

We’re very fortunate these days that a diagnosis with diabetes is no longer a death sentence—due mostly to that healing elixir that mimics a natural substance in our bodies known as insulin. Injectable “insulin analogs,” as these medicines are called, are life-saving substances that have only been available to patients since the 1920s.

Whether or not you require insulin at this time, it’s probably in your future as a person with diabetes—therefore it’s important to get to know it, without fear.

Diabetes and insulin production

People without diabetes have a great, fully-automatic system controlling their insulin output, while we people with diabetes might be said to be operating on “manual transmission.” We need to constantly think about what gear we’re in and make adjustments accordingly.

Meaning: the bodies of non-diabetic people constantly secrete low levels of “background” insulin to cover their basic metabolic needs. Their bodies also secrete short bursts of insulin during meals to help absorb the food-induced increases in glucose. Their healthy pancreases simply know, automatically, how much insulin is required to cover any given food they might eat.

In people with diabetes, this system is “broken.” Type 1 diabetics generally don’t produce any insulin at all, and the bodies of people with type 2 can’t process the insulin that is present. So we use insulin shots to do our best to mimic these two types of insulin secretion.

Basal vs. bolus insulin

The background, or “basal” insulin is given to diabetics in the form of a long-acting insulin such as Lantus, NPH or Levemir insulin. This allows glucose—the common fuel for your body’s cells—to leave your blood and enter the cells.

The other type of insulin secretion, in response to a meal, is called a “bolus” dose, and is given to diabetics in the form of a fast-acting insulin such as Humalog, Novolog, Apidra or regular insulin. It is necessary to calculate the amount of “bolus” (mealtime) insulin needed to cover the carbohydrates you will eat at any given meal.

Again, the constant challenge is to administer insulin via a needle, insulin pen or pump, or other device in a way that most closely replicates the body’s basal and bolus needs.

Note that many type 2 diabetics take basal insulin only, often in the form of once-daily Lantus shot. This is usually sufficient to cover their insulin needs for many years.

Read Part 1 of this series: “The Truth About Insulin: Why It's Not Just a Last Resort.”