Managing Insulin in an Emergency

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From wildfires to hurricanes, disasters seem to be getting more and more common. Being prepared for an emergency is important for everyone, but it’s even more important if you have a chronic health condition like diabetes. Routines suddenly change, supplies and medicines can be hard to get and hard to store, and added stress makes it harder to manage your blood sugar. Read on for important information about storing and using insulin in an emergency.

Using Insulin

In a power outage when refrigerated insulin isn’t available:

  • Try to keep your insulin as cool as possible, but make sure not to freeze it. Insulin that has been frozen can break down and will be less effective.
  • Keep your insulin away from direct heat and out of direct sunlight, which also make it less effective.
  • For up to 4 weeks, you can use insulin in opened or unopened vials that have been stored at room temperature (between 59°F and 86°F).
  • Realistically, you may have to use insulin that has been stored above 86°F. If so, monitor your blood sugar regularly. If you’re living in an emergency shelter, let someone in charge know if your blood sugar is too high or low, so they can get help if needed. Contact your doctor as soon as the emergency is over.

Switching Insulin

In an emergency, you may need to use a different insulin brand or type instead of your usual insulin. You should work with your doctor if you need to switch insulin brands or types, but that might not be possible in crisis conditions. In that case, follow this emergency guidance from the US Food & Drug Administration (FDA) and be sure to monitor your blood sugar closely and get medical attention as soon as possible.

Using an Insulin Pump

If you use an insulin pump, you may be able to substitute another insulin for your usual insulin. Check the instructions for your pump to see which insulin types will work. The guidance also explains which insulin types you can use instead of your usual insulin if you need to switch from using your pump to using injectable insulin (taken with a needle).

Getting Back to Normal

When you can get your usual insulin and store it properly, throw away any insulin that was stored at room temperature or exposed to very high or low temperatures. Plan to visit your doctor if you have questions about managing your diabetes going forward or have any other health concerns.

INSULIN SWITCHING DOCUMENT

Insulin, Medicines, & Other Diabetes Treatment

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Taking insulin or other diabetes medicines is often part of treating diabetes. Along with healthy food choices and physical activity, medicine can help you manage the disease. Some other treatment options are also available.

What medicines might I take for diabetes?

The medicine you take will vary by your type of diabetes and how well the medicine controls your blood glucose levels, also called blood sugar. Other factors, such as your other health conditions, medication costs, and your daily schedule may play a role in what diabetes medicine you take.

Type 1 diabetes

If you have type 1 diabetes, you must take insulin because your body no longer makes this hormone. You will need to take insulin several times during the day, including with meals. You also could use an insulin pump, which gives you small, steady doses throughout the day.

Type 2 diabetes

Some people with type 2 diabetes can manage their disease by making healthy food choices and being more physically active. Many people with type 2 diabetes need diabetes medicines as well. These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose. Even if you do not take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.

Gestational diabetes

If you have gestational diabetes, you should first try to control your blood glucose level by making healthy food choices and getting regular physical activity. If you can’t reach your blood glucose target, your health care team will talk with you about diabetes medicines, such as insulin or the diabetes pill metformin, that may be safe for you to take during pregnancy. Your healthcare team may start you on diabetes medicines right away if your blood glucose is very high.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. You may also need medicines for other health problems, such as high blood pressure or high cholesterol, as part of your diabetes care plan. View resources that may help you manage your medication plan.

What are the different types of insulin?

Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. Then the effects of the insulin wear off over the next few hours or so.

What are the different ways to take insulin?

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. You may decide that needles are not for you and prefer a different method. Talk with your doctor about the options and which is best for you. Most people with diabetes use a needle and syringe, pen, or insulin pump. Inhalers, injection ports, and jet injectors are less common.

Needle and syringe

You’ll give yourself insulin shots using a needle and syringe. You will draw up your dose of insulin from the vial, or bottle, into the syringe. Insulin works fastest when you inject it in your belly, but you should rotate spots where you inject insulin. Other injection spots include your thigh, buttocks, or upper arm. Some people with diabetes who take insulin need two to four shots a day to reach their blood glucose targets. Others can take a single shot.

Photo of an insulin vial and a syringe.
Insulin shots involve drawing insulin from a vial into a syringe and then injecting it under your skin.

Pen

An insulin pen looks like a pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and then replace after use. Insulin pens cost more than needles and syringes but many people find them easier to use.

Photo of an insulin pen
An insulin pen is a convenient way to take insulin

Pump

An insulin pump is a small machine that gives you small, steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the needle under your skin and it stays in place for several days. Insulin then pumps from the machine through the tube into your body 24 hours a day. You also can give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod.

Photo of a woman holding an insulin pump with the tube connected to a patch on her stomach, where the needle is inserted.
Insulin pumps deliver insulin 24 hours a day.

Inhaler

Another way to take insulin is by breathing powdered insulin from an inhaler device into your mouth. The insulin goes into your lungs and moves quickly into your blood. Inhaled insulin is only for adults with type 1 or type 2 diabetes.

Injection port

An injection port has a short tube that you insert into the tissue beneath your skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. You inject insulin through the port with a needle and syringe or an insulin pen. The port stays in place for a few days, and then you replace the port. With an injection port, you no longer puncture your skin for each shot—only when you apply a new port.

Jet injector

This device sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.

What oral medicines treat type 2 diabetes?

You may need medicines along with healthy eating and physical activity habits to manage your type 2 diabetes. You can take many diabetes medicines by mouth. These medicines are called oral medicines.

Most people with type 2 diabetes start medical treatment with metformin pills. Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better. This drug may help you lose a small amount of weight.

Other oral medicines act in different ways to lower blood glucose levels. You may need to add another diabetes medicine after a while or use a combination treatment. Combining two or three kinds of diabetes medicines can lower blood glucose levels more than taking just one.

Read about different kinds of diabetes medicines from the Food and Drug Administration (FDA).

What other injectable medicines treat type 2 diabetes?

Besides insulin, other types of injected medicines are available. These medicines help keep your blood glucose level from going too high after you eat. They may make you feel less hungry and help you lose some weight. Other injectable medicines are not substitutes for insulin. Learn more about noninsulin injectable medicines.

What should I know about side effects of diabetes medicines?

Side effects are problems that result from a medicine. Some diabetes medicines can cause hypoglycemia, also called low blood glucose, if you don’t balance your medicines with food and activity.

Ask your doctor whether your diabetes medications can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Take your diabetes medicines as your health care professional has instructed you, to help prevent side effects and diabetes problems.

Do I have other treatment options for my diabetes?

When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an “artificial pancreas” and pancreatic islet transplantation for some people with type 1 diabetes.

Bariatric surgery

Also called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1

Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2

Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.

Artificial Pancreas

The NIDDK has played an important role in developing “artificial pancreas” technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.

In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.

You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable—or help you sleep through the night without the need to wake and test your glucose or take medicine.

The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your healthcare provider about whether this system might be right for you.

The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.

Pancreatic islet transplantation

Pancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.

What is insulin?

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Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.

Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy.

Insulin’s Role in Blood Glucose Control

When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.

  • Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.
  • Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.
  • Insulin also lowers blood glucose levels by reducing glucose production in the liver.

In a healthy person, these functions allow blood glucose and insulin levels to remain in the normal range.

Types of Insulin

There are many different types of insulin. The type lets you know how fast the insulin starts working or how long it lasts in your body. Your health care provider will help you find the insulin that is best for you.

  • Rapid-Acting – This insulin starts working within 15 minutes after you use it. It is mostly gone out of your body after a few hours. It should be taken just before or just after you eat.
  • Short-Acting – This insulin starts working within 30 minutes to 1 hour after you use it. It is mostly gone out of your body after a few hours. It should be taken 30-45 minutes before you eat.
  • Intermediate-Acting – This insulin starts working within 2-4 hours after you use it. It reaches its highest level in your blood around 6-8 hours after you use it. It is often used to help control your blood sugar between meals. Some people use this type of insulin in the morning, at bedtime, or both.
  • Long-Acting – This insulin starts working within 2 to 4 hours after you use it. It can last in the body for up to 24 hours. It is often used in the morning or at bedtime to help control your blood sugar throughout the day.
  • Pre-Mixed – This is a mix of two different types of insulin. It includes one type that helps to control your blood sugar at meals and another type that helps between meals.
General Tips
  • Never share insulin needles (syringes) or devices.
  • Ask your doctor or nurse to show you how to inject your insulin.
  • Always wash your hands before you inject your insulin.
  • Do not inject your insulin in the exact same spot on your body each time.
    • The skin may get thick or thin if you use the same spot.
    • Inject in the same general area of your body.
  • Do not use your insulin if it looks cloudy or looks like something is floating in it. Take it back to the drug store for a new one.
  • Do not use insulin needles (syringes), pens, and injectors after the expiration date printed on the label or on the box.

What you need to know about smoking and diabetes

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The 2014 Surgeon General’s Report has found that smoking is a cause of type 2 diabetes, which is also known as adult-onset diabetes. Smokers have a greater risk of developing type 2 diabetes than do nonsmokers. The risk of developing diabetes increases with the number of cigarettes smoked per day.

How smoking causes type 2 diabetes

Smoking increases in inflammation in the body. Inflammation occurs when chemicals in cigarette smoke injure cells, causing swelling and interfering with proper cell function. Smoking also causes oxidative stress, a condition that occurs as chemicals from cigarette smoke combine with oxygen in the body. This causes damage to cells. Evidence strongly suggests that both in inflammation and oxidative stress may be related to an increased risk of diabetes.

The evidence also shows that smoking is associated with a higher risk of abdominal obesity, or belly fat. Abdominal obesity is a known risk factor for diabetes because it encourages the production of cortisol, a hormone that increases blood sugar. Smokers tend to have higher concentrations of cortisol than nonsmokers.

What smoking means to people with diabetes 

Studies have confirmed that when people with type 2 diabetes are exposed to high levels of nicotine, insulin (the hormone that lowers blood sugar levels) is less effective. People with diabetes who smoke need larger doses of insulin to control their blood sugar.

Smokers who have diabetes are more likely to have serious health problems, including:

  • heart and kidney disease;
    poor blood flow in the legs and feet that can lead to foot infections, ulcers, possible amputation of toes or feet;
  • possible amputation of toes or feet;
  • retinopathy (an eye disease that can cause blindness);
  • peripheral neuropathy (damaged nerves to the arms and legs that cause numbness, pain, weakness, and poor coordination).

Even though we don’t know exactly which smokers will develop type 2 diabetes, we do know that all diabetic smokers should quit smoking or use any type of tobacco product immediately. The health bene ts of quitting begin right away. People with diabetes who quit have better control of their blood sugar. Studies have shown that insulin can start to become more effective at lowering blood sugar levels eight weeks after a smoker quits.

10 Things That Can Spike Your Blood Sugar

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When you first found out you had diabetes,  you tested your blood sugar often to understand how food, activity, stress, and illness could affect your blood sugar levels. By now, you’ve got it figured out for the most part. But then—bam! Something makes your blood sugar zoom up. You try to adjust it with food or activity or insulin, and it dips low. You’re on a rollercoaster no one with diabetes wants to ride.

Knowledge is power! Look out for these surprising triggers that can send your blood sugar soaring:

  1. Sunburn—the pain causes stress, and stress increases blood sugar levels.
  2. Artificial sweeteners—more research needs to be done, but some studies show they can raise blood sugar.
  3. Coffee—even without sweetener. Some people’s blood sugar is extra-sensitive to caffeine.
  4. Losing sleep—even just one night of too little sleep can make your body use insulin less efficiently.
  5. Skipping breakfast—going without that morning meal can increase blood sugar after both lunch and dinner.
  6. Time of day—blood sugar can be harder to control the later it gets.
  7. Dawn phenomenon—people have a surge in hormones early in the morning whether they have diabetes or not. For people with diabetes, blood sugar can spike.
  8. Dehydration—less water in your body means a higher blood sugar concentration.
  9. Nose spray—some have chemicals that trigger your liver to make more blood sugar.
  10. Gum disease—it’s both a complication of diabetes and a blood sugar spike.

Watch out for other triggers that can make your blood sugar fall. For example, extreme heat can cause blood vessels to dilate, which causes insulin absorb more quickly and could lead to low blood sugar. If an activity or food or situation is new, be sure to check your blood sugar levels before and after to see how you respond.

What are the different types of insulin? 

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Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. Then the effects of the insulin wear off over the next few hours or so.

Source: Insulin basics. American Diabetes Association website.  Last edited 2015. Accessed August 25, 2016.
Types of Insulin and How They Work 
Insulin type How fast it starts to work (onset) When it peaks How long it lasts (duration)
Rapid-acting About 15 minutes after injection 1 hour 2 to 4 hours
Short-acting, also called regular Within 30 minutes after injection 2 to 3 hours 3 to 6 hours
Intermediate-acting 2 to 4 hours after injection 4 to 12 hours 12 to 18 hours
Long-acting Several hours after injection Does not peak 24 hours; some last longer

The chart above gives averages. Follow your doctor’s advice on when and how to take your insulin. Your doctor might also recommend premixed insulin, which is a mix of two types of insulin. Some types of insulin cost more than others, so talk with your doctor about your options if you’re concerned about cost.

What are the different ways to take insulin?

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. You may decide that needles are not for you and prefer a different method. Talk with your doctor about the options and which is best for you. Most people with diabetes use a needle and syringe, pen, or insulin pump. Inhalers, injection ports, and jet injectors are less common.

Needle and syringe

You’ll give yourself insulin shots using a needle and syringe. You will draw up your dose of insulin from the vial, or bottle, into the syringe. Insulin works fastest when you inject it in your belly, but you should rotate spots where you inject insulin. Other injection spots include your thigh, buttocks, or upper arm. Some people with diabetes who take insulin need two to four shots a day to reach their blood glucose targets. Others can take a single shot.

Insulin shots involve drawing insulin from a vial into a syringe and then injecting it under your skin.

Pen

An insulin pen looks like a pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and then replace after use. Insulin pens cost more than needles and syringes but many people find them easier to use.

An insulin pen is a convenient way to take insulin

Pump

An insulin pump is a small machine that gives you small, steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the needle under your skin and it stays in place for several days. Insulin then pumps from the machine through the tube into your body 24 hours a day. You also can give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod.

Insulin pumps deliver insulin 24 hours a day.

Inhaler

Another way to take insulin is by breathing powdered insulin from an inhaler device into your mouth. The insulin goes into your lungs and moves quickly into your blood. Inhaled insulin is only for adults with type 1 or type 2 diabetes.

Injection port

An injection port has a short tube that you insert into the tissue beneath your skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. You inject insulin through the port with a needle and syringe or an insulin pen. The port stays in place for a few days, and then you replace the port. With an injection port, you no longer puncture your skin for each shot—only when you apply a new port.

Jet injector

This device sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.

Insulin, Medicines, & Other Diabetes Treatments

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Taking insulin or other diabetes medicines is often part of treating diabetes. Along with healthy food choices and physical activity, medicine can help you manage the disease. Some other treatment options are also available.

What medicines might I take for diabetes?

The medicine you take will vary by your type of diabetes and how well the medicine controls your blood glucose levels, also called blood sugar. Other factors, such as your other health conditions, medication costs, and your daily schedule may play a role in what diabetes medicine you take.

Type 1 diabetes
If you have type 1 diabetes, you must take insulin because your body no longer makes this hormone. You will need to take insulin several times during the day, including with meals. You also could use an insulin pump, which gives you small, steady doses throughout the day.

Type 2 diabetes
Some people with type 2 diabetes can manage their disease by making healthy food choices and being more physically active. Many people with type 2 diabetes need diabetes medicines as well. These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose. Even if you do not take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.

Gestational diabetes
If you have gestational diabetes, you should first try to control your blood glucose level by making healthy food choices and getting regular physical activity. If you can’t reach your blood glucose target, your health care team will talk with you about diabetes medicines, such as insulin or the diabetes pill metformin, that may be safe for you to take during pregnancy. Your health care team may start you on diabetes medicines right away if your blood glucose is very high.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. You may also need medicines for other health problems, such as high blood pressure or high cholesterol, as part of your diabetes care plan.

TuDiabetes Talks Live Chat! Cycling 205.5 miles with Diabetes! 8pm ET, 5pm PT

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TTFBRiding

Join us HERE at the time and date of the event

Hi!  My name is Anthony Hightower.  I was diagnosed with Type 1 Diabetes at age 13 and have spent my adult life seeking to raise awareness, educate, and support research efforts.

As an avid cyclist, I co-founded a team called “Duck Fiabetes” and have leveraged this passion to raise over $60,000 to the American Diabetes Association’s Tour de Cure.  I was recently a camp counselor at Camp Hodia, a camp for diabetic youth, where I was camp counselor to 12 teenage boys.

I was born and raised in Northern California. I own and operate an industrial Shrink wrap business.  In my free time I love talking about Diabetes hanging out with family, friends, and my fur babies (Chelsie and Brady).

Episode 24: Afrezza User

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If every there was a rock star diabetes drug, Afrezza is it.

In this episode Corinna Cornejo speaks with Emily Coles about how the inhalable insulin Afrezza has captured the imagination of the diabetes patient community and its impact on the diabetes treatment landscape.

We also share highlights from a live interview with Sam Finta, aka AfrezzaUser. Sam spent years being as careful as possible and feeling like “giving up” on his diabetes. Severe depression and anxiety inspired him to seek better means of diabetes treatment. He was fortunate to obtain one of the last openings in MannKind’s Afrezza drug trial in Atlanta through Dr. Bruce Bode of the Atlanta Diabetes Center. Since then, Sam has provided honest, genuine, and truthful information about his experiences with Afrezza via social media ( on Yahoo message Boards, blogspots and others) .

You can find the complete interview with Sam Finta in our archives.

Everybody Talks Diabetes Podcast Corinna Cornejo

Episode 23: D.I.Y. Pancreas System

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Dana Lewis is one of the creators of the DIY Pancreas System, or DIYPS.

In this episode Corinna Cornejo and Mila Ferrer talk about the promise and perils DYIPS represents.

Diagnosed at age 14 with type 1, Dana Lewis had the usual experience of years of frustration of dealing with diabetes devices that did not communicate with each other. She often imagined a system that would take data from each device, run it through the algorithm that every person with diabetes uses in their head dozens (or hundreds) of times a day, and automate some of the decision-making process. In late 2013, this became a reality after someone shared their code to help pull data off of a CGM in real-time. Dana and her now-husband Scott Leibrand used the CGM data to create a decision-assist system they called #DIYPS, the “Do-It-Yourself Pancreas System”.

We share highlights from Emily Cole’s interview with Dana Lewis in this podcast. You can find the complete interview in the TuDiabetes archives..

 

Everybody Talks Diabetes Podcast Corinna Cornejo

Advances in glucagon with Locemia Solutions

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Locemia Solutions is a Canadian-based pharmaceutical development company, which sole focus is on innovating the rescue treatment of severe hypoglycemia. The team at Locemia is working on providing people with diabetes and those that touch their lives, with a simple, needle-free glucagon rescue product for the treatment of severe hypoglycemia, which would be easy to teach, easy to carry and easy to use – helping to expand the number of people who feel confident in dealing with the unpredictability of hypoglycemia, and providing peace of mind for people who use insulin every day. Locemia’s passion and promise – driven by its members personal involvement and investment in the diabetes community – is to fill an unmet need through innovation, awareness and empowerment—rooted in needle-free simplicity,  for everyone to be able to help anyone—quickly and easily— deal with severe low blood sugar.