By Dr. K. Javeed Nayeem, MD
If you are an Insulin user or have someone in your family who uses Insulin, please read this article very carefully. Studies and surveys have shown that at present India is only slightly behind China when it comes to the incidence of Diabetes and our country is actually on its way to becoming the ‘Diabetes Capital’ of the world. Although present day statistics say that one in seven Indians is a diabetic, there is a feeling among medical researchers that this figure is grossly incorrect when you take into account the fact that there are millions of undiagnosed diabetics across the length and breadth of our vast country.
Diabetes is the ‘bitter-sweet’ disease that takes a very heavy toll both in terms of morbidity and mortality on our population because it is very often absolutely symptomless in its early stages and utterly ruthless in its later stages. The second thing that gives this disease a great killing advantage is the fact that because it does not cause any kind of discomfort or pain in the early stages, many diagnosed diabetics too tend to neglect controlling their blood glucose levels for far too long periods, waking up from their slumber only when they begin to experience discomfort and pain. And, very often, by the time this happens the disease would have done a great deal of irreparable damage either to their nerves, hearts, eyes or kidneys.
While most diabetics are treated quite effectively with what doctors now call ‘Life-Style Modification’ and oral anti-diabetic drugs, a good many of them will end up requiring Insulin replacement by way of injections as they go on in life. It is this group of Insulin users that I have decided to target in this article.
These days Insulin is available in many kinds, many strengths and in many forms of dispensers. Primarily there are vials from which the users fill their Insulin syringes and there are also different injecting devices that are pre-loaded by the manufacturers or that can be loaded with pre-filled cartridges of Insulin. If you happen to be using a disposable, pre-filled, Insulin injecting pen for yourself or for someone in your family you are not at risk. But if you happen to be using Insulin from a vial or from a re-loadable pen you have to exercise great caution in view of the fact that Insulin is available in different types and different strengths in our country.
Coming to the first problem area, please note that many Insulin preparations, especially in our country, come in two different strengths. While most come in a concentration of forty units per millilitre, quite a few come in a concentration of one hundred units per millilitre. Tailor-made to these two strengths, insulin injecting syringes too come in two different configurations with appropriate markings and labelling on them.
Now, if you take a vial of the 40 unit/ml Insulin and draw it up in a 100unit/ml syringe you will end up loading two and a half times less dose than what has been prescribed for you. Conversely if you take a vial of 100units/ml insulin and draw it up in a 40units/ml syringe you will end up loading two and a half times more dose than what you should. While the former mistake can make your glucose levels soar sky-high the latter mistake can quickly and quite painlessly transport you there for good! So to be nearer to dear earth and farther from God for some more time, for God’s sake never ever interchange the two different kinds of insulin syringes!
Insulin syringes are very cheap and both kinds which come at exactly the same cost are readily available at every neighbourhood chemist and so your laziness in going there should not harm you or your loved ones. And, also to avoid the bother of buying a new and expensive injecting pen do not load cartridges of one kind into injecting devices that are calibrated for the other kind just because you may be having one lying uselessly around your house. This ‘penny wise and pound foolish’ act of false thrift can cost you very dearly.
Now, coming to the second very important problem, please note that different types of insulin have different potencies and different durations of action that can last from just over an hour to well over twenty four hours. So when your doctor prescribes a particular type of insulin for you, he or she would have done so with a great deal of attention to your individual needs. It clearly means that you cannot replace this specifically prescribed type of insulin with something that your friend or neighbour may be taking even if you feel greatly tempted by the fact that the latter option which may be doing a great job for them is much cheaper!
Please note that the difference between your needs and their needs can be like the difference between the earth and the sky! By yielding to temptation here just to cut cost that seems just too compelling you will end up losing control of your diabetes completely with an under dose or worse still, killing yourself with an overdose of Insulin! So what is good for your neighbour is certainly not good for you. The lesson to be learnt here is exactly like the Biblical commandment: Thou shall not covet thy neighbour’s wife; and Thou shall also not covet thy neighbour’s insulin!
Senior citizens and noisy Neighbours
When I tell many of my elderly patients that their blood pressure readings are on the higher side they seem more than a little surprised and assert that they are very faithful when it comes to their diet and medication. But very often they mournfully blame the lack of tranquillity in and around their homes and the consequent lack of sleep which may be the reason for their high readings.
This seems true too, going by my observation over the past few months that these high BP readings in the elderly and periods of holidays and festivals seem to have a distinct relationship. So it is time for us who are not too old yet to wake up a little from our insensitivity and look around us to see if we are disturbing the tranquillity of our neighbourhood and consequently the sleep of the elders who are around us. Mind you, we will have to be wearing their shoes sooner or later!
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