Simplifying one of the most misunderstood medications of all time.
By Wil Dubois
It's clearer than water from an alpine mountain spring. It's as expensive as French perfume. It's nearly 100 years old. It's been blessed, cursed, feared, and loved. Virtually all animals have it, or something very much like it. Horses have it. Dogs have it. Mice have it. Fish have it. So too do earthworms, fruit flies, and mosquitos.
In the Body
From the perspective of biology, insulin is the elixir of the Fountain of Life. OK, well, technically it's a peptide hormone, meaning that it's a functional protein—a protein engineered by nature to carry out a specific task. If you want to get even more technical about it, insulin is composed of 51 amino acids and has a molecular weight of 5808.
In "normal" people and critters, insulin is produced by the body's pancreas. The hormone's job is to guide glucose molecules from the blood stream into individual cells, earning it the title of a "transport hormone." Insulin is a navigator, hunting guide, and traffic cop all rolled into one. If your body fails to produce insulin you have type 1 diabetes, and your blood sugar rapidly skyrockets with potentially deadly effect. If your body produces insulin—but not enough for its needs because of insulin resistance—you have type 2 diabetes, and your blood sugar slowly skyrockets, but still with potentially deadly effect.
In the Bottle
From the perspective of diabetes therapy, insulin is the ultimate medicine. It always works. It gets along well with other medications. There is no maximum safe amount. It has virtually no side effects—it won't make you cough, ache, burp, or have diarrhea. It's infinitely scalable. It's simple, safe, and natural.
Insulin has a long track record, too. It was "discovered" and synthesized nearly a century ago by Dr. Frederick Banting and his assistant Charles Best working at the University of Toronto. Over the decades since, insulin has had a number of makeovers, but it's the same basic molecule. It was originally distilled from ground-up animal pancreases, generally from cows and pigs. In recent decades "human" insulin has been grown in massive production plants, using either yeast or E.coli bacteria.
It has come in a variety of "strengths," and over time various chemicals have been added to slow down its action or speed to it up. So while over the years it has featured different lights, bells, and whistles, it remains the same basic medicine.
But I don't want to talk about the body's insulin today. I want to talk about insulin in a bottle.
Who Needs Insulin?
Everyone, of course. But I guess you were asking which people with diabetes need insulin from a bottle. Actually, the answer is the same: everyone. Now all type 1's need insulin right out of the gate. I think most people know that. Our bodies don't make any at all and to stay alive we must import insulin from outside to keep the sugar in our blood in check. But what is less well known is that virtually all type 2s—in the fullness of time—will also need insulin from outside.
The reason for this is simple: Type 2 diabetes is a progressive disease. It gets worse and worse and worse over time. Pills will only go so far. Eventually, most type 2s who live long enough will need insulin. So, given the natural course of diabetes and the almost guaranteed need for insulin, why do so many people freak out about taking it?
Well, it might be that taking insulin involves needles.
Why a Needle?
Insulin needs to be injected. Why? Why can't we have a pill? Well, remember that I told you that it's actually a protein? So if you put it in a pill, your stomach mistakes it for a T-bone steak and digests it. Trust me, pharma companies big and small are working night and day on a work-around to put insulin into a pill, but with no great success yet.
OK, why can't we have a patch? Well, remember that I told you insulin has an atomic weight of 5808? In plain English that means it has a very big butt. It's a huge mongo molecule. Too big, in fact, to fit through your skin. That's why nothing happens if you pour insulin onto your hands. But again, the friendly pharma folks are working on ways to stretch the skin to force the molecules in. But don't hold your breath. The I-patch is years away.
In the meantime, to get insulin through your skin and into your body without being digested, a needle is involved. That needle might be attached to an ol' fashioned insulin syringe, something called an insulin pen, or to an insulin pump.
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On endo appointment days, we first go into a small room where Charlie has his height and weight measured and recorded. The nurse also pricks his finger and absorbs a small drop of blood to which she feeds into an A1c machine. “Do you want?” Charlie asked, offering up his blood like a potato chip. “No,” I said. “We’re fine.” In the past, we wouldn’t let the blood go to waste without also checking blood sugar. ...