Diabetes - general info, please.

Hi Steve, mayo clinic.com may help with some of your questions.

Hi Steve!
When you say "average" diabetic, I think you mean Type 1 diabetes. As Kimmie said, Mayo clinic is great. And I'm sure others will chime in here with info. on that type of diabetes.

stormie said:

Hi Steve!
When you say "average" diabetic, I think you mean Type 1 diabetes. As Kimmie said, Mayo clinic is great. And I'm sure others will chime in here with info. on that type of diabetes.

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Actually, the average diabetic in Hawaii is type 2--the adult onset variety.

Steve W said:

Hi,

I'm looking for some very basic info, please, on the 'average' diabetic and how you treat the condition.

1. In which part of your body do you inject the insulin?
2. Do you always test your blood sugar before every shot, or, after many years with the illness, can it become routine and you can safely take a shot at specific times each day without testing?
3. How much is a month's supply of insulin/syringes, etc?
4. Where do you store insulin?
5. Can you make up shots and store them to use later? (If so, where do you store them?)
6. After many years with the illness, does the prick of the shot become barely noticeable, or is it always painful?

Thanks for any help.
Cheers,
Steve

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Let's see if I can help you with some of these. I'm only going on what I learned from one diabetic and research I did for a series of articles:

1. I've seen it administered in the arm, leg, flesh over the stomach

2. Some people can feel what's going on with their blood sugar. Responsible people do tests

3. Depends on your insurance coverage

4. In the reefer

5. Person I lived with used to carry one around--especially when going out to eat or drink. Glove compartment.

6. Scar tissue builds up at injection sites. It gets harder to inject. My friend told me that it hurts, or not, almost from shot to shot

Tiger said:

Actually, the average diabetic in Hawaii is type 2--the adult onset variety.

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Just to clarify, I was referring to the description he (Steve) gave, which said "average." Then he described what he was looking for, which sounded like Type 1. Type 2 diabetics don't usually give themselves shots or use an insulin pump.

I'm not a diabetic, but my brother-in-law is Type I since the age of fourteen.

Steve W said:

Hi,

I'm looking for some very basic info, please, on the 'average' diabetic and how you treat the condition.

1. In which part of your body do you inject the insulin? Anywhere is okay, but most diabetics just go for a fatty area that's convenient to reach - abdomen, thighs or buttocks are common.
2. Do you always test your blood sugar before every shot, or, after many years with the illness, can it become routine and you can safely take a shot at specific times each day without testing? If you're very disciplined with your diet, you could go more by the clock or by what you plan to eat. Most diabetics will test their blood several times a day and use the numbers and how they feel to gauge the shots. It will also depend on what type of insulin you use. There's fast-acting, long-lasting and all sorts of in-betweens.
3. How much is a month's supply of insulin/syringes, etc? without insurance, a vial of insulin will retail for about $30 (again, this will vary with type of insulin) and a ten pack of needles will cost you $8 or so. Insurance will greatly subsidize these costs.
4. Where do you store insulin? Good boys and girls will keep it in the fridge. Most people keep it in a cabinet.
5. Can you make up shots and store them to use later? (If so, where do you store them?) you can, but a lot of insulin needs shaking to mix thoroughly and it's not all that much more convenient to carry around premade syringes, so mostly, I think no.
6. After many years with the illness, does the prick of the shot become barely noticeable, or is it always painful? It always is a needle going into your skin. Just like with getting blood drawn, sometimes it hurts more than others. Testing machines, however, have greatly improved and they have ones now that are virtually painless.

Thanks for any help.
Cheers,
Steve

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1. Arms, thighs, stomach, butt--anywhere fatty/fleshy (you don't want to be jabbing through muscle).

2. If you're smart you check it. It can be difficult to gauge by feel alone what your sugar is, and even if your daily routine is incredibly predictable--my diabetic brother is also autistic, so really, by choice he eats the same things and does the same stuff almost every day--there are always going to be unknown factors that you can't predict. Like getting sick can throw your sugar levels, and you may not be aware yet that you're coming down with something.

3. Can't remember off the top of my head. Depends on your insurance. ^_^;

4. The fridge or a cool closet.

5. I suppose you could, but I can't see much purpose to it. How would you know in advance what your sugar will be and how much insulin you will need? And not just how many units you will need, but how much fast-acting vs slow-acting? And when you load the syringe, you pull the cap off the plunger, so now if the syringe were to get jostled around some insulin could come out and you'd have the wrong dose. There are alternatives to the regular syringe-deal, like the insulin pump, but I can't see a point to pre-loaded syringes. It really doesn't take that long to fill the syringe.

6. You're supposed to try and vary the spot where you give the shot so you don't do too much damage in the same spot--the same way you don't prick the same finger every day. You're fighting to prevent nerve damage. I'd say it probably depends on whether it's a very used spot or not.

Type 2 diabetics eventually may need to give themselves insulin. At first blood sugar levels can usually be controlled through diet and exercise, but eventually insulin shots may be needed.

For a good basic description, check out the following website from the American diabetes association:

http://www.diabetes.org/home.jsp

Assuming this is for a story, the time period will determine how the character controls their diabetes. The last decade or so has shown remarkable improvement in how diabetics handle their blood sugar.

Going off two close friends and believe it or not, managing my cat's diabetes (which is similiar to human):

Steve W said:

Hi,

1. In which part of your body do you inject the insulin? As previously stated, anywhere fleshy
2. Do you always test your blood sugar before every shot, or, after many years with the illness, can it become routine and you can safely take a shot at specific times each day without testing? People who are managing it smartly tend to test throughout the day, though if you're really going off the charts (either direction), you feel physical symptoms
3. How much is a month's supply of insulin/syringes, etc? Depends a lot of how much insulin you are using per shot. Some brands are more expensive than others, but are longer lasted. Generally, once opened, they're only good for about 30 days.
4. Where do you store insulin? In the fridge, NOT in the door shelves though. While some insulin requires shaking before use, others cannot be shaken at all (reduces the effectiveness)
5. Can you make up shots and store them to use later? (If so, where do you store them?) One of my friends carries a kit containing the insulin, a couple of needles and his testing equipment. It's about the size of a large wallet.
6. After many years with the illness, does the prick of the shot become barely noticeable, or is it always painful? My friends often say the repeated testing through the day becomes more painful than the shot.. even with relatively painless testers now. I've tested myself and felt nothing, but then I don't have to test upwards of 5 times a day.

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Michelle

TheIT said:

Type 2 diabetics eventually may need to give themselves insulin. At first blood sugar levels can usually be controlled through diet and exercise, but eventually insulin shots may be needed.

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Yes, that's why I said "usually." A close family member is Type 2.

I think the question is what effect you're aiming for? If the character had a good knowledge of how her body reacts to food and insulin, it might work. Almost everyone who tests records the readings and uses the data to determine what to do.

I don't take shots, but my mother did and she just gave herself one in the morning. Note that my mother was diagnosed as diabetic a couple of decades ago before testing became simple.

Nowadays, I believe rather than a single shot in the morning, the treatment is several smaller shots during the day to directly control blood sugar.

Why is it important that the character just takes the shot without testing? Testing takes a matter of seconds and tells her how much insulin to use. Do you want her to give herself too much or too little? Too much insulin and she run the risks of her blood sugar dropping too low which could lead to her passing out. Too little and her blood sugar could be too high which causes long term damage.

Steve W said:

Hi guys,

This is really useful. Thanks.

I have a character who's in a rush, two mornings in a row, so just takes her usual shots without testing. Could this work? (Not in an ideal world, but in some cases.)

I'd really rather have her not test at all on a daily basis -- to have been injecting herself for so long that she knows if she takes a shot early morning, she'll be fine for the rest of the day. Would that work with slow-acting insulin, or would she need another shot later the same day?

Thanks for everything so far.
All the best and Merry Christmas,
Steve

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Depends on what type of insulin she takes and what activities she'll be involved in that day. If she's well controlled, it won't be a big deal to miss testing a couple of days in a row.

I take four injections a day, one before each meal and one at bedtime. I tend to test myself numerous times a day because it helps me maintain better control.

You asked about pain--sometimes it hurts, sometimes it doesn't. I usually inject in my abdomen because it hurts less there (for me, anyway). And insulin prices vary depending on what type/brand of insulin. For instance, WalMart sells R and NPH for about 20 bucks a bottle. The types I'm taking right now (Humalog and Lantus) run about 80 bucks a bottle and I use about a bottle and a half of each a month.

Testing supplies can be pretty expensive, too. Again, it depends on the brand and type of machine you use. Got to figure in how many times a day your character will test, too, if this is important to the story. Most strips run about a dollar apiece (again, depends on the brand).

I've been insulin dependent many, many years, and my daughter is insulin dependent, too. Just give me a holler if I can help you with anything else diabetes related.

Merry Christmas to you, too!

ETA: Sticking my finger to test my blood always hurts way more than the shots do! My daughter says the same thing.

Id also be very happy to answer all and any questions *jumping up and down for joy* I can be useful here lol

1. In which part of your body do you inject the insulin?

I always use my stomach.. besides my backside its the only place I have enough fatty tissue to inject.. injecting into muscle is Very bad ju ju.. your insulin can put itself into action all at once instead of over a time delay like its supposed to.. theres too much blood supply to muscle compared to fatty tissue, also never inject anyplace you plan to do exorcise, if you plan on lifting weights don't use your arms, if you plan on running don't use your legs etc etc. This can also result in your insulin kicking in all at once

Do you always test your blood sugar before every shot, or, after many years with the illness, can it become routine and you can safely take a shot at specific times each day without testing?

I don't test Hardly as often as I'm supposed to. This is something I'm very bad about. I play guitar and don't like using my fingers, so I have a meter I can take blood from my arm with. as said before.. this hurts far more than the shots.


How much is a month's supply of insulin/syringes, etc?

A months supply of syringes = $15 for wal-mart brand syringes
Insulin = 2 different types, Regular and NPH (known as R and N) $20 a bottle Novolin brand. 1 bottle of each a month.

Where do you store insulin?

Fridge. Insulin is a bacteria believe it or not and will die in any climate outside of the body unless kept cold (but not freezing, freezing will also kill it)

Can you make up shots and store them to use later? (If so, where do you store them?)

Yes but the syringes as well need to be stored in the fridge.

After many years with the illness, does the prick of the shot become barely noticeable, or is it always painful?

Its always painful.. in fact.. I still cant just jab it in.. I do it so slowly it hurts some people to watch, really it doesn't hurt that bad most times though.. the feel of the rush of cold fluid entering the body sucks a little bit though.. imagine shoving an ice cube up an orifice of your body it doesn't belong lol

Good read, Insulinboy; but you sure mean insulin is produced by
bacteria (biotechnology) rather than insulin is a bacteria. Insulin is a hormone. You have to keep it in a fridge because proteins (polypeptides) are denatured by heat

Steve W said:

Hi guys,

I have a character who's in a rush, two mornings in a row, so just takes her usual shots without testing. Could this work? (Not in an ideal world, but in some cases.)

I'd really rather have her not test at all on a daily basis -- to have been injecting herself for so long that she knows if she takes a shot early morning, she'll be fine for the rest of the day. Would that work with slow-acting insulin, or would she need another shot later the same day?

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This is really asking for it in my opinion. Even if your life is extraordinarily routine, your daily sugar levels can't be entirely predicted. To not test at all in a day--and to regularly not test for many days--is dangerous. Some people are very good at sensing lows and highs, but it's not a precise art. A low can put your character in a diabetic coma. Frequent highs can eventually cause damage. These are things a responsible diabetic wants to avoid.

I remember a girl in my college dorm who was not a responsible diabetic--didn't feel like testing before classes sometimes, etc--and one time, when she did get around to testing her sugar, it was at 600. Needless to say this is extremely bad.

You can get away with skipping, but to a lot of diabetics, I would think that never testing doesn't suggest that your character has it totally under control, but that they're suicidally risky.

Also, one shot in the morning really doesn't set you up for the whole day..I mean, it could, I suppose, but you'd have little control over what your sugar levels are over the whole day's stretch. Your activity levels will vary throughout the day after all. You want to keep your blood sugar levels within a fairly narrow range; testing before meals is a way to fine-tune those sugar levels to where you want them. I'll admit though that I only know a handful of diabetics, so I only know the way they do it. Other people probably have other systems. But playing it safe has worked well so far for us.

I think it might help if we understood what your goals were in making your character like this--it seems like you want a character who is a diabetic, yet who doesn't really have to deal with being a diabetic. Or who doesn't want to? Are they an intentionally risky person?

If you don't want to deal with shots and stuff all the time, there's alternatives; some people use insulin pumps that they wear around their waists. This might be the kind of thing you're looking for.

ErylRavenwell said:

Good read, Insulinboy; but you sure mean insulin is produced by
bacteria (biotechnology) rather than insulin is a bacteria. Insulin is a hormone. You have to keep it in a fridge because proteins (polypeptides) are denatured by heat

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Sorry my bad.. its been a while since they tought me all of that at the hospitol and I was rather young at the time lol

Steve W said:

Hi,

I'm looking for some very basic info, please, on the 'average' diabetic and how you treat the condition.

1. In which part of your body do you inject the insulin?
2. Do you always test your blood sugar before every shot, or, after many years with the illness, can it become routine and you can safely take a shot at specific times each day without testing?
3. How much is a month's supply of insulin/syringes, etc?
4. Where do you store insulin?
5. Can you make up shots and store them to use later? (If so, where do you store them?)
6. After many years with the illness, does the prick of the shot become barely noticeable, or is it always painful?

Thanks for any help.
Cheers,
Steve

Click to expand...

I inject in my abdomen.

No, I don't have to check my blood sugar before every shot. Three to four times per week is usually enough.

Insulin and syringes cost roughlt $150 per month, but this can vary a LOT depending on the type of insulin you use, how often you have to check your blood sugar, etc.

I store insulin in the refirgerator. It can be safely kept out of the fridge for up to three days, such as when you travel, but in the fridge is necessary for long term storage.

Yes, I can draw shots for later use, and they, too, are kept in teh fridge, unless we're travelling somewhere.

Shots never hurt if you're very careful to insert the needle between nerve endings, but this takes practice, and, unfortunately, many with diabetes are not taught how to do this. If you don't do it, the shots can be exceedingly painful.

Insulin

Oh, and for most diabetices, slow and fast acting insulin are mixed. You need both. Fast acting alone is usually taken just before, or immediately after, you eat. Slow acting is taken well before you eat, and keeps you going. Fast acting and activities aren't recommended for most diabetics because the combination often produces very low blood sugar levels.

But for most, there's a balance. I'm on 75/25. Some are on 50/50. Others are on 90/10. Some few are on 100% slow or fast. But most are on a mix, and 75/25 is the most common.

And many diabetics do take one shot per day, and they take it first thing in the morning. These once a day shots are 75/25, 90/10, or 100% slow acting. All those I know who take only one shot per day take 100 units.

I take two shots of 75/25 each day, one before breakfast, and one before supper. I used to take one shot of 90/10 per day, but talked my doctor into the two shots per day because it gives me a bit more control and freedom.

For blood sugar testing, you need a tester, test strips, and a drop of blood. With the tester I use (OneTouch Ultra), you insert a test strip into a slot on the side, verify the number which comes up matches the number on the test strip bottle, then prick your finger until you have a drop of blood and lay the edge of the test strip against the blood drop. The blood wicks into the strip, and about five seconds later the reading comes up on the tester. This tester keeps track of average readings for the last month plus has history which you can download into a computer for tracking.

Test strips: Appearance depends on the brand. Usually they're about an inch long and about a quarter inch wide. Different batches of test strips are coded with a number, so you need to make certain the tester is calibrated to match the test strip number to make sure the reading is accurate. There's also a test fluid you can buy to make sure the bottle of test strips is good. Nowadays, some testers come with cartridges of test strips so you don't need to handle little strips of plastic. They're good for people without much dexterity.

For the blood drop: I use a lancet (sp?). It looks like a large pen. There's a button & slide on the side, and inside is a spring loaded with a disposable sharp lancette (like a pin set in plastic). To get a sample, you push the slide down to set the spring, adjust the top to set how deep it should go, lay the end against the side of your fingertip, and push the button. Some testers also allow you to get the sample from the forearm. Pain depends on placement. Sometimes it stings, sometimes I hardly feel it. For me, it's usually pretty easy to draw blood so I use the lightest setting and switch to a different finger each time I test. Pricking the same spot over and over hurts. For people who have thick skin on their fingers, sometimes it's a lot more difficult and may take a couple of tries. For sanity, wash your hands first with soap and water, and dispose and replace the lancette after each sample. Disposing of sharp objects like needles and lancettes should be done into a sharps container, not directly into the trash.

Hope this helps.

It really depends on the maturity of the child. Many are able to manage their own injections when they're younger than 12, while others aren't ready until they're older. For instance, my nephew was a teenager before he started giving his own injections.

The American Diabetes Association site has tons of great info. Might be worth a look for your research.

Hi,
I have had type I diabetes since I was 22 months old, so practically all of my life -- and I still hate having it.
I was taught to do my own injections at the age of just 7 years old. I also don't do the testing very often and always know when my sugar level is getting low. I hate the tests, they hurt like hell and I can never get any blood out of my fingers, but hey, I've had this for 44 years so far and am doing ok!

Ellie

Steve W said:

Hi,

Sorry, forgot to ask in my original list of questions - what's the youngest age the average child should be allowed to be responsible for his/her own injections, please?

In an early draft I put 10, and that stuck, but now that seems way too young. I don't want her to be too old, so would 12 work?

Thanks,
Steve

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