American Medical Association Family Medical Guide - American Medical Association [607]
In addition to the standard insulin syringe, a variety of disposable penlike devices are available. These devices allow you to inject insulin by turning a dial to select the dose. Each device can hold about 150 to 300 units of insulin. In some cases, the pen is prefilled with insulin; in others, a disposable cartridge is used, providing added convenience to people who take multiple injections a day. Always inspect your pens and cartridges to make sure that you have been given the correct kind of insulin (rapidly acting, long-acting, or mixed).
An alternative to multiple daily injections of insulin is a course of treatment called continuous insulin therapy, which uses an external, wearable device (called an insulin pump) to infuse specific amounts of insulin automatically and continuously through a thin plastic tube inserted under the skin, usually on the abdomen. Several small, highly reliable insulin pumps are currently available that are about the size of a pager and can hold up to a 3-day supply of insulin. The pumps are about as effective as daily injections, but many people find the pumps more convenient and comfortable. Because the pumps do not sense blood glucose levels, you still need to do frequent blood sugar tests for best results. (Implantable insulin pumps remain experimental.)
Checking blood glucose levels
Many people with diabetes find it helpful to check their blood glucose levels at home daily even if they are only taking oral glucose-lowering medications (hypoglycemics; see page 896). People who are taking insulin may need to check their blood sugar three to seven times a day or as often as their doctor recommends. You can test your blood sugar level with a machine that provides a digital readout. A pricking device that comes with the machine enables you to take your blood sample quickly and easily. Some newer devices allow you to take blood samples from skin areas other than the fingertips. The results obtained by the machine provide valuable information on how well your diabetes is being controlled and will enable you and your doctor to take steps to improve this control by adjusting your diet, insulin injections, or treatment with drugs when your sugar level fluctuates. Some newer machines allow you to download the information to a computer for analysis.
Having regular hemoglobin A1C tests (see page 895) can track your average blood sugar over the last 3 to 4 months, which can help you and your doctor evaluate how successfully your blood sugar level is being controlled. Your doctor will encourage you to know your hemoglobin A1C test numbers and strive to keep them as close to the normal range (less than 8 percent) as you can without triggering excessively low blood sugar reactions. These tests are available for home use.
Continuous blood glucose monitoring
Several useful devices are available that can continuously monitor glucose levels in the tissues beneath the skin instead of glucose in the blood. Fluid in tissues (called interstitial fluid) can provide extremely useful information about blood sugar. Some of these devices have an alarm that alerts you when your blood sugar level is very high or very low or if it is changing rapidly. Other devices track the blood glucose level to provide a retrospective analysis to help determine how well the blood sugar is being controlled between meals and during sleep; treatment can then be adjusted if necessary. Doctors are hopeful that in the future these devices will be attached to an automatic insulin delivery system that provides insulin on demand in response to glucose levels.
Pancreas transplants
Pancreas transplantation has become a widely used approach to treating type 1 diabetes, usually when a person also has advanced kidney disease. A kidney transplant (see page 820) is usually done at the same time. Although pancreas transplantation techniques continue to improve, a pancreas transplant is a technically complex surgical procedure with significant potential complications. However, many people who have type