Last updated: Apr 09, 2008
andy-mandell
Newer types of insulin allowed Andy to reduce his number of daily injections.
(ANDY MANDELL)

The good news about insulin is the multitude of choices available today. There are long-acting insulins to keep the blood sugar smooth all day and all night and rapid-acting insulins to keep blood sugar levels at bay after meals. There is short-acting, or "regular," insulin and intermediate-acting insulin called NPH.



It may not be as bad as you think
Insulin has come a long way since 63-year-old Andy Mandell, executive director of Defeat Diabetes Foundation, a Madeira Beach, Fla.-based educational organization, began taking it.

"When I started with my insulin injections, I was taking this long needle—I called it a harpoon—and it was like 28 gauge or 29 gauge," says the martial arts aficionado.

His regimen consisted of two different kinds of insulin: One he'd take every six hours around the clock to ensure that his body had enough insulin to control sugar levels between meals and overnight and the other was a rapid-acting insulin to handle any spikes in blood sugar that might occur after meals.

Taking insulin in this way mimics the action of a healthy pancreas, which produces a steady amount of insulin around the clock and bursts of the hormone to cope with meals. New types of insulin have reduced the need for multiple injections and can be taken with smaller gauge needles.
 
 

Long-acting insulin
For many people with type 2 diabetes, Lantus (insulin glargine), a long-acting insulin approved by the U.S. Food and Drug Administration in 2000, proved to be a boon.

Kathy Davis, 51, a clinical research coordinator in the Toledo, Ohio, area, has been on the once-a-day injection for about a year. "I love it; it's great. My hemoglobin A1C has been 5.9 to 6.2."

In 2002 Mandell switched to Lantus, which covers his basal, or background, insulin needs for 24 hours, eliminating three shots a day. He also upgraded the delivery of insulin with shorter, thinner 31-gauge needles.

"It can sting a little bit sometimes, but certainly it's better than that harpoon I was taking," he says. Mandell also takes Apidra, a rapid-acting insulin, to handle mealtime spikes in blood sugar.

Pre-mixed insulin
Pre-mixed insulins combine an intermediate-acting insulin with one that starts to work more quickly. They're handy for patients because one shot takes care of two different insulin needs. But these concoctions are not as precise as some doctors would like.

At his endocrine practice in North Kansas City, Mo., Richard Hellman, MD, uses very little pre-mixed insulin. People's insulin requirements vary a lot, but the ratios of intermediate and shorter-acting insulin are fixed, he says, "so I feel it's a compromise that has done more for convenience."

Inhaled insulin: off the market
Another innovation, the first inhaled insulin, Exubera, proved not to be very popular. In October 2007 Pfizer said it would stop selling the product. Difficult dosing, a higher cost, and the need for frequent lung-function tests likely damped enthusiasm for this breakthrough treatment.