posted April 09, 2000 09:13 AM            

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*Y2Kylee*

posted April 09, 2000 12:14 PM            

Body weight;
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Timing of insulin administration in relation to food intake and exercise;
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Individual variation: two different people can respond in a very different way to a given dose of insulin, even if they are of a similar height, weight and other personal characteristics. The fact that a certain dose does not seem to cause a problem for one person does not mean this will be so for another. In addition, the response to insulin will also vary greatly within any one individual over time, according to changes in one or more of the above noted factors.
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5-10 Units of a short acting preparation may have little or no observable impact on someone who eats a meal soon before or after but this dose could cause hypoglycemia and collapse in a person who has not consumed adequate food in close proximity to the time when the insulin begins to take effect (insulin starts to take effect within 5-10 minutes if injected by intra-muscular route and in 30-60 minutes if injected by subcutaneous route). Foods with a high glycemic index will maintain the blood glucose level for a short period of time, perhaps an hour or so whilst those with a low glycemic index will provide for more sustained glucose levels.
Risk Reduction Advice:
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Given the risks of using insulin for non medical purposes, the best advice one can give is not use it in this way. Even the body building magazines such as "Muscle Media 2000" advise: "If you're thinking about using insulin, think twice - it's really risky!"(3) However, if you are not persuaded by this advice and are determined to pursue its use in the hope of achieving some additional anabolic or other gains, you should take the following precautions:
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Consider using the natural method of raising your blood insulin level during workouts by consuming glucose containing fluids at intervals during exercise. These fluids may have a protein sparing effect and at the same time, will help maintain keep your blood glucose and blood insulin levels. However, if you decide to use insulin, you should consider the following advice:
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Always use insulin in the presence of someone else who knows about and understands the exact risks of using insulin in this manner, so they are able to act quickly and appropriately should something go wrong;
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Always use a sterile needle and syringe every time and a clean injecting technique (e.g. don't touch the needle or the skin where you are going to inject, with your fingers and don't breathe on or cough over the injection site before or after injecting.)
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Be aware that 1.0 ml of insulin contains one hundred International Units (100 IU), 0.1 ml of insulin contains ten (10) IU and 0.01 ml contains one (1.0) IU. So take care in measuring out your insulin �.it is very concentrated!
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Note that 0.01 ml is the volume contained in the space between the smallest graduated markings on a 1.0 ml Terumo diabetic syringe;
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Inject by the subcutaneous route (injecting just under the skin and preferably in the abdominal area or outer part of the upper thigh), not intramuscularly or intravenously as using the latter routes can lead to a rapid rise in blood insulin level and a sudden hypoglycemic episode;
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Alternate your injection sites in order to minimize tissue damage ("lipoatrophy" or "lipohypertrophy";
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Always use a short acting, "regular" insulin (e.g. Actrapid, Insulin Neutral, Humulin R, Hypurin Neutral) rather than a longer acting insulin preparation (e.g. Semilente, Lente or Ultralente);
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Use a human insulin rather than an animal insulin preparation if possible (there is little animal insulin available now);
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Start with no more than 5 IU (0.05 ml) of this short acting/ regular insulin preparation and increase the dose gradually over a period of one week, to a dose no higher than 20 IU (0.20 ml) per day. Doses above this will expose you to progressively greater risk and most body builders who use insulin believe there is no advantage in taking doses higher than this. Anecdotal evidence amongst bodybuilders suggests increased doses leads to excess bodyfat accumulation.
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The writer would caution against users falling into the trap of thinking: "If 20 units is good, 40 units will be twice as good" or "Joe says he injected 20 units and it didn't affect him, so it will be safe for me to inject 30 or 40 units". All drugs have a therapeutic dose range and above this, may be toxic or even lethal. If you are not diabetic, your body does not require additional insulin and there is no therapeutic range for you. In addition, people are different and often respond differently to drugs. An individual may also respond differently to the same drug in the same dose at different times, depending on a wide range of factors such as their general health, alcohol or other drugs taken, food eaten, exercise undertaken before, during or after drug administration and so on.
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Don't use a medium or long acting insulin in the middle or latter part of the day, as you may very well experience a hypoglycemic attack whilst you are asleep. If this happens, neither you nor anyone else will be aware of or able to respond to your urgent need for glucose, in order to prevent possible serious harm.
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Dietary Guidelines:
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Close attention to diet is extremely important in people using insulin, whether this is for legitimate medical purposes or for other reasons. You can reduce your risk by consuming an adequate amount and mixture of high and low G.I. carbohydrate foods and drinks immediately after using insulin and at regular intervals (every 2-3 hours) throughout the day.
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High G.I. carbohydrates (e.g. sweets, soft drinks and ice-cream) will raise your blood sugar quickly and prevent early hypoglycemia. Low G.I. carbohydrates (e.g. white pasta, high amylose rice, softened whole grain breads and instant noodles) are metabolized more slowly and will keep your blood glucose level up over a more extended period of time, when the medium acting insulin preparations begin to take effect;
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55-65% of your total daily energy intake should be in the form of carbohydrates, 15-20% as protein and ~20% as fat. You should seek advice from a dietitian about your daily requirements but most heavy training athletes need to consume between 3,000 and 5,500 Calories per day (depending on the sport and level of training) and between 450 and 800 grams of carbohydrate each day. If you are a body builder who weighs 100 kg and your total energy requirements are calculated to be 4,000 calories/ day, you should aim to eat approximately 570 grams of carbohydrate each day. If your total energy requirements are calculated to be 5,000 calories/ day, you should aim to eat approximately 720 grams of carbohydrate each day.
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Divide up your calculated total daily carbohydrate requirements over the course of your waking hours and consume frequent carbohydrate meals throughout the day. For example, if you require 4,000 calories per day, you might eat six meals of 650-700 Calories at 2-3 hour intervals.
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This would mean eating approximately 90-100 grams of carbohydrate each meal, which for example you will obtain from 7 slices of bread alone or 4-5 slices of bread with 1 � tablespoons of honey or 500 ml of Sustagen or 3 slices of bread eaten with a 450 gram can of baked beans. You can refer to the attached food tables to work out your own requirements according to your own food preferences. You will need to choose a mixture foods from this table with a high, medium or low G.I., according to the nature and level of the training you are doing.
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Once again, the writer would strongly recommend that you consult a dietitian who has an interest and experience in sports nutrition, in order to assist you design a dietary program which is best suited to your training goals and needs and to your food preferences. It is equally important that you find a dietitian with whom you feel comfortable telling about your insulin or other performance enhancing substance use, as their advice may otherwise be less than useful to you. If your dietitian does not know about and does not take such substance use into account, their advice may even add to the dangers associated with this substance use.
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Always have a source of glucose or other high G.I. food ready at hand, in case you should begin to experience the symptoms of hypoglycemia. If this does occur, you should take this glucose or food without delay. You should eat or drink 15-20 grams of carbohydrate to begin with, which is contained in ~ 2 slices of white or brown bread, two glasses of milk, a half glass of soft drink, a tablespoon of honey or six jelly beans.
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Other examples of glucose or other high Glycemic index carbohydrate preparations which you can use include: glucose tablets, glucose powder mixed in a small volume of water, barley sugar, or other sweets or if these are not immediately available, a sugar containing cordial, soft drink or plain sugar dissolved in water. This should be followed by an adequate low Glycemic index carbohydrate meal to prevent further hypoglycemia since the insulin levels are likely to remain high for some hours after the high Glycemic index carbohydrates are used up (metabolized) in the body.
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The Crucial Role of the Friend or Peer Observer:
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If you are going to use insulin, it is essential that you have a friend or peer observer remain with you in case you experience problems. This person really needs to be with you for the whole time while the insulin preparation used is working.
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Be aware that the risk of hypoglycemia occurs not at the time of insulin injection but rather, when the insulin starts to take effect. The risk will be greatest when your insulin blood level nears or reaches its highest level, usually 30-60 minutes afterwards if a short acting insulin preparation is used (by subcutaneous injection) and up to 20 hours later if a long acting insulin is used.
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Consider giving this paper to the person who is going to be with you when you use insulin, so they are aware of the things to look out for and what to do if you should experience a hypoglycemic reaction. The following instructions are for a peer observer or other person who may find you experiencing difficulty as a result of overdosing on insulin or any other drug or combination of drugs:
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Instructions for the Peer Observer Assisting an Insulin User:
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If the person who has used insulin states that they are beginning to feel any of the following symptoms:
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faintness,
dizziness,
thirst,
hunger,
nausea,
weakness,
sweating,
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Or if you observe that they have become:
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confused,
disorientated,
sweaty,
drowsy,
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You should immediately give them glucose or a sugar containing drink or food as mentioned above. However, you should not try to give a person food or fluids if they are so drowsy that they are unable to swallow it, since they will be at risk of accidentally breathing in (aspirating) this food or fluid. If they cannot readily respond to your questions or your commands, you should assume they are unable to swallow anything safely.
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If the person loses consciousness, you should place them in either a "lateral" or "coma" position, tilting the head fully back and jaw forward, in order to ensure an open airway and protect them from possible aspiration. Keep them in this position while medical assistance is being sought.
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You should then immediately call an ambulance by dialing "911", to get them to a hospital without any delay whatsoever. When the ambulance arrives, you should tell the ambulance officers exactly what the person has taken and what you have observed so the correct treatment can be provided promptly. This is essential as the person's life may be at stake.
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Severe hypoglycemia or a combination of alcohol and other drugs, particularly drugs which suppress the central nervous system, can cause a person to stop breathing and their heart to stop beating. Remember, it only takes a few minutes for someone to suffer permanent brain damage or to die, once they stop breathing.
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There are several common signs which may be apparent in someone who has overdosed from one or a combination of drugs. These include:
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very slow or shallow breathing or no breathing at all (listen close to the person's mouth and nose for breath sounds and look for movement of their chest wall)
snoring or gurgling breathing in someone who is asleep
blue lips and fingernails (caused by lack of oxygen)
no response to shaking, calling their name or pain (try pinching their earlobe and pressing down hard on one of their fingernails with a pen)
very slow, faint pulse or no pulse at all
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What To Do in the Event of an Overdose:
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stay calm,
squeeze earlobe/ press on fingernail of person in an effort to arouse them
if person responds, try to walk them around
if no response, check person's breathing and pulse
if unconscious but breathing, place in lateral or coma position
call an ambulance by dialing 911 �
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they will give you advice on what to do, which might include:-
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if there is a pulse but the person is not breathing, start artificial respiration,
otherwise known as Expired Airways Resuscitation (EAR), without delay
if no pulse, start cardio-pulmonary resuscitation (CPR)
stay with the person, continuing to administer artificial respiration or CPR until the ambulance arrives. Keep them in the lateral or coma position if they are breathing on their own.
tell the ambulance officers exactly what they may have taken and what you have observed
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The writer would like to emphasize once more that this paper should in no way be construed as an encouragement to people to use insulin in an effort to increase muscle mass, sports performance or appearance. Rather, it represents a pragmatic attempt at providing harm reduction advice to people who choose to take the risk of using insulin in this way, despite their knowledge of those risks.

YOU GOTS TO READ MY BROTHER!