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Diabetes Insulin

The discovery of insulin revolutionized the treatment of diabetes. A successful pregnancy in a diabetic woman was rare. A major operation or a severe infection in a diabetic used to be a disaster. Insulin radically transformed this dismal picture. Insulin has not only increased the life expectancy of diabetics but has improved the quality of their lives. A well controlled pregnant diabetic may now look forward to a happy outcome and a diabetic child can grow normally. A diabetic can now undergo a major operation or withstand a severe infection. Insulin has transformed diabetes from a sure cause of death into a reasonably controlled ailment.

Who needs insulin treatment?

All persons with diabetes do not need insulin treatment. By definition, persons with type 1 diabetes require life long insulin for survival. I hese are usually persons whose diabetes started before 30 years of age, whose diabetes had a rapid onset, who are thin and weak and who have/had diabetic coma. Persons with fasting blood glucose above 300 mg per cent or with ketones in urine usually require insulin.

Persons with type 2 diabetes, which has not been controlled by diet, exercise and oral drugs, necessarily require insulin not for survival but to achieve normoglycaemia.

Diabetics who have developed severe infection like carbuncle, abscess, pneumonia, tuberculosis or gangrene also require insulin. Insulin is essential in pregnant diabetic women if optimum control of diabetes is not achieved by diet alone. Diabetics undergoing a major surgical operation also require insulin. Insulin is necessary in persons who have developed diabetes following the removal of pancreas. It is often required in diabetes due to calcification of the pancreas.

Many diabetics feel that insulin injections once begun will have to be taken for life and try to postpone the "doomsday". Withholding insulin from insulin-dependent diabetics is dangerous. There is no production of insulin by the pancreas in these diabetics and hence insulin has to be supplied from outside. However, in some middle-aged or elderly diabetics the disease becomes mild after it is controlled initially with insulin and later can be treated by oral drugs or by diet alone.

Basic limitations of insulin treatment

In normal individuals, insulin produced by the pancreas, goes to the liver first and then to the general blood stream. On the other hand, when insulin is injected in persons with diabetes, it first enters the general blood stream. Therefore, the current insulin treatment is unphysiological.

Structure of insulin

Insulin molecule consists of two chains of amino acids, chain A and chain B. 'A' chain has 21 amino acids while the longer 'B' chain has 30 amino acids. These chains are connected by two bridges containing 2 sulphur atoms. The amino acid sequence in different animals has been worked out. Insulin with different properties has been prepared by altering the insulin chain. Intact insulin chains are essential for insulin action.

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Diabetes Insulin