Diabetes Management

The Ultimate Guide to Insulin

Insulin can be a confusing term. Is it a medication? Something produced by the body? Is it good or bad for me?

In this article, we will walk through exactly what insulin is and the surrounding health implications.

What is Insulin?

Insulin is a naturally occurring hormone (a chemical messenger) that is produced by the pancreas.

The role of insulin is to control blood sugar levels (also known as blood glucose) by allowing glucose to enter body cells where it can be used as energy. This is an important process as the body requires blood glucose to stay within a tight margin to function properly.

When foods containing sugars or starches, known as carbohydrates, are eaten, they are broken down into blood glucose.

Glucose is the preferred source of energy for the body, but it requires insulin to be used. Insulin is the “key” that allows glucose to escape the bloodstream and be used as an energy source.

A normal pancreas secretes a large amount of insulin after meals, known as a “bolus,” and a small amount of insulin throughout the day, known as the “basal” amount.

When insulin is not working correctly, it can lead to severe complications such as diabetes and heart disease.

What is Injected or Inhaled insulin?

The word insulin may also refer to insulin medication. Insulin medication is the same hormone discussed above, but it comes in a variety of different types.

Insulin was first used for medicinal purposes in the 1920s using cattle or pig insulin. Later, e.coli bacteria were used to manufacture human insulin. This significantly improved insulin availability genetically.

Today, many forms of insulin are used, including “insulin analogs.” Insulin analogs are alterations to normal insulin to create a more effective product. Insulin medication is used for people with diabetes to manage their blood glucose.

Fast-acting Injected Insulin. This type of Insulin is used just before meals to cover the rise in glucose from the meal. Brand names such as Novolog and Humalog are examples of fast-acting insulin. This medication is given as an injection.

Intermediate-acting injected insulin. Intermediate-acting refers to insulin types that are somewhere between long and short-acting. They can be used to cover both meals and provide background insulin. NPH is an example of this type of insulin.

Long-acting injected Insulin. Lantus and Levemir are examples of long-acting insulin that are designed to provide small amounts of insulin over a long or very long period to cover the body’s basal or background insulin needs.

Inhaled insulin. Inhaled insulin is a newer form of insulin that is used as an inhaled powder instead of an injection. This powder is composed of a rapid-acting form of human insulin. Inhaled insulin works faster than injected insulin.

Common health problems associated with Insulin

Since Insulin has a vital role in regulating blood sugar levels, any imbalance of insulin can lead to health problems, the most common of which is diabetes.

Diabetes results from two main issues: insulin resistance and insulin deficiency. Insulin resistance is when the pancreas is still producing an ample supply of insulin, but it is not able to be used correctly by the body.

In other words, if insulin is the key that allows glucose to enter the cells, insulin resistance is when the locks have been unexpectedly changed.

Insulin resistance is caused by several factors, including genetics, obesity, and poor diet habits. It is the leading cause of Type 2 diabetes.

Over time, as insulin resistance worsens, the pancreas compensates by producing more and more insulin, eventually burning out insulin production. When the pancreas can no longer keep up with insulin demands, this is known as insulin deficiency.

As insulin resistance worsens, insulin medication is often required to maintain blood glucose control. Those with Type 1 diabetes have a complete insulin deficiency and are entirely reliant on insulin medication for survival.

So to recap on the main types of diabetes:

Type 1 diabetes: the pancreas cannot produce any insulin; lifelong insulin medication is required to manage blood glucose.


Type 2 diabetes: The most common type of diabetes. It occurs when insulin is no longer working correctly. Diet, exercise, pills, and insulin are various treatments for this condition.

Insulin and Cardiovascular disease

Insulin resistance is also a factor in the development of the metabolic syndrome.

Metabolic syndrome is a collection of risk factors that includes abnormal cholesterol, high blood sugars, high waist circumference, and high blood pressure. Those with metabolic syndrome have a higher risk of cardiovascular disease.

Cardiovascular disease is also the leading cause of death in those with diabetes. What connects insulin problems with heart disease? It turns out a few factors are involved:

  • High blood sugars. When blood glucose stays high for too long, it will start to impact the blood vessels that supply major organ systems. The heart may need to pump harder to keep blood moving.

  • Plaque build-up. Insulin resistance is often associated with lower HDL cholesterol. HDL is the “good” cholesterol that helps to clean out blood vessels. Keeping cholesterol in check is an essential goal of those with diabetes.

  • Abdominal obesity. Having extra fat along the midsection is especially dangerous to heart health. Abdominal fat is both a cause of insulin resistance and makes existing insulin resistance worse.

  • Uncontrolled blood pressure. Most people with type 2 diabetes have high blood pressure. High blood pressure will harden the blood vessels and can increase the chances of heart attack or stroke.

  • Lack of exercise. A sedentary lifestyle is associated with a higher risk of death and can worsen insulin resistance.

Synthesis and release of Insulin

Now that the basics of insulin problems are covered let’s dive into how insulin is produced in the body.

The pancreas is a small organ located behind the stomach. Inside of the pancreas is specialized cells known as beta cells that produce and secrete insulin.

Insulin is stored in these beta cells until it is ready for release. Insulin is released in two different phases, as previously mentioned: the bolus and the basal.

  • Bolus Insulin: The pancreas responds quickly to a rise in blood glucose after eating by releasing a large amount of insulin. After a meal, insulin levels return to normal to avoid lowering glucose too much. A normal functioning pancreas can bolus even very large meals.

  • Basal Insulin: Outside of meals, a basic level of insulin must be maintained to avoid abnormal changes in blood glucose. To accomplish this task, the pancreatic beta cells produce small amounts of insulin throughout the day.

To sum up, insulin is released when the body senses that blood glucose levels are too high, and insulin is held when blood glucose levels are normal or low.

Managing when to release insulin is one of the most important functions of the pancreas.

Insulin medications attempt to mimic a pancreas but do so imperfectly. This is why dealing with high and low blood sugars are common for those dependent on insulin.

Natural alternatives to Insulin

Although insulin can be a life-saving medical treatment, many people are reluctant to start insulin.

Whether it is fear of injections, side effects, or the notion that beginning insulin is admitting to “failure,” there are many reasons people prefer to avoid insulin.

For those people, what alternatives are available? The answer to this question is highly dependent on the specific situation and degree of insulin issues.

In some cases, insulin is required, and there is no alternative available, these are summarized below:

  • Type 1 diabetes. As previously established, those with type 1 diabetes absolutely require insulin medication for survival.

  • Severe insulin deficiency. With advanced type 2 diabetes, insulin deficiency can be severe enough to require insulin medication.

  • Inadequate diabetes control. If blood glucose continues to be too high despite non-insulin therapies, insulin should be considered to avoid health complications.

However, people with prediabetes, metabolic syndrome, and mild forms of type 2 diabetes have many options to improve insulin resistance without insulin medication.

  • Weight loss. Losing even 5% of your body weight can dramatically improve insulin resistance. Making small lifestyle changes to reduce portion sizes, prepare more meals at home, and track what you are eating can go a long way in helping to shed some extra pounds.

  • Exercise. Physical activity is a natural insulin sensitizer. Exercise helps the body soak up blood glucose and can be especially helpful after meals. Sitting less, taking the stairs, parking far away, and lifting weights are great options. Aiming for at least 30 minutes of physical activity most days of the week is recommended.

  • Oral medications. Most people with type 2 diabetes start with oral medications such as metformin. For many, medications are sufficient to control blood glucose along with diet and exercise.

  • Supplements. Certain supplements have been studied for their role in assisting with glucose issues. Research shows that alpha-lipoic acid can help improve insulin sensitivity in those with type 2 diabetes. The plant substance berberine has also been shown to reduce fasting and meal glucose levels. Blond psyllium (a fiber supplement), cinnamon, and white mulberry extract also have some evidence supporting their use for lowering blood sugars. When considering a supplement, weigh the available evidence carefully and make sure to use them in conjunction with the above strategies.

Conclusion

Insulin is a naturally occurring substance produced by the pancreas. In a normal functioning pancreas, insulin is secreted in response to high blood sugars in order to maintain a safe level of blood glucose.

Disorders such as diabetes occur due to insulin imbalances, such as insulin resistance and insulin deficiency. Insulin is also used as a medication to restore blood glucose control in those with diabetes.

For those looking for alternatives to insulin, diet, exercise, oral medications, and supplements can go a long way in improving insulin sensitivity. Still, some people will require insulin medication no matter what.

Sources

  1. 12, L. reviewed: J., & 18, L. edited: J. (n.d.). The History of a Wonderful Thing We Call Insulin.
  2. Cardiovascular Disease and Diabetes. (n.d.).
    Gleissner, C. A., Galkina, E., Nadler, J. L., & Ley, K. (2007). Mechanisms by which diabetes increases cardiovascular disease.
  3. Insulin Basics. (n.d.). Retrieved from https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics?language_content_entity=en.
  4. Petersen, M. C., & Shulman, G. I. (2018, October 1). Mechanisms of Insulin Action and Insulin Resistance.

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