or needle. "The process of putting the infusion set in place is called an insertion, and is very much like giving a standard insulin injection" (Pump Therapy). The infusion set is to be changed every two to three days to reduce the risk of insulin build up under the skin and infection.

Dr. David Bell, professor of medicine at the University of Alabama has prescribed insulin pumps for hundreds of his patients over the past decade. In an interview published in Diabetes Forecast magazine he explains: The pump delivers insulin much more like a normally functioning pancreas would. Consider John, who doesn't have diabetes. John's cells need energy throughout the day, even when he's just sitting around. Therefore, he needs insulin throughout the day so that glucose can get into his cells. His pancreas obliges by secreting a very low level of insulin throughout the day and night.

This natural insulin is extremely fast-acting. When John eats, he needs more insulin. As soon as his blood glucose level starts to go up, his pancreas delivers a surge of fast-acting insulin. That's what the pump does for you. You program your pump to deliver tiny amounts of fast-acting insulin throughout the day and night. This is called the basal rate.

You also program the pump to deliver extra insulin just before your meals. These extra blasts of insulin are called boluses. When asked if the pump could be considered an artificial pancreas, he is quick to say no. He points out that an artificial pancreas would sense changes in blood glucose and adjust insulin delivery accordingly. With the pump, a diabetic must still test blood glucose levels regularly and program their pump according to the results (McCarren). A diabetic who uses an insulin pump has considerably more flexibility with regard to mealtimes and a schedule of eating than those on injections have.

There is no longer a concern about making sure that mealtime coincides with the peaking of long acting insulin injected earlier in the day. Pump wearers have the freedom to eat whenever they want to. With the push of a button, a bolus of insulin instantly provides coverage for the food about to be eaten. In addition to this, pump wearers have the luxury of being able to eat foods that have always been considered off limits to diabetics. A pump wearer must be able to determine the number of grams of carbohydrates in a particular food. Once this number is calculated, the ratio of units of insulin to grams of carbohydrates, which is a predetermined number based on the individual, is programmed by the pump wearer to be delivered immediately.

This roughly mimics the way the normal pancreas operates, and is why it is possible for pump wearing diabetics to enjoy formerly taboo foods. Perhaps the most significant benefit of the insulin pump, compared to diabetes management with insulin injections, lies in the ability that pump wearers have to maintain tighter control of their blood sugar levels on an ongoing basis than ever before. With the pump, it is possible for diabetics to maintain their blood sugar levels within a much narrower and more desirable range than has ever been possible with insulin injections. This translates into fewer long-term complications suffered by pump wearing diabetics than by diabetics who do not use a pump. Medical costs for care related to complications of diabetes is skyrocketing. Direct medical expenditures for diabetes care in 1997 exceeded $44 billion (Lebovitz).

Insulin pump use could help lower these skyrocketing costs by reducing the complications of diabetes through tighter control and better management of insulin therapy. In an interview with Mike McIntyre, a forty eight year old man who has been a type I diabetic for thirty years, he commented, "The pump has afforded me more freedom and flexibility with regard to eating and living than ever. I love the pump and would recommend it to any diabetic. It's the next best thing to a cure" (McIntyre). Every day we are getting closer and closer to a cure for this disease.

Meanwhile, there is some revolutionary technology on the horizon which promises to make lives easier for diabetics. "Implantable insulin pumps with external, hand held controls are now being tested for safety and effectiveness in large scale clinical trials" (Scavini). Another among these emerging technological advances is a new, powdered form of insulin which is inhaled through the nose. Also in the research and development phase is islet cell transplanting. These are the cells in the pancreas that are responsible for regulating the production of insulin. These new forms of technology are still in the relatively early stage, but are not too far down the road from becoming available to the public and being widely used and appreciated among diabetics of all ages.

Until then, the insulin pump remains the best and most effective way to administer insulin that exists today. Work Cited Page Science Odyssey: People and Discoveries. "Banting and Best Isolate Insulin 1922". web (Retrieved 10 October 2000) American Diabetes Association: Diabetes Info. "The Diagnosis". web (Retrieved 10 October 2000) Hingley, Audrey.

"Diabetes Demands a Triad of Treatments". FDA Consumer May / June 1997: pg. 33. Lebovitz, Harold E. MD. Therapy for Diabetes Mellitus.

Alexandria: American Diabetes Association, 1999. Ledger, Marshall. "Electronics in the Body Shop". Alumni Magazine Consortium Aug. 1988: pg. 3. McCarren, Marie.

"Prepare To Pump". Diabetes Forecast Sept. 1995: pg. 2. McIntyre, Mike. Telephone interview. 19 Nov. 2000.

PharmInfoNet: Diabetes Statistics. "Prevalence of Diabetes in the United States". web (Retrieved 10 October, 2000) Pump Therapy. "Flexibility!" About. com: web (Retrieved 10 October, 2000) Scavini, Marina MD, and David S. Schade, MD. "Implantable Insulin Pumps" Clinical Diabetes Vol. 14 No. 2 March / April 1996.