insulin

insulin /in·su·lin/ (in´sdbobr-lin)

1. a protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans. The major fuel-regulating hormone, it is secreted into the blood in response to a rise in concentration of blood glucose or amino acids. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis.

Insulin. The precursor proinsulin is cleaved internally at two sides (arrows) to yield insulin and C peptide.

2. a preparation of insulin, either of porcine or bovine origin or a recombinant form with sequence the same as or similar to that in humans, used in the treatment of diabetes mellitus; classified as rapid-acting, intermediate-acting, or long-acting on the basis of speed of onset and duration of activity.

3. regular insulin; a rapid-acting, unmodified form of insulin prepared from crystalline bovine or porcine insulin.

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insulin aspart  a rapid-acting analogue of human insulin created by recombinant DNA technology.

buffered insulin human  insulin human buffered with phosphate; used particularly in continuous infusion pumps.

extended insulin zinc suspension  a long-acting insulin consisting of porcine or human insulin in the form of large zinc-insulin crystals.

insulin glargine  an analogue of human insulin produced by recombinant DNA technology, having a slow, steady release over 24 hours.

insulin human  a protein corresponding to insulin elaborated in the human pancreas, derived from pork insulin by enzymatic action or produced synthetically by recombinant DNA techniques; sometimes used specifically to denote a rapid-acting regular insulin preparation of this protein.

isophane insulin suspension  an intermediate-acting insulin consisting of porcine or human insulin reacted with zinc chloride and protamine sulfate.

Lente insulin  insulin zinc suspension.

insulin lispro  a rapid-acting analogue of human insulin synthesized by means of recombinant DNA technology.

NPH insulin  isophane i. suspension.

prompt insulin zinc suspension  a rapid-acting insulin consisting of porcine insulin with zinc chloride added to produce a suspension of amorphous insulin.

regular insulin  insulin (3).

Semilente insulin  prompt insulin zinc suspension.

Ultralente insulin  extended insulin zinc suspension.

insulin zinc suspension  an intermediate-acting insulin consisting of porcine or human insulin with a zinc salt added such that the solid phase of the suspension contains a 7:3 ratio of crystalline to amorphous insulin.

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in·su·lin (ns-ln)

n.

1. A polypeptide hormone that is secreted by the islets of Langerhans, helps regulate the metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, and promotes protein synthesis and the formation and storage of neutral lipids.

2. Any of various pharmaceutical preparations containing this hormone that are derived from the pancreas of certain animals or produced through genetic engineering and are used parenterally in the medical treatment and management of insulin-dependent diabetes mellitus.

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Insulin

A hormone secreted by the pancreas in response to high blood sugar levels that induces hypoglycemia. Insulin regulates the body's use of glucose and the levels of glucose in the blood by acting to open the cells so that they can intake glucose.

Mentioned in: Diabetes Mellitus, Diabetic Ketoacidosis, Gestational Diabetes, Hypothermia, Insulin Resistance

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insulin

[in′səlin]

Etymology: L, insula, island

1 a naturally occurring polypeptide hormone secreted by the beta cells of the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood as well as to the parasympathetic nervous system and other stimuli. The hormone acts to regulate the metabolism of glucose and the processes necessary for the intermediary metabolism of fats, carbohydrates, and proteins. Insulin lowers the blood glucose level and promotes transport of glucose into the muscle cells and other tissues. Inadequate secretion of insulin causes elevated blood glucose and triglyceride levels and ketonemia, as well as the characteristic signs of diabetes mellitus, including increased desire to eat, excessive thirst, increased urination, and eventually lethargy and weight loss. Uncorrected severe deficiency of insulin is incompatible with life. Normal findings of insulin assay in adults are levels of 5 to 24 mmU/mL.

2 a pharmacologic preparation of the hormone administered in treating diabetes mellitus. The various preparations of insulin available for prescription vary in onset, intensity, and duration of action. Animal source insulins, pork and beef, have been discontinued in the U.S. market. Human insulin is derived by recombinant DNA technology and is termed quick acting, intermediate acting, or long acting. Most replacement insulin is given by subcutaneous injection in individualized dosage schedules and insulin pumps, but insulin also can be replaced intravenously. Adverse reactions include hypoglycemia and insulin shock that result from excess dosage and hyperglycemia and diabetic ketoacidosis from inadequate dosage. Fever, stress, infection, pregnancy, surgery, and hyperthyroidism may significantly increase insulin requirements; liver disease, hypothyroidism, vomiting, and renal disease may decrease them. Blood tests for glucose and ketones are performed to determine the need for adjustment of the dosage or of the schedule of administration. See also human insulin.

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insulin (inˑ·s·lin),

n hormone produced by the pancreas that regulates blood glucose levels by stimulating the absorption of sugars into the cells.

Insulin injection sites.

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insulin (antidiabetic hormone) (in´-slin´ an´tēdī´bet´ik),

n a hormone produced by the beta cells of the islets of Langerhans in the pancreas. It promotes a decrease in blood sugar. Its action may be influenced by the pituitary growth hormone, adrenocorticotropic hormone; hormones of the adrenal cortex; epinephrine; glucagon; and thyroid hormone.

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insulin (obtained from beef or pork, or human recombinant technology),

n brand names: Velosulin, Humulin R, Novolin R, Lente Insulin;
drug class: exogenous insulin, antidiabetic;
action: decreases blood glucose; important in regulation of fat and protein metabolism;
uses: ketoacidosis; type 1 and type 2 diabetes mellitus; hyperkalemia; hyperalimentation.

insulin, exogenous

n a type that comes from a source external to a diabetic patient's body, taken to offset the patient's natural deficiency of insulin.

insulin, intermediate-acting,

n a type that is a medium between rapid-acting and long-acting insulins; the onset is not as fast as rapid-acting insulin, but it reaches its peak action over a 4- to 12-hour period.

insulin, Lente

n.pr an intermediate-acting type that reaches its peak action over a 4- to 12-hour period.

insulin, Lispro,

n.pr a rapid-acting type that reaches its peak action in 30 to 90 minutes.

insulin, long-acting,

n a type that has a slow onset but reaches its peak action from 12 to 16 hours after administration.

insulin, NPH,

n a synthetic type used to treat diabetes. Classified as intermediate acting; peak action occurs 4 to 10 hours after administering.

insulin, rapid-acting,

n a synthetic type of insulin used to treat diabetes. Reaches peak action 30 to 90 minutes after administering.

insulin, regular,

n a synthetic type used to treat diabetes. Classified as short acting; peak action occurs 2 to 3 hours after administering.

insulin resistance,

n a complication of diabetes mellitus characterized by a need for more than 200 units of insulin per day to control hyperglycemia and ketosis. The cause is associated with insulin binding by high levels of antibody.

insulin shock,

n See shock, insulin.

insulin, short-acting,

n a synthetic type used to treat diabetes. Reaches peak action 2 to 3 hours after administering. Also called
regular insulin.

insulin, ultralente

n a synthetic type used to treat diabetes. Classified as long acting, with peak action occurring 12 to 16 hours after administering.

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insulin

a double-chain peptide hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis.

The secretion of endogenous insulin is a response of the beta cells to a stimulus. The primary stimulus is glucose; others are amino acids, particularly leucine, and the 'gut hormones', such as secretin, pancreozymin and gastrin. These chemicals play an important role in maintaining normal blood glucose levels by triggering the release of insulin after ingestion of a meal.

Commercially prepared insulin is available in various types, which differ in the speed with which they act and in the duration of their effectiveness. There are three main groups: rapid acting (regular or semilente), intermediate acting (isophane suspension or NPH, zinc suspension or lente), and long acting (protamine zinc suspension or PZI, or ultralente). Mixtures are also marketed.

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insulin deficiency

diabetes mellitus.

insulin-dextrose therapy

a combination used in emergencies to lower blood potassium levels in acute hypoadrenocorticism.

insulin:glucagon ratio

ratio of insulin to glucagon; thought to determine the predominance of the action of one hormone over the other.

insulin:glucose ratio

a comparison of simultaneously obtained blood levels of immunoreactive insulin and plasma glucose. An increased ratio suggests an insulin-secreting tumor of the pancreas. A modification is the amended insulin:glucose ratio, based on the calculation:

$$\vskip13.5pt{\rm {serum\ insulin (\rmmu U/ml)\times100} \over {\rm plasma \ glucose (mg/dl) - 30}$$

immunoreactive insulin

radioimmunoassay methods are used in determining blood levels of insulin. Increased levels are found with hypoglycemia caused by functional islet cell tumors.

insulin pump

a device consisting of a syringe filled with a predetermined amount of short-acting insulin, a plastic cannula and a needle, and a pump that periodically delivers the desired amount of insulin. Sometimes used in humans, but of limited application in animals.

insulin sensitivity test, insulin response test

used to differentiate diabetes mellitus from pituitary and adrenal diabetes. A test dose of exogenous insulin will produce a rapid and marked decrease in blood glucose if the pancreas is not secreting sufficient insulin. A much less dramatic response is produced if hyperglycemia is due to excessive secretion of either pituitary or adrenocortical hormones rather than insufficient insulin production.

insulin syringe

disposable syringe with a capacity of 1 ml or less and a fine gauge needle (27-29G) attached, and graduation markings corresponding to insulin units in standard preparations. Needles may also be treated to minimize pain on injection.

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insulin, regular (insulin injection) Warning - High-alert drug!

Humulin R, Humulin-R Regular U-500 (concentrate), Insulin-Toronto (CA), Novolin ge Toronto (CA), Novolin R, Novolin R PenFill

Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it's converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.

Availability

Glulisine, recombinant: 100 units/ml in 10-ml vials

Isophane suspension, injection (regular): 70 units NPH and 30 units regular insulin/ml (100 units/ml total), 50 units NPH and 50 units regular insulin/ml (100 units/ml total)

Isophane suspension (NPH insulin): 100 units/ml

Lispro: 100 units/ml in 10-ml vials and 1.5-ml cartridges

Regular insulin injection: 100 units/ml

Regular U-500 (concentrated), insulin human injection: 500 units/ml

Zinc suspension, extended (ultralente): 100 units/ml

Zinc suspension (lente insulin): 100 units/ml

⊘Indications and dosages

➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin-dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics

Adults and children: In newly diagnosed diabetes, total of 0.5 to 1 unit/kg/day subcutaneously as part of multidose regimen of short- and long-acting insulin. Dosage individualized based on patient's glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/ml) for patients requiring more than 200 units/day.

➣ Diabetic ketoacidosis

Adults and children: Loading dose of 0.15 units/kg (nonconcentrated regular insulin) I.V. bolus, followed by continuous infusion of 0.1 unit/kg/hour until glucose level drops. Then administer subcutaneously, adjusting dosage according to glucose level.

Contraindications

• Hypersensitivity to drug or its components
• Hypoglycemia

Precautions

Use cautiously in:
• hepatic or renal impairment, hypothyroidism, hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

☞ Be aware that insulin is a high-alert drug whether given subcutaneously or I.V.
☞ Don't give insulin I.V. (except nonconcentrated regular insulin), because anaphylactic reaction may occur.
• When mixing two types of insulin, draw up regular insulin into syringe first.
• For I.V. infusion, mix regular insulin only with normal or half-normal saline solution, as prescribed, to yield a concentration of 1 unit/ml. Give every 50 units I.V. over at least 1 minute.
• Rotate subcutaneous injection sites to prevent lipodystrophy.
• Administer mixtures of regular and NPH or regular and lente insulins within 5 to 15 minutes of mixing.

Route	Onset	Peak	Duration
I.V. (regular)	10-30 min	15-30 min	Unknown
Subcut. (glulisine)	Rapid	Unknown	Short
Subcut. (lente)	1-2.5 hr	7-15 hr	24 hr
Subcut. (lispro)	15 min	30-90 min	6-8 hr
Subcut. (lispro/protamine mix; regular U-500 conc.)	Unknown	Unknown	Unknown
Subcut. (NPH)	1-1.5 hr	4-12 hr	24 hr
Subcut. (regular)	30-60 min	2-4 hr	Unknown
Subcut. (ultralente)	8 hr	10-30 hr	>36 hr

Adverse reactions

Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect)

Skin: urticaria, rash, pruritus

Other: edema; lipodystrophy; lipohypertrophy; erythema, stinging, or warmth at injection site; allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect

Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect

Beta-adrenergic blockers (nonselective): masking of some hypoglycemia symptoms, delayed recovery from hypoglycemia

Lithium carbonate: decreased or increased hypoglycemic effect

Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels

Liver and thyroid function tests: interference with test results

Urine vanillylmandelic acid: increased level

Drug-herbs. Basil, burdock, glucosamine, sage: altered glycemic control

Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect

Garlic, ginseng: decreased blood glucose level

Drug-behaviors. Alcohol use: increased hypoglycemic effect

Marijuana use: increased blood glucose level

Smoking: increased blood glucose level, decreased response to insulin

Patient monitoring

• Monitor glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
☞ Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.
☞ Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).
• Monitor for glycosuria.
• Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Teach patient how to administer insulin subcutaneously as appropriate.
• Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.
• Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.
☞ Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.
• Instruct patient to store insulin in refrigerator (not freezer).
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.
• Instruct patient to wear medical identification stating that he is diabetic and takes insulin.
• Advise patient to have regular medical, vision, and dental exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

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insulin (lispro)

Humalog, Humalog Pen

Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it's converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.

Availability

Glulisine, recombinant: 100 units/ml in 10-ml vials

Isophane suspension, injection (regular): 70 units NPH and 30 units regular insulin/ml (100 units/ml total), 50 units NPH and 50 units regular insulin/ml (100 units/ml total)

Isophane suspension (NPH insulin): 100 units/ml

Lispro: 100 units/ml in 10-ml vials and 1.5-ml cartridges

Regular insulin injection: 100 units/ml

Regular U-500 (concentrated), insulin human injection: 500 units/ml

Zinc suspension, extended (ultralente): 100 units/ml

Zinc suspension (lente insulin): 100 units/ml

⊘Indications and dosages

➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin-dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics

Adults and children: In newly diagnosed diabetes, total of 0.5 to 1 unit/kg/day subcutaneously as part of multidose regimen of short- and long-acting insulin. Dosage individualized based on patient's glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/ml) for patients requiring more than 200 units/day.

➣ Diabetic ketoacidosis

Adults and children: Loading dose of 0.15 units/kg (nonconcentrated regular insulin) I.V. bolus, followed by continuous infusion of 0.1 unit/kg/hour until glucose level drops. Then administer subcutaneously, adjusting dosage according to glucose level.

Contraindications

• Hypersensitivity to drug or its components
• Hypoglycemia

Precautions

Use cautiously in:
• hepatic or renal impairment, hypothyroidism, hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

☞ Be aware that insulin is a high-alert drug whether given subcutaneously or I.V.
☞ Don't give insulin I.V. (except nonconcentrated regular insulin), because anaphylactic reaction may occur.
• When mixing two types of insulin, draw up regular insulin into syringe first.
• For I.V. infusion, mix regular insulin only with normal or half-normal saline solution, as prescribed, to yield a concentration of 1 unit/ml. Give every 50 units I.V. over at least 1 minute.
• Rotate subcutaneous injection sites to prevent lipodystrophy.
• Administer mixtures of regular and NPH or regular and lente insulins within 5 to 15 minutes of mixing.

Route	Onset	Peak	Duration
I.V. (regular)	10-30 min	15-30 min	Unknown
Subcut. (glulisine)	Rapid	Unknown	Short
Subcut. (lente)	1-2.5 hr	7-15 hr	24 hr
Subcut. (lispro)	15 min	30-90 min	6-8 hr
Subcut. (lispro/protamine mix; regular U-500 conc.)	Unknown	Unknown	Unknown
Subcut. (NPH)	1-1.5 hr	4-12 hr	24 hr
Subcut. (regular)	30-60 min	2-4 hr	Unknown
Subcut. (ultralente)	8 hr	10-30 hr	>36 hr

Adverse reactions

Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect)

Skin: urticaria, rash, pruritus

Other: edema; lipodystrophy; lipohypertrophy; erythema, stinging, or warmth at injection site; allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect

Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect

Beta-adrenergic blockers (nonselective): masking of some hypoglycemia symptoms, delayed recovery from hypoglycemia

Lithium carbonate: decreased or increased hypoglycemic effect

Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels

Liver and thyroid function tests: interference with test results

Urine vanillylmandelic acid: increased level

Drug-herbs. Basil, burdock, glucosamine, sage: altered glycemic control

Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect

Garlic, ginseng: decreased blood glucose level

Drug-behaviors. Alcohol use: increased hypoglycemic effect

Marijuana use: increased blood glucose level

Smoking: increased blood glucose level, decreased response to insulin

Patient monitoring

• Monitor glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
☞ Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.
☞ Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).
• Monitor for glycosuria.
• Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Teach patient how to administer insulin subcutaneously as appropriate.
• Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.
• Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.
☞ Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.
• Instruct patient to store insulin in refrigerator (not freezer).
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.
• Instruct patient to wear medical identification stating that he is diabetic and takes insulin.
• Advise patient to have regular medical, vision, and dental exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

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insulin

Physiology A disulfide-linked polypeptide hormone produced by the beta cells of the pancreatic islets, which controls serum glucose and anabolism of carbohydrates, fat, protein. See Biphasic insulin, PEPCK, Proinsulin, rDNA insulin.

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Patient discussion about insulin.

Q. I've a chronic pain website & would love 2 get comments on how 2 make it better http://chronicpain.today.c

A. nice site! very useful! i liked the "freebies"...good idea. how about some links to videos about the subject? could be nice...

Q. When will a generic brand of insulin be available? The cost of insulin seems to be way too high... And with the ever rising population of diabetics, you'd think some other companies would jump unto the bandwagon with a cheaper insulin... what's up with that?

A. Unfortunately, as long as Eli Lilly has an effective monopoly on the American market and docs continue to perscribe the latest "flavor" of insulin, the situation is unlikely to change. Personally, I refuse to use Lilly's products (use Novo Nordisk insulin instead) and am still using the regular and NPH I was using 20 years ago... Also, because Type I diabetes tends to affect children, parents are naturally always seeking the next new thing. Doesn't make for an environment conducive to cheaper alternatives, which is a real shame for us all.

Q. is there an alternative for the Insulin shots? something less painful but yet effective as the old way?

A. Here is a good site on alternative insulin delivery: http://www.diabetes.org/for-parents-and-kids/diabetes-care/alternative-insulin.jsp Hope this helps.