Insulin is not a life sentence. Why this treatment can save lives

The invention of insulin – 100 years ago – turned diabetes from an incurable disease into one that can be well-managed. How exactly does insulin affect our bodies, and how has it evolved in the past 100 years? Here are the answers:

Many people think that if they begin to take insulin, they will have to continue with it forever and suffer side effects, but this is not quite true. This year marks the 100th anniversary of the invention of insulin, a drug that changed the world, and this is the opportunity to shatter some myths about the drug. 

What is insulin?

Insulin is a hormone. Hormones are the form in which there is a connection between different systems in the body. "The job of insulin is to tell the cells, 'Open the gates and let the glucose in,' which is critical because glucose is our energy source. Energy molecules are produced from glucose, and when that doesn't happen, the cells are starved and have nothing to produce energy from," explained Prof. Zuckerman-Yaffe, adding that our brains are very glucose-dependent and can use very little other forms of energy. When diabetics inject themselves with insulin, they receive this vital hormone externally.

Who needs insulin?

Insulin is the only drug for type 1 diabetes (formerly mistakenly called juvenile diabetes). In this type of disease, patients suffer from a lack of insulin production in the body. In type 2 diabetes, there is a relative lack of insulin, so the picture is more complex. This type of disease has several types of treatments. "Since in type 2 diabetes there is a relative lack of insulin, the cells require much more insulin for the same amount of glucose, and the pancreas tries to keep up and produce more and more until at some point it fails to produce the required amount," explained Prof. Zuckerman-Yaffe. "Therefore, the drugs we have for diabetes, on the one hand, lower this increased consumption of insulin, and in another way, give more insulin." She explains that the role of insulin in type 2 diabetes is in situations where there is an insulin deficiency.

How has insulin changed in the last 100 years?

The world of diabetes has taken a significant turn in recent years due to the invention of basal insulin - long-acting insulin. This development mimics the body's natural secretion of insulin. "The pancreas in our body continuously secretes insulin. There is a certain level of insulin that is secreted into the bloodstream constantly, but when eating food, when you need to get a lot of glucose into the cells, there is a secretion of a large amount of insulin," explained Prof. Zuckerman-Yaffe, "When we talk about making up the insulin deficiency for type-2 diabetics, it is often enough for us to fill the need with the basal, continuous insulin, and the body will be able to fill in the gap."

She added that today there are very long-acting and very safe insulins that have changed how diabetes patients are treated, making treatment simpler and with fewer side effects. "The secret to diabetes is to achieve balance. The uniqueness of long-acting insulin is that it fills in the gaps in a very safe way, and often it is the only treatment that can help," said Prof. Zuckerman-Yaffe. "There are also ultra-long insulins available today that last for more than 24 hours. Although they are still injected once a day, they are active for a longer period, so the chance of side effects due to delaying injection is reduced."

Is insulin a life sentence? Must one remain with the same dose for a lifetime?

"There are situations in which a person is diagnosed with high sugar levels, and the only way to lower their glucose levels is by giving a large amount of insulin. Sometimes after a certain period of time, the pancreas recovers, and the treatment changes, but at the beginning with this diagnosis, it is necessary," explained Prof. Zuckerman-Yaffe.

What are the side effects of insulin?

The main side effect for diabetics who are being treated with insulin is hypoglycemia - a drop in sugar levels in the body. "This is one of the reasons why they developed ultra-long insulin. With these treatments, the fear of hypoglycemia is reduced to a minimum," said Prof. Zuckerman-Yaffe, "The pancreas is an amazing organ. It knows how to secrete the exact amount of insulin so that, on the one hand, there will be no hypoglycemia, and on the other hand, there will not be high sugar levels. But when giving insulin externally, there is always a fear of inaccuracy and error. Fortunately, with long-acting insulin, the chances of this phenomenon occurring are extremely low."

Diabetes in the older adult population  

Ultra-long insulins are of great importance for the older population, where the fear of a drop in blood sugar levels is greater. The concept of treating diabetes in older adults has changed in the last decade, and it is now clear that the treatment should be oriented to biological age and not chronological age. In fact, it is necessary to assess the physical and cognitive state (learning abilities, memory and thinking) of the older person with diabetes, outline the therapeutic plan according to this situation, and use interventions that can lower the rate of deterioration in these areas. 

For additional information or questions, contact your physician.

This article was written in cooperation with Sanofi