Insulin – how does it work?

If you’re a nurse involved in direct patient care, you’ve probably administered insulin sooner or later in your profession. Have you ever wondered how insulin works?

Basic insulin overview

Before we dive into the mechanics of how insulin works, let’s first take a look at some basics. Insulin is a substance normally secreted by the beta cells of the pancreas that helps the body use or store glucose. In individuals with type 1 diabetes, beta cells are destroyed, so that they need an external source of insulin to assist the body process glucose. People with type 2 diabetes still produce insulin, but their bodies don’t respond well to it. They need oral diabetes medications or one other type of insulin to assist regulate their blood sugar levels.
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Injectable insulin is produced using recombinant DNA technology and will be classified based on onset, peak, and duration of motion (i.e., rapid, short-acting, intermediate-acting, long-acting, and really long-acting). It is dissolved or suspended in a liquid, and the usual strength within the US is U-100, which suggests it accommodates 100 units of insulin per milliliter of liquid. U-500 can be available for patients with extreme insulin resistance. (American Diabetes Association, North Dakota). It will likely be injected subcutaneously into fatty tissue and absorbed into the blood.
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Inhaled insulin became available in 2015 and is a fast-acting preparation that ought to be taken firstly of every meal. It will be utilized by individuals with type 1 or type 2 diabetes. Please do not forget that in patients requiring prolonged inhaled insulin therapy, it ought to be administered along with long-acting injectable insulin.

Mechanism of insulin motion (Facts and comparisons, 2019)

How does insulin work? When carbohydrates are eaten, the body breaks them down into glucose, a straightforward sugar and the body’s primary source of energy. When blood glucose levels rise, the pancreas releases insulin, which helps glucose enter the cells. Insulin is secreted into the bloodstream and binds to receptors on the surface of the goal cell membrane. When insulin and its receptor enter the cell, it prompts glucose transporter channels, which travel to the cell surface, allowing glucose to enter and be utilized in metabolism (Perkins, 2017).

Specific goal cells are present in the liver, skeletal muscle and adipose tissue. In the liver, insulin stimulates the synthesis of glycogen and fatty acids, that are released into the circulation in the shape of lipoproteins. In skeletal muscle, insulin increases protein and glycogen synthesis. In adipose tissue, insulin helps process circulating lipoproteins and aids within the synthesis and storage of triglycerides by adipocytes. Additionally, insulin stimulates cellular uptake of amino acids and increases cellular permeability to ions reminiscent of potassium, magnesium, and phosphate (Facts and Comparisons, 2019).

Types of insulin (Perkins, 2017; American Diabetes Association, North Dakota)

More than 20 various kinds of insulin are currently used, categorized by how they’re made, how they work within the body, and the way expensive they’re. They are prescribed based on onset, peak and duration.
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Nursing Considerations for Insulin Administration (Lippincott Solutions, 2022; Perkins, 2017)

• Vary injection sites (arms, abdomen, thighs and buttocks) and locations inside the same site to forestall tissue damage.

• Make sure the insulin type, unit dose and syringe are correct.
• When combining insulins in a syringe, be certain they’re compatible.
  • Rapid-acting or short-acting insulin is evident
  • Intermediate-acting insulin is cloudy
  • Clear insulin ought to be drawn first to forestall rapid insulin from being contaminated with intermediate-acting insulin; remember: “clear or cloudy.”
• Before withdrawing insulin, gently roll and invert the bottle; don’t shake.
• Insulin is often administered using a syringe, but it might even be administered using an insulin pen and pump. In emergency situations, rapid-acting insulin will be administered intramuscularly or intravenously (Perkins, 2017).
• Patients ought to be monitored closely for signs of hypoglycemia and hyperglycemia.

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Full details will be present in the leaflet that comes with the drugs or within the Nursing2022 Medicines Manual + medicines updates.
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American Diabetes Association (n.d.). Insulin basics. https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics

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Facts and comparisons (2019, April 10). Insulin: mechanism of motion. https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/5545816?cesid=9FvSbckjjuQ AND
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Lippincott procedures. (2022, May 20). Subcutaneous injection. https://procedures.lww.com/lnp/search.do?m=50&d=591&query=insulin&a=true

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Perkins, A. (2017). Insulin basics. (3), 30-35. https://www.doi.org/10.1097/01.NME.0000514211.23263.96 Â Â Â
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