OUR past two issues on insulin appear to have stirred the hornet's nest, to say the least. Our cell as well as hospital phone have been receiving questions and inquiries about the many insulin preparations introduced by Novo Nordisk. On the patients" side, questions about how many injections to take, how thin are the needles, the price and drugstores where they could buy the insulins.
Surprisingly, doctors, mostly internists and family physicians- some of them my former students at SLU Med school- also phoned in, most of them grateful for the new information about the modern insulins and the convenience as well as efficacy of the Novo insulins.
Well, dear readers, patients and doctors, more good news are coming our way. In a few more days, Novo Nordisk will be bringing in their Next Generation Flexpen with the following advantages, both to the patient and his doctor. New color-coded labels are available for Levemir -- the "slim insulin", NovoRapid -- for fast action during emergency conditions, and the very popular NovoMix 30 -- the biphasic insulin aspart 30, 30% premix insulin analoguie insulin aspart and 70% protaminated insulin aspart. Obviously, the distinct colors would help avoid mix-ups especially in families who have diabetic patients on insulin. The new Flexpen requires only just a gentle push, thus less effort is needed to inject. What's more is the unique feature of a reassuring audible click for patients when dialing both up and down, therefore giving the patient more confidence in dose setting.
Novo Nordisk, with its battlecry of Changing Diabetes reminds our patients some practical guidelines in insulin therapy. Among the DO's are, identify your insulin by its name, which should be made easier with the color-coded labels. Store your insulin in a refrigerator but not in the freezer, or in a cool dark dry place. Tell relatives and friends or colleagues on how to deal with hypoglycemic episodes. Always take your insulin supplies and other equipment when you are travelling. Gently resuspend cloudy insulin immediately before injection and dispose the used needles appropriately.
Don't include leaving your insulin near a stove, radiator or warm places and sunlight. Don't use clear soluble insulin it gets cloudy. Don't wait till you run out of insulin before obtaining a new supply and don't forget to carry with you, at all times, sugar or glucose with you at all times or perhaps a candy. Don't inject in exactly the same place every day. For example, if you inject in your leg, choose a different place on either leg the next day.
Insulin may be injected into the subcutaneous tissue( under the skin) of the upper arm, the anterior (front) and lateral (side) aspects of the thigh; also in the buttocks and in the abdomen, avoiding a circle of about 2 inch radius around the navel. It has been shown that the abdomen has the fastest rate of absorption, followed by the arms, thighs and buttocks. Exercise increases the rate of absorption from the injection site. Rotation of injection site is important to prevent lipohypertrophy or lipoatrophy -- unsightly, uneven bulging masses in the site of injection because disorderly accumulation of fat. It is also recommended that rotating within one area is better -- rotating injections systematically within the abdomen -- rather than rotating to a different area the next day. This practice may decrease the variability in the absorption of insulin from day to day.
Indeed, dear readers and patients, especially our diabetics, with all the available medicines for diabetes mellitus, insulin might just be the only one -- depending on your clinical circumstances -- reliable, efficacious and effective controller of your blood sugar. And the medical community is thankful to Novo Nordisks for their "patient-friendly" insulins!