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Insulin is a hormone produced by the pancreas to help the body use and store glucose. Glucose is a source of fuel for the body.

With diabetes, the body cannot regulate the amount of glucose in the blood (called glycemia or blood sugar). Insulin therapy can help some people with diabetes maintain their blood sugar levels.

Information

Carbohydrates from food are broken down into glucose and other sugars. Glucose is absorbed from the digestive tract into the bloodstream. Insulin lowers blood sugar by allowing it to move from the bloodstream into muscle, fat, and other cells, where it can be stored or used as fuel. Insulin also tells the liver how much glucose to produce when you are fasting (have not had a recent meal).

People with diabetes have high blood sugar because their body does not make enough insulin or because their body does not respond to insulin properly.

With type 1 diabetes the pancreas produces little to no insulin.

With type 2 diabetes the fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. Over time, the pancreas stops making as much insulin.

Insulin Doses and Types

Insulin therapy replaces the insulin the body would normally make. People with type 1 diabetes must take insulin every day.

People with type 2 diabetes need to take insulin when other treatments and medicines fail to control blood sugar levels.

Insulin doses are given in two main ways

Basal dose – provides a steady amount of insulin delivered all day and night. This helps maintain blood glucose levels by controlling how much glucose the liver releases (mainly at night when the time between meals is longer).

Bolus dose – provides a dose of insulin at meals to help move absorbed sugar from the blood into muscle and fat. Bolus doses can also help correct blood sugar when it gets too high. Bolus doses are also called nutritional or meal-time doses.

There are several types of insulin available. Insulin types are based on :

Onset – how quickly it starts working after injection

Peak – time when the dose is the strongest and most effective

Duration – total time the insulin dose stays in the bloodstream and lowers blood sugar

Types of insulin:

Rapid-acting or fast-acting insulin starts working within 15 minutes, peaks in 1 hour, and lasts for 4 hours. It is taken right before or just after meals and snacks. It is often used with longer-acting insulin.

Regular or short-acting insulin reaches the bloodstream 30 minutes after use, peaks within 2 to 3 hours, and lasts 3 to 6 hours. This is taken a half-hour before meals and snacks. It is often used with longer-acting insulin.

Intermediate-acting insulin starts working within 2 to 4 hours, peaks in 4 to 12 hours, and lasts 12 to 18 hours. This is taken mostly either twice a day or once at bedtime.

Long-acting insulin starts to work a few hours after injection and works for about 24 hours, sometimes longer. It helps control glucose throughout the day. It is often combined with rapid- or short-acting insulin as needed.

Premixed or mixed insulin is a combination of 2 different types of insulin. It has both a basal and bolus dose to control glucose after meals and throughout the day.

Inhaled insulin is a rapid-acting breathable insulin powder that starts working within 15 minutes of use. It is used just before meals.

One or more types of insulin may be used together to help control your blood sugar. You also may use insulin along with other diabetes medicines. Your health care provider will work with you to find the right combination of medications for you.

Your provider will tell when and how often you need to take insulin.

Your dosing schedule may depend on:

Your weight

Type of insulin you take

How much and what you eat

Level of physical activity

Your blood sugar level

Other health conditions

Your provider can calculate the insulin dose for you. Your provider will also tell you how and when to check your blood sugar and time your doses during the day and night.

Ways to Take Insulin

Insulin cannot be taken by mouth because stomach acid destroys insulin. It is most often injected under the skin into fatty tissue. There are different insulin delivery methods available:

Insulin syringe – insulin is drawn from a vial into a syringe. Using the needle, you inject the insulin under the skin.

Insulin pump – a small machine worn on the body pumps insulin under the skin throughout the day. A small tube connects the pump to a small needle inserted into the skin.

Insulin pen – disposable insulin pens have prefilled insulin delivered under the skin using a replaceable needle.

Inhaler – a small device you use to inhale insulin powder through your mouth. It is used at the start of meals.

Injection port – a short tube is inserted into the tissue under the skin. The port containing tube is adhered to skin using adhesive tape. Fast-acting insulin is injected into the tube using a syringe or pen. This allows you to use the same injection site for 3 days before rotating to a new site.

You can talk with your health care provider about your preferences when deciding on an insulin delivery method.

Insulin is injected into these sites on the body:

Abdomen

Upper arm

Thighs

Hips

Your provider will teach you how to give an insulin injection or use an insulin pump or other device. It is important not to always use the same site as this can decrease how effective the insulin is for you.

Points to Remember

You need to know how to adjust the amount of insulin you are taking:

When you exercise

When you are sick

When you will be eating more or less food

When you are traveling

Before and after surgery

When to Call the Doctor

If you are taking insulin, contact your provider if:

You think you may need to change your insulin routine

You have any problems taking insulin

Your blood sugar is too high or too low and you don’t understand why

Medroxyprogesterone as common brand name Depo Provera is an intramuscular and subcutaneous injection used to as a contraceptive to prevent pregnancy.

Medroxyprogesterone subcutaneous injection is also used to treat endometriosis- (a condition in which the type of tissue that lines the uterus (womb) grows in other areas of the body and causes pain, heavy or irregular menstruation [periods], and other symptoms).

Medroxyprogesterone is in a class of medications called progestins. It works to prevent pregnancy by preventing ovulation (the release of eggs from the ovaries). Medroxyprogesterone also thins the lining of the uterus. This helps to prevent pregnancy in all women and slows the spread of tissue from the uterus to other parts of the body in women who have endometriosis.

Depo injection is a very effective method of birth control but does not prevent the spread of human immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency syndrome [AIDS]) or other sexually transmitted diseases.

WARNING

Medroxyprogesterone injection may decrease the amount of calcium stored in your bones. The amount of calcium in your bones may not return to normal even after you stop using the injection and this may cause osteoporosis even after menopause.

How should this medicine be used?

Medroxyprogesterone intramuscular injection comes as a suspension (liquid) to be injected into the buttocks or upper arm. It is usually given once every 3 months (13 weeks) by a healthcare provider in an office or clinic.

Medroxyprogesterone subcutaneous injection comes as suspension to be injected just under the skin. It is usually injected once every 12 to 14 weeks by a healthcare provider in an office or clinic.

You must receive your first medroxyprogesterone subcutaneous or intramuscular injection only at a time when there is no possibility that you are pregnant. Therefore, you may only receive your first injection during the first 5 days of a normal menstrual period, during the first 5 days after you give birth if you are not planning to breast-feed your baby, or during the sixth week after giving birth if you are planning to breast-feed your baby.

If you have been using a different method of birth control and are switching to this injection, your doctor will tell you when you should receive your first injection.

What special precautions should I follow?

Before using medroxyprogesterone injection,
tell your doctor and pharmacist if:

You are allergic to medroxyprogesterone (Depo-Provera, depo-subQ provera 104, Provera, in Prempro, in Premphase) or any other medications.

Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

Tell your doctor if you or anyone in your family has or has ever had breast cancer or diabetes.

Also tell your doctor if you have or have ever had problems with your breasts such as lumps, bleeding from your nipples, an abnormal mammogram (breast x-ray), or fibrocystic breast disease (swollen, tender breasts and/or breast lumps that are not cancer); unexplained vaginal bleeding;irregular or very light menstrual periods; excessive weight gain or fluid retention before your period; blood clots in your legs, lungs, brain, or eyes; stroke or mini-stroke; migraine headaches; seizures; depression; high blood pressure; heart attack; asthma; or heart, liver, or kidney disease.

Tell your doctor if you think you might be pregnant, you are pregnant, or you plan to become pregnant. If you become pregnant while using medroxyprogesterone injection, call your doctor immediately. Medroxyprogesterone may harm the fetus.

Tell your doctor if you are breast-feeding. You may use medroxyprogesterone injection while you are breast-feeding as long as your baby is 6 weeks old when you receive your first injection. Some medroxyprogesterone may be passed to your baby in your breast milk but this has not been shown to be harmful. Studies of babies who were breast-fed while their mothers were using medroxyprogesterone injection showed that the babies were not harmed by the medication.

Tell your doctor if you or anyone in your family has osteoporosis; if you have or have ever had any other bone disease or anorexia nervosa (an eating disorder); or if you drink a lot of alcohol or smoke a great deal.

Tell your doctor if you take any of the following medications: corticosteroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); or medications for seizures such as carbamazepine (Tegretol), phenytoin (Dilantin), or phenobarbital (Luminal, Solfoton).

If you are having surgery, including dental surgery, tell the doctor or dentist that you are using medroxyprogesterone injection.

You should know that your menstrual cycle will probably change while you are using medroxyprogesterone injection. At first, your periods will probably be irregular, and you may experience spotting between periods. If you continue to use this medication, your periods may stop completely. Your menstrual cycle will probably return to normal some time after you stop using this medication.

What special dietary instructions should I follow?

You should eat plenty of foods that are rich in calcium and vitamin D while you are receiving medroxyprogesterone injection to help decrease the loss of calcium from your bones.

Your doctor will tell you which foods are good sources of these nutrients and how many servings you need each day. Your doctor also may prescribe or recommend calcium or vitamin D supplements.

What should I do if I forget a dose?

If you miss an appointment to receive an injection of medroxyprogesterone, call your doctor. You may not be protected from pregnancy if you do not receive your injections on schedule. If you do not receive an injection on schedule, your doctor will tell you when you should receive the missed injection.

Your doctor will probably administer a pregnancy test to be sure that you are not pregnant before giving you the missed injection. You should use a different method of birth control, such as condoms until you receive the injection that you missed.

What side effects can this Medroxyprogesterone cause?

Medroxyprogesterone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
changes in menstrual periods
weight gain
weakness
tiredness
nervousness
irritability
depression
difficulty falling asleep or staying asleep
hot flashes
breast pain, swelling, or tenderness
stomach cramps or bloating
leg cramps
back or joint pain
acne
loss of hair on scalp
swelling, redness, irritation, burning, or itching of the vagina
white vaginal discharge
changes in sexual desire
cold or flu symptoms
pain, irritation, lumps, redness or scarring in the place where the medication was injected
Some side effects can be serious.

The following side effects are uncommon, but if you experience any of them, call your doctor immediately:
sudden shortness of breath
sudden sharp or crushing chest pain
coughing up blood
severe headache
nausea
vomiting
dizziness or faintness
change or loss of vision
double vision
bulging eyes
difficulty speaking
weakness or numbness in arm
seizure
yellowing of the skin or eyes
extreme tiredness
pain, swelling, warmth, redness, or tenderness in one leg only
menstrual bleeding that is heavier or lasts longer than normal
severe pain or tenderness just below the waist
rash
hives
itching
difficulty breathing or swallowing
swelling of the hands, feet, ankles, or lower legs
difficult, painful, or frequent urination
constant pain, pus, warmth, swelling, or bleeding in the place where the medication was injected

If you are younger than 35 years old and began to receive medroxyprogesterone injection in the last 4 to 5 years, you may have a slightly increased risk that you will develop breast cancer.

Medroxyprogesterone injection may also increase the chance that you will develop a blood clot that moves to your lungs or brain.

Talk to your doctor about the risks of using this medication.
Medroxyprogesterone injection is a long-acting birth control method. You might not become pregnant for some time after you receive your last injection.

Talk to your doctor about the effects of using this medication if you plan to become pregnant in the near future.

Medroxyprogesterone injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

WARNINGS
Medroxyprogesterone injection may decrease the amount of calcium stored in your bones. The longer you use this medication, the more the amount of calcium in your bones may decrease. The amount of calcium in your bones may not return to normal even after you stop using medroxyprogesterone injection.

Loss of calcium from your bones may cause osteoporosis (a condition in which the bones become thin and weak) and may increase the risk that your bones might break at some time in your life, especially after menopause (change of life).

Tag hormone

Insulin Therapy