Unveiling the Complexity of Insulin Usage

This series is specially designed to provide support and foster a sense of empowerment for parents of children living with Type 1 diabetes.

Welcome to Video 3 of 3 in The Type 1 Diabetes Conundrum series.

In this series, I am unveiling what makes Type 1 diabetes complex and challenging to manage.

This video in the series delves into the world of insulin and its crucial role in managing diabetes.

If you follow my videos, you’ll know I help parents of children with T1D understand the importance of safely striving for normal blood glucose – why the treatment goal for Type 1 diabetes is to keep blood sugar as close to normal as possible to delay or prevent complications.

As a mom, I have deep respect for insulin. It is the lifesaving medication that keeps my son alive.

Prior to insulin’s discovery at the University of Toronto in 1921, a child with Type 1 diabetes could not survive. I will forever be grateful for this “elixir of life”.

I also believe insulin is one of the things that makes diabetes so hard to manage.

I’ve got a lot I want us to cover in this video, so let’s get right to it and unveil how using insulin presents challenges.

To appreciate how using insulin presents challenges in T1D management, let’s focus on 3 main points:

Number 1. There is a lot to know even when learning the basics about insulin usage.

Number 2. There is variability in how insulin absorbs and takes effect once injected into the body.

And number 3. The most common side effect of insulin medication is hypoglycemia, and this can be a barrier to getting normal blood sugars.

Let’s start with Point #1.

As our children receive insulin injections daily, often 4 or 5 times per day whether via MDI or using a pump, you might imagine we parents comprehend how our child’s insulins work when injected in the body. Yet when I ask parents, most tell me they “sometimes” know how insulins work.

That is understandable! Because there is so much to know when caring for a child with Type 1 diabetes, AND there’s a lot to wrap your head around when using insulin!

If your child was diagnosed some time ago, think about what you may already know about insulin.

Before diagnosis, you likely knew very little.

Now you know about basal insulin and bolus insulin;

the insulin delivery methods of syringes, pens, pumps, and inhalers;

where on the body to inject insulin;

not to put insulin in the freezer or leave it out in the hot sun.

You hopefully understand the onset, peak effect, and duration time of each of your child’s insulins.

And you’ve learned to get prescriptions, set aside time and money or accessed insurance to get insulin and insulin supplies.

There is a lot to know even about the basics!

You can tell there’s a lot to know when you are advised to ask the following questions when you get a prescription for a medication such as insulin.

Having to know this much about insulin can make diabetes seem hard.

There is a lot to know and keep straight in your head!

Our second point related to how using insulin presents challenges:

There is variability in how insulin absorbs and takes effect once injected into the body.

We face a number of challenges here.

Every time our child gets an insulin injection, there is variability in two ways:

1. variability in terms of insulin absorption (what the absorption rate of that insulin will be, how much and how well did that insulin absorb?), AND
2. variability in terms of the insulin’s action as a drug (what effects will that insulin medication have on the body)

Repeat injections of identical insulin amounts may not induce an identical effect in your child’s body.

For many people, when they we inject insulin, they can’t always predict what the outcome will be!

I created this visual to help parents understand the factors that may impact insulin absorption and insulin’s action as a drug.

This variability can make it hard to dose insulin in a predictable, reproducible, and safe way. 

And finally, Point 3!

Insulin is a medication I know I have to use with caution. I want to use the amount of insulin required to meet my son’s body’s needs but no more than that, because insulin medication cannot sense low glucose in the blood.

I wish exogenous insulin could just shut off and stop working once my son’s blood glucose level was in normal range; instead, once injected, insulin is live and active in his body until its duration of action has passed. Even when the body’s glucose levels drop, that insulin keeps working, which is why hypoglycemia is the main side effect of insulin therapy.

The very elixir that lowers blood glucose and metabolizes food, so your child can live, has as its most common and serious side effect the potential for a hypoglycemic emergency!

This is part of the reason why we see blood glucose targets for children with T1D more than double the normal value for healthy humans.

Using too much or too little insulin is dangerous for our children.

As PhD and biomedical engineer, Matthew Webber, explains:

“When you talk to a lot of diabetics, they’ll choose to keep their blood glucose higher than would be ideal because of how scary hypo events are.

They’re making a gamble that they’d rather have cardiovascular disease and risk of stroke and other sorts of things in 20 years than have a hypo event tonight.”

The most common side effect of insulin medication is hypoglycemia, and this can be a barrier to getting normal blood sugars.

We are coming to the end of this Type 1 Diabetes Conundrum series about what makes diabetes hard to manage?

We discussed:

how T1D places substantial demands on families, and from a human body perspective, we looked at

the many factors that impact blood glucose and how using insulin presents challenges to achieving normal blood glucose and protect our children’s health.

Now by this point in the video, I am aware you may be feeling discouraged, “Thanks, Beth, for sharing with me all the ways it’s hard to manage T1D.” My intent is not to make you feel discouraged, but to encourage you to reflect on the reality of the challenges that Type 1 diabetes presents, so you can take action.

So, what, as a parent, can you do? Because you need hope that your child isn’t destined to a life of diabetic complications, that you are able to safely strive for normal blood glucose. And you need a plan.

This is the inspiration behind my program for parents called The Nutrition Effect.

Insulin and food have the greatest impact on blood glucose control, and when you choose to feed your child foods that have minimal or less effect on blood glucose, there is a positive flow-on effect: there will be a reduction in the after-meal glucose rise and in the amount of insulin your child needs to cover the meal. A minimal glucose rise and giving your child a small amount of insulin cover that minimal rise, will give you greater predictability and can lead to improved glycemic control and diabetes outcomes for your child.

It is also a much safer approach to diabetes management.

The Nutrition Effect group program is a transformative 4-week journey, unlocking the interplay between blood glucose, insulin, and food, empowering you to lead your child towards a brighter, healthier future.

I guide committed families to reflect on the reality of their situation, understand the interplay between blood glucose, insulin, and food, and create a personalized nutrition plan using Therapeutic Carbohydrate Reduction that helps to achieve normal glucose levels and nourish your child's growing body, so you can get off the blood sugar roller coaster, reduce the risk of diabetic complications, alleviate stress, and manage diabetes with more confidence.

For more information about, or to enrol in the The Nutrition Effect program, visit:

https://www.t1dnutrition.com/programs

I sincerely hope you’ve found the Type 1 Diabetes Conundrum series helpful!

If you have a question or concern that you want me to address in an upcoming video, let me know in the comments section.

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References:

Arnaud, C.H. (2022, January 30). "Insulin’s second century: 100 years after insulin was first used to treat type 1 diabetes, researchers are still finding ways to improve it". Chemical and Engineering News, 100 (4). https://cen.acs.org/pharmaceuticals/biologics/insulin-improve-better-glucose-responsive-basal-oral/100/i4

https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments#questionst

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