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Instead, like in other nations, approximately 350,000 women served as uniformed auxiliaries in non-combat roles in the U.S. armed forces. These roles included: administration, nurses, truck drivers, mechanics, electricians, and auxiliary pilots. Women also took part outside of formal military structure in the resistances of France, Italy, and Poland, as well as in the British SOE and American OSS which aided these. Women were forced into sexual slavery; the Imperial Japanese Army forced hundreds of thousands in Asia to become comfort women, before and throughout World War II. Allies Australia Australian women played a larger role in World War 2 than they had done in World War I.
Many women wanted to play an active role, and hundreds of voluntary women's auxiliary and paramilitary organisations had been formed by 1940. A shortage of male recruits forced the military to establish female branches in 1941 and 1942. Canada When war began to look unavoidable in the late 1930s, Canadian women felt obligated to help the fight. In October 1938, the Women's Volunteer Service was established in Victoria, British Columbia. Soon, all the provinces and territories followed suit and similar volunteer groups were emerged. "Husbands, brothers, fathers, boyfriends were all joining up, doing something to help win the war. Surely women could help as well!"
In addition to the Red Cross, several volunteer corps had designed themselves after auxiliary groups from Britain. These corps had uniforms, marching drills and a few had rifle training. It became clear, that a unified governing system would be beneficial to the corps. The volunteers in British Columbia donated two dollars each to pay the expenses so a representative could talk to politicians in Ottawa. Although all of the politicians appeared sympathetic to the cause, it remained "premature" in terms of national necessity. In June 1941, the Canadian Women's Army Corps was established. The women who enlisted would take over Drivers of light mechanical transport vehicles Cooks in hospitals and messes Clerks, typists, and stenographers at camps and training centres Telephone operators and messengers Canteen helpers On July 2, 1942 women were given permission to enlist in what would be known as the Canadian Women's Auxiliary Air Force.
Lastly the Royal Canadian Navy created the Women's Royal Canadian Naval Service (WRENS). The WRENS were the only corps that were officially a part of their sanctioning body as a women's division. This led to bureaucratic issues that would be solved most easily by absorbing the civilian corps governed by military organizations, into women's divisions as soldiers.
According to the RCAF the following are the requirements of an enlisted woman: Must be at least 18 years of age, and younger than 41 years of age Must be of medical category A4B (equivalent of A1) Must be equal to or over 5 feet (152 cm), and fall within the appropriate weight for her height, not being too far above or below the standard Must have a minimum education of entrance into high school Be able to pass the appropriate trades test Be of good character with no record of conviction for an indictable offence Women would not be considered for enlistment if they were married and had children dependent on them.
Training centres were required for all of the new recruits. They could not be sent to the existing centres as it was necessary that they be separated from male recruits. The Canadian Women's Army Corps set up centres in Vermilion, Alberta and Kitchener, Ontario. Ottawa and Toronto were the locations of the training centres for the Canadian Women's Auxiliary Air Force. The WRENS were outfitted in Galt, Ontario. Each service had to come up with the best possible appeal to the women joining, for they all wanted them. In reality, the women went where their fathers, brothers and boyfriends were.
Women had numerous reasons for wanting to join the effort; whether they had a father, husband, or brother in the forces, or simply felt it a duty to help. One woman blatantly exclaimed that she could not wait to turn eighteen to enlist, because she had fantasies of assassinating Hitler. Many women aged 16 or 17 lied about their age in order to enlist. The United States would allow only women who were at least twenty-one to join. For their young female citizens, Canada was the logical option. Recruitment for the different branches of the Canadian Forces was set up in places like Boston and New York.
Modifications were made to girls with US citizenship, having their records marked, "Oath of allegiance not taken by virtue of being a citizen of The United States of America". Women had to undergo to medical examinations and meet fitness requirements as well as training in certain trades, depending on the aspect of the armed forces of which they wanted to be a part. Enlisted women were issued entire uniforms minus the undergarments, for which they would receive a quarterly allowance. To be an enlisted woman during the creation stages was not easy. Besides the fact that everyone was learning as they went, they did not receive the support they needed from the male recruits.
To begin with, women were initially paid two-thirds of what a man at the same level would make. As the war progressed the military leaders began to see the substantial impact the women could make. This was taken into account and the women received a raise to four-fifths of the wages of a man. A female doctor however, would receive equal financial compensation to her male counterpart. The negative reaction of men towards the female recruits was addressed in propaganda films. Proudly She Marches and Wings on Her Shoulder were made to show the acceptance of female recruits, while showing the men that although they were taking jobs traditionally intended for men, they would be able to retain their femininity.
Other problems faced early on for these women were those of a more racial nature. An officer of the CWAC had to write to her superiors regarding whether or not a girl of "Indian nationality" would be objected to for enlistment. Because of Canada's large population of immigrants, German women also enlisted, creating great animosity between recruits. The biggest difficulty was the French-Canadian population. In a document published on the 25 November 1941, it was declared that enlisted women should "unofficially" speak English. However, seeing the large number of capable women that this left out, a School of English was stabled for recruits in mid-1942.
In 1942, Mary Greyeyes-Reid became the first First Nations woman to join the Canadian Forces. She was featured in photographs to represent native people in the forces, yet at the same time was not welcome in the barracks due to discrimination. Once in training, some women felt that they had made a mistake. Several women cracked under the pressure and were hospitalized. Other women felt the need to escape, and ran away. The easiest and fastest way out of the service was pregnancy. Women who found out that they were expecting were given a special, quickly executed, discharge. The women who successfully graduated from training had to find ways to entertain themselves to keep morale up.
Softball, badminton, tennis, and hockey were among popular pastimes for recruits. Religion was of a personal matter to the recruits. A minister of sorts was usually on site for services. For Jewish women, it was custom that they were able to get back to their barracks by sundown on Sabbath and holidays; a rabbi would be made available if possible. At the beginning of the war 600,000 women in Canada held permanent jobs in the private sector, by the peak in 1943 1.2 million women had jobs. Women quickly gained a good reputation for their mechanical dexterity and fine precision due to their smaller stature.
Women also had to keep their homes together while the men were away. "An Alberta mother of nine boys, all away at either war or factory jobs – drove the tractor, plowed the fields, put up hay, and hauled grain to the elevators, along with tending her garden, raising chickens, pigs, and turkeys, and canned hundreds of jars of fruits and vegetables". In addition to physical jobs, women were also asked to cut back and ration. Silk and nylon were used for the war efforts, creating a shortage of stockings. Many women painted lines down the back of their legs to create the illusion of wearing the fashionable stockings of the time.
India In India, policies resembled those of Great Britain, except that women were not used in anti-aircraft units, and there was no conscription of women for munitions work. The Women's Auxiliary Corps operated from 1939 to 1947, with peak strength of 850 officers and 7,200 auxiliaries in the Indian army. A small naval section operated in the Royal Indian Navy. The nationalist movements in India during the war split on military service. Mahatma Gandhi opposed fascism and on his advice youths from India joined the armed forces to fight with Britain along with allies. One faction of Congress led by Subhas Chandra Bose was so opposed that it cooperated with Nazi Germany, and actually enlisted soldiers who fought alongside Japanese soldiers against the British and Indians in Burma.
The "Rani of Jhansi Regiment" involved these women in combat on behalf of the Indian National Army. It was active from 1943-45. Bose spent a good deal of effort on him developing anti-British anti-imperialist ideology designed to mobilize models of women as mothers and sisters in Indian tradition. Bose argued that the direct involvement of women was necessary to achieve total independence of India from the colonial powers. Bose articulated a modern definition of female heroism that involved combat. In actual practice, very few of his female soldiers were directly involved in combat; they largely had support roles in logistics and medical care.
Italy After 1943 Italian women joined the anti-fascist resistance, and also served in the fascist army of Mussolini's rump state that formed in 1943. They did not serve in the main Italian army. Some 35,000 women (and 170,000 men) joined in the Resistance. The women were used as auxiliary support and were not allowed in senior ranks. Most did cooking and laundry duty. Some were guides, messengers, and couriers near the front lines. A few were attached to small attack groups of five or six men engaged in sabotage. Some all-female units, engaged in civilian and political action. The Germans aggressively tried to suppress them, sending 5000 to prison, deporting 3000 to Germany.
About 650 died in combat or by execution. On a much larger scale, non-military auxiliaries of the Catholic Centro Italiano Femminile (CIF) and the leftist Unione Donne Italiane (UDI) were new organizations that gave women political legitimacy after the war. Poland 1939 The Polish military maintained a number of Women's Military Assistance Battalions, trained by the Przysposobienie Wojskowe Kobiet (Female Military Training) and commanded by Maria Wittek. During the Invasion of Poland they saw combat, playing auxiliary roles in defensive action. Janina Lewandowska was a pilot. Marianna Cel was a member of Henryk Dobrzański's guerilla unit 1939-1940. Underground Krystyna Skarbek worked for Polish underground in Hungary and later joined SOE.
Writer Zofia Kossak-Szczucka helped Jews during the Holocaust, was arrested and imprisoned in the Auschwitz concentration camp. Wanda Jakubowska survived Auschwitz and directed The Last Stage, a concentration camp film. Elżbieta Zawacka was a paratrooper, courier and fighter. Grażyna Lipińska organised an intelligence network in Germany occupied Belarus 1942-1944. In occupied Poland women played an important role in the resistance movement. Their most important role was as couriers carrying messages between cells of the resistance movement and distributing news broadsheets and operating clandestine printing presses. During partisan attacks on Nazi forces and installations they served as scouts. About 40,000 of Polish women were imprisoned in Ravensbrück concentration camp.
Zofia Posmysz survived two camps and described her story, inspiring Passenger 1953 film. Wanda Jakubowska was imprisoned in Auschwitz and after the war directed a classic film The Last Stage. Jewish women fought in the Warsaw Ghetto Uprising and several smaller fights. The Stroop Report contains a picture of HeHalutz female fighters captured with weapons. During the Warsaw Rising of 1944, female members of the Home Army were couriers and medics, but many carried weapons and took part in the fighting. Among the more notable women of the Home Army was Wanda Gertz who created and commanded DYSK (Women's sabotage unit).
For her bravery in these activities and later in the Warsaw Uprising she was awarded Poland's highest awards - Virtuti Militari and Polonia Restituta. Many nurses were murdered on September the 2nd, 1944. Anna Świrszczyńska was a nurse and expected to be executed. She described later the Rising in her poems. One of the articles of the capitulation was that the German Army recognized them as full members of the armed forces and needed to set up separate prisoner-of-war camps to hold over 2000 female prisoners-of-war. Małgorzata Fornalska was one of important Communist activists, arrested and killed by Germans. Helena Wolińska-Brus was influential in Communist underground Gwardia Ludowa, later Armia Ludowa.
Many female teachers organized underground education. Many women worked for Żegota: Zofia Kossak-Szczucka, Irena Sendler, Antonina Żabińska. Armed forces A number of all-female units in the Polish forces in exile were also established. These included the Anders Army, the Women's Auxiliary Service which was deployed in Italy and served across the Polish Army, Navy, and Air Force. The Soviet First Polish Army had the Emilia Plater Independent Women's Battalion, whose members took part in fighting as part of sentry duties. Extermination The Holocaust Stefania Wilczyńska cooperated with Janusz Korczak working in a Jewish orphanage in Warsaw Ghetto, they died in Treblinka extermination camp.
Romani genocide Gentiles Thousands of women were killed during Pacification actions in German-occupied Poland. Tens of thousands were killed by Ukrainian nationalists in Volhynia and Eastern Galicia. Tens of thousands of non-Jewish women were shot in August 1944 at Warsaw during Ochota massacre and Wola massacre. Concentration camps and slave work Zofia Kossak-Szczucka, Seweryna Szmaglewska, Krystyna Żywulska were imprisoned in Auschwitz and later described their experiences in novels. Many women were Zivilarbeiters or camp or prison inmates who had to work for Germans. There existed a camp for girls in Dzierżązna, Łódź Voivodeship, a subcamp of the Polen-Jugendverwahrlager der Sicherheitspolizei in Litzmannstadt.
Babies born by the prisoners were starved in Nazi birthing centres for foreign workers. Nazi human experimentation Sexual contacts German historian Maren Röger describes three subjects: Intimacy Terror (rapes) Prostitution. Soviet Union The Soviet Union mobilized women at an early stage of the war, integrating them into the main army units, and not using the "auxiliary" status. More than 800,000 women served in the Soviet Armed Forces during the war, which is roughly 3 percent of total military personnel, mostly as medics. About 300,000 served in anti-aircraft units and performed all functions in the batteries—including firing the guns. A small number were combat flyers in the Air Force, forming three bomber wings and joining into other wings.
Women also saw combat in infantry and armored units, and female snipers became famous after commander Lyudmila Pavlichenko made a record killing 309 Germans (mostly officers and enemy snipers). Great Britain Workplace When Britain went to war, as before in World War I, previously forbidden job opportunities opened up for women. Women were called into the factories to create the weapons that were used on the battlefield. Women took on the responsibility of managing the home and became the heroines of the home front. According to Carruthers, this industrial employment of women significantly raised women's self-esteem as it allowed them to carry out their full potential and do their part in the war.
During the war, women's normative roles of "house wife" transformed into a patriotic duty. As Carruthers put it, the housewife has become a heroine in the defeat of Hitler. The roles of women shifting from domestic to masculine and dangerous jobs in the workforce made for important changes in workplace structure and society. During the Second World War, society had specific ideals for the jobs in which both women and men participated. When women began to enter into the masculine workforce and munitions industries previously dominated by men, women's segregation began to diminish. Increasing numbers of women were forced into industry jobs between 1940-1943.
As surveyed by the Ministry of Labour, the percentage of women in industrial jobs went from 19.75 per cent to 27 per cent from 1938-1945. It was very difficult for women to spend their days in factories, and then come home to their domestic chores and care-giving, and as a result, many women were unable to hold their jobs in the workplace. Britain underwent a labour shortage where an estimated 1.5 million people were needed for the armed forces, and an additional 775,000 for munitions and other services in 1942. It was during this "labour famine" that propaganda aimed to induce people to join the labour force and do their bit in the war.
Women were the target audience in the various forms of propaganda because they were paid substantially less than men. It was of no concern whether women were filling the same jobs that men previously held. Even if women were replacing jobs with the same skill level as a man, they were still paid significantly less due to their gender. In the engineering industry alone, the number of skilled and semi-skilled female workers increased from 75 per cent to 85 per cent from 1940-1942. According to Gazeley, even though women were paid less than men, it is clear that women engaging in war work and taking on jobs preserved by men reduced industrial segregation.
In Britain, women were essential to the war effort. The contribution by civilian men and women to the British war effort was acknowledged with the use of the words "home front" to describe the battles that were being fought on a domestic level with rationing, recycling, and war work, such as in munitions factories and farms and men were thus released into the military. Women were also recruited to work on the canals, transporting coal and munitions by barge across the UK via the inland waterways. These became known as the "Idle Women", initially an insult derived from the initials IW, standing for Inland Waterways, which they wore on their badges, but the term was soon adopted by the women themselves.
Many women served with the Women's Auxiliary Fire Service, the Women's Auxiliary Police Corps and in the Air Raid Precautions (later Civil Defence) services. Others did voluntary welfare work with Women's Voluntary Services and the Salvation Army. Women were "drafted" in the sense that they were conscripted into war work by the Ministry of Labour, including non-combat jobs in the military, such as the Women's Royal Naval Service (WRNS or "Wrens"), the Women's Auxiliary Air Force (WAAF or "Waffs") and the Auxiliary Territorial Service (ATS). Auxiliary services such as the Air Transport Auxiliary also recruited women. In the early stages of the war such services relied exclusively on volunteers, however by 1941 conscription was extended to women for the first time in British history and around 600,000 women were recruited into these three organizations.
In these organizations women performed a wide range of jobs in support of the Army, Royal Air Force (RAF) and Royal Navy both overseas and at home. These jobs ranged from traditionally feminine roles like cook, clerk and telephonist to more traditionally masculine duties like mechanic, armourer, searchlight and anti-aircraft instrument operator. British women were not drafted into combat units, but could volunteer for combat duty in anti-aircraft units, which shot down German planes and V-1 missiles. Civilian women joined the Special Operations Executive (SOE), which used them in high-danger roles as secret agents and underground radio operators in Nazi occupied Europe.
Propaganda British Women's Propaganda was issued during the war in attempts to communicate to the house-wife that while keeping the domestic role, she must also take on a political role of patriotic duty. Propaganda was meant to eliminate all conflicts of personal and political roles and create a heroine out of the women. The implication with propaganda is that it asked women to redefine their personal and domestic ideals of womanhood and motivate them go against the roles that have been instilled in them. The government struggled to encourage women to respond to posters and other forms of propaganda. One attempt to recruit women into the labour force was in one short film My Father's Daughter.
In this propaganda film a wealthy factory owner's daughter begs to do her part in the war, but her father carries the stereotypical belief that women are meant to be caretakers and are incapable of such heavy work. When one foreman presents one of the most valuable and efficient workers in the factory as the daughter, the father's prejudices are eliminated. The encouraging message of this short film is "There's Not Much Women Can't Do". Military roles The most common role of women in active service was that of a searchlight operator. All of the members of the 93rd Searchlight Regiment were women.
Despite being limited in their roles, there was a great amount of respect between the men and women in the mixed batteries. One report states "Many men were amazed that women could make adequate gunners despite their excitable temperament, lack of technical instincts, their lack of interest in aeroplanes and their physical weaknesses". While women still faced discrimination from some of the highly stereotypical older soldiers and officers who did not like women "playing with their guns", women were given rifle practice and taught to use anti-aircraft guns while serving in their batteries. They were told that this was in case the Germans invaded.
If that were to ever happen, they would be evacuated immediately. Three quarters of women who entered the wartime forces were volunteers, compared to men who made up less than a third. Single or married women were eligible to volunteer in WAAF, ATS or WRNS and were required to serve throughout Britain as well as overseas if needed, however the age limits set by the services varied from each other. Generally women between 17 and 43 could volunteer and those under 18 required parental consent. After applying, applicants had to fulfill other requirements, including an interview and medical examination; if they were deemed fit to serve then they were enrolled for the duration of the war.
WRNS was the only service that offered an immobile branch which allowed women to live in their homes and work in the local naval establishment. WRNS was the smallest of the three organizations and as a result was very selective with their candidates. Of the three organizations, WAAF was the most preferred choice; the second being WRNS. ATS was the largest of the three organizations and was least favoured among women because it accepted those who were unable to get into the other forces. ATS had also developed a reputation of promiscuity and poor living conditions, many women also found the khaki uniform unappealing and as a result favoured WRNS and WAAF over ATS.
Over 640,000 British women served in various auxiliary services of the British armed forces. Limitations Whilst women were limited in some of their roles, they were expected to perform to the same standard as a male soldier performing the same role, and although they could not participate in frontline combat, they still manned anti-aircraft guns and defences which actively engaged hostile aircraft above Britain. Women went through the same military training, lived in the same conditions and did almost the same jobs as men, with the exception of not being able to participate in front-line combat. This important distinction meant that women did not tend to be nominated for medals of valour or bravery, because they were only awarded for "active operations against enemy in the field", which women could not take part in.
Women were also distinct because of the titles by which they were addressed in the army, although these tended to be no different from their male counterparts. They wore the same rank insignia as their male counterparts. Many members of the ATS were respected by the units they were attached to despite their different insignia. The only major difference between an ATS member and a male member of the Regular Army was discipline: a woman was not allowed to be court marshalled unless she herself chose to be. The women in the service were also under the authority of the female officers of the ATS, instead of the male officers under whom they served directly.
This meant any disciplinary action was entirely in the hands of the ATS, removing male influence from the process. Volunteers Despite their obvious distinctions from men, women were eager to volunteer. Many of the servicewomen came from restricted backgrounds; therefore they found the army liberating. Other reasons women volunteered included escaping unhappy homes or marriages, or to have a more stimulating job. The overwhelming reason for joining the army, though, was patriotism. As in World War I, Great Britain was in a patriotic fervour throughout World War II to protect itself from foreign invasion. Women, for the first time, were given the opportunity to help in their native land's defense, which explains the high number of female volunteers at the beginning of the war.
Despite the overwhelming response to the call for female volunteers, some women refused to join the forces; many were unwilling to give up the civilian job they had, and others had male counterparts that were unwilling to let them go . Others felt that war was still a man's job, and not something women should be involved in. Similar to the men's forces, women's forces were mostly volunteer throughout the war. When women's conscription did come into effect, however, it was highly limited. For example, married women were exempt from any obligation to serve unless they chose to do so, and those who were called could opt to serve in civil defense (the home front).
During the war, approximately 487,000 women volunteered for women’s services; 80,000 for WRNS, 185,000 for WAAF and 222,000 for ATS. By 1941 the demands of the wartime industry called for women's services to be expanded so that more men could be relieved of their previous positions and take on more active roles on the battle field. Of all the women's services, ATS needed the greatest number of new applicants; however due to ATS' lack of popularity, they were unable to gain the estimated 100,000 new volunteers needed. To try and change women's opinions on ATS, living conditions were improved and a new more flattering uniform was made.
In 1941 the Registration for Employment Order was introduced in hopes of getting more women enrolled. This act could not force women to join the forces, but instead required women aged from 20–30 to try to find employment through labour exchanges and provide information on their current employment and family situations. Those who were deemed eligible were persuaded into the war industry because the Ministry of Labour did not have the power to force. Propaganda was also used to persuade women into the women's services. By the end of 1941, ATS had only gained 58,000 new workers, falling short of expectations.
Ernest Bevin then called for conscription and by late 1941 with the National Service Act it became compulsory for women aged from 20–30 to join military service. Married women were exempt from conscription, but those who were eligible had the option to work in war industry or civil defense if they did not want to join one of the services. Women were able to request which force they wished to join but most women were put into ATS because of its need for new applicants. The National Service Act was repealed in 1949 but by 1944 women were no longer being called up for service because relying on volunteers was thought to be enough to complete the required tasks during the final stages of war.
Women also played an important role in British industrial production during the war, in areas such as metals, chemicals, munitions, shipbuilding and engineering. At the beginning of the war in 1939 17.8% of women made up employment in these industries and by 1943 they made up 38.2%. With the start of the war there was an urgent need to expand the country's labour force and women were seen as a source of factory labour. Before the war, women in industrial production worked exclusively on assembly, which was seen as cheap and undemanding work, but during the war women were needed in other areas of the production process that had previously been carried out by men, such as Lathe operation.
The Ministry of Labour created training centres that gave an introduction to the engineering process, and by 1941 women were allowed entrance as the importance of the engineering industry grew and became a large source of female employment. Areas such as aircraft manufacture, light and heavy general engineering and motor vehicle manufacturing all saw an increase in female employment during the war. Aircraft production saw the largest rise in female employment as it rose from 7% in 1935 to 40% in 1944. At the start of the war men who were already in engineering were prevented from going to war because engineering was seen as an important industry to war production but in 1940 there became a need for more female workers to supply the necessary labour for factory expansion.
By 1941 with the shortage of skilled labour the Essential Workers Order was introduced which required all skilled workers to register and prevented workers from quitting from jobs that were deemed essential to the war effort without agreement from a National Service Officer. The Registration for the Employment Order in 1941 and the Women of Employment Order in 1942 also attempted to get more women into the workforce. The Women of Employment Order required women ages 18–45 to register for labour exchanges and by 1943 the maximum age was raised to 50, which brought an additional 20,000 women into the workforce.
Aircraft production was given the top labour priority and many women were diverted into it with some even being transferred from agricultural production. Interpretation of aerial photographs A vital job was interpreting aerial photographs taken by British spy planes over Allied Europe. There was equality in this work that was not found anywhere else during the war: women were considered equal to men in this field. Women played a role in the planning of D-Day in this capacity – they analyzed the photos of the Normandy Coast. Women as photo analysts also participated in the biggest intelligence coup of the war – the discovery of the German V1 flying bomb.
The participation of women allowed these bombs to be destroyed. Civilian pay scales Although many women were doing jobs that men had previously done during the war, there were still pay distinctions between the two sexes. Women's pay was significantly lower than men's pay. The average female in manufacturing was earning $31 per week while the average male earned $55 per week. Equal pay was rarely achieved as employers wanted to avoid labour costs. Skilled work was often broken down into smaller tasks and labelled skilled or semi-skilled and then paid according to women's pay rates. Women who were judged to be doing "men's work" were paid more than women who were thought to be doing "women's work" and the employers' definition of this varied regionally.
Women were receiving closer wages to their male counterparts; however despite the government's expressed intentions, women continued to be paid less than men for equivalent work and were segregated in terms of job description, status, and the hours they put in. In 1940 Ernest Bevin persuaded engineering employers and unions to give women equal pay to men since they were taking on the same tasks that men previously had; this became the Extended Employment of Women Agreement. Generally, pay increases depended on the industry; industries that were dominated by women before the war, like textiles and clothing, saw no changes in pay.
However the gap between male and female earnings narrowed by 20-24% in metals, engineering and vehicle building and by 10-13% in chemicals, which were all deemed important to the war effort. Overtime hours also differed, with women getting 2–3 hours and men 9-10 a week. Women’s hours were still regulated because of their perceived responsibilities to take care of their family and household. High profile The British gave high prestige to their women's units who therefore escaped much of the vulgar commentary. The two daughters of Prime Minister Churchill were both in uniform. In February 1945, Princess Elizabeth joined the Women's Auxiliary Territorial Service as an honorary second subaltern with the service number of 230873.
She was a driver for the Second Subaltern Windsor Unit. Post-war Post-war, women turned to marriage or to civilian jobs. The Army returned to the male-dominated field it was before the war. "[Demobilisation] was a big disappointment to a lot of us. It was an awful and wonderful war. I wouldn't have missed it for anything; some of the friends we made were forever" one female recounted after being dismissed from service to return to her normal job. Married women were released from service sooner at the end of the war, so they could return home before their husbands to ensure the home was ready when he returned from the front.
Despite being largely unrecognised for their wartime efforts in the forces, the participation of women in World War II allowed for the founding of permanent women's forces. Britain instituted these permanent forces in 1949, and the Women's Voluntary Services are still a standing reserve force today. United States Yugoslavia Yugoslavia was dissolved during the war, but the resistance units were active. The Communist Yugoslav National Liberation Movement claimed 6,000,000 civilian supporters; its two million women formed the Antifascist Front of Women (AFŽ), in which the revolutionary coexisted with the traditional. The AFŽ managed schools, hospitals and local governments. About 100,000 women served with 600,000 men in Tito's Yugoslav National Liberation Army.
It stressed its dedication to women's rights and gender equality and used the imagery of traditional folklore heroines to attract and legitimize the partizanka. After the war, women were relegated to traditional gender roles, but Yugoslavia is unique as its historians paid extensive attention to women's roles in the resistance, until the country broke up in the 1990s. Then the memory of the female soldiers faded away. Axis and associated countries Finland Finnish women took part in defence: nursing, air raid signaling, rationing and hospitalization of the wounded. Their organization was called Lotta Svärd, named after the poem, where voluntary women took part in auxiliary work of the armed forces to help those fighting on the front.
Lotta Svärd was one of the largest, if not the largest, voluntary group in World War II. They did not fire guns, a rule in Lotta Svärd. Germany The majority of German girls were members of League of German Girls (BDM). The BDM helped the war effort in many ways. On the eve of war 14.6 million German women were working, with 51% of women of working age (16–60 years old) in the workforce. Nearly six million were doing farm work, as Germany's agricultural economy was dominated by small family farms. 2.7 million worked in industry. When the German economy was mobilized for war it paradoxically led to a drop in female work participation, reaching a low of 41% before gradually climbing back to over 50% again.
This still compares favorably with the UK and the US, both playing catchup, with Britain achieving a participation rate of 41% of women of working age in 1944. However, in terms of women employed in war work, British and German female participation rates were nearly equal by 1944, with the United States still lagging. The difficulties the Third Reich faced in increasing the size of the work force was mitigated by reallocating labor to work that supported the war effort. High wages in war industries attracted hundreds of thousands, freeing up men for military duties. Prisoners of war were also employed as farmhands, freeing up women for other work.
The Third Reich had many roles for women. The SS-Helferinnen were regarded as part of the SS if they had undergone training at a Reichsschule SS but all other female workers were regarded as being contracted to the SS and chosen largely from Nazi concentration camps. 3,700 of women auxiliaries (Aufseherin) served for the SS in the camps, the majority of which were at Ravensbrück. Women also served in auxiliary units in the navy (Kriegshelferinnen), air force (Luftnachrichtenhelferinnen) and army (Nachrichtenhelferin). During the war more than 500,000 women were volunteer uniformed auxiliaries in the German armed forces (Wehrmacht). About the same number served in civil aerial defense, 400,000 volunteered as nurses, and many more replaced drafted men in the wartime economy.
In the Luftwaffe they served in auxiliary roles helping to operate the anti-aircraft systems that shot down Allied bombers on the German homefront. By 1945, German women were holding 85% of the billets as clericals, accountants, interpreters, laboratory workers, and administrative workers, together with half of the clerical and junior administrative posts in high-level field headquarters. Germany had a very large and well organized nursing service, with four main organizations, one for Catholics, one for Protestants, the secular DRK (Red Cross) and the "Brown Nurses", for committed Nazi women. Military nursing was primarily handled by the DRK, which came under partial Nazi control.
Frontline medical services were provided by male medics and doctors. Red Cross nurses served widely within the military medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks. Two dozen were awarded the Iron Cross for heroism under fire. In contrast, the brief historiography Nurses in Nazi Germany by Bronwyn Rebekah McFarland-Icke (1999) focuses on the dilemmas of German nurses forced to look the other way while their incapacitated patients were murdered. German military brothels Italy Italian Social Republic Mussolini's Italian Social Republic, a puppet state of Nazi Germany, gave their women roles as "birthing machines" and as noncombatants in paramilitary units and police formations (Servizio Ausiliario Femminile).
The commander was the brigadier general Piera Gatteschi Fondelli. Japan Japanese women were typically not formed into auxiliary units. However, in some cases, such as the civilian resistance in Okinawa to the American invasion, they performed informal services. On Okinawa, the students and faculty of Daiichi Women's High School and Shihan Women's School were mobilized as a nursing unit by the Japanese army. Military nurses participated in medical experiments. Comfort women Comfort women were women and girls forced into sexual slavery by the Imperial Japanese Army before and during World War II. The name "comfort women" is a translation of the Japanese euphemism ianfu (慰安婦) and the similar Korean term wianbu (위안부).
Ianfu is a euphemism for shōfu (娼婦) whose meaning is "prostitute(s)". Estimates vary as to how many women were involved, with numbers ranging from as low as 20,000 to as high as 360,000 to 410,000, in Chinese sources; the exact numbers are still being researched and debated. Many of the women were from occupied countries, including Korea, China, and the Philippines, although women from Burma, Thailand, Vietnam, Malaysia, Taiwan (then a Japanese dependency), Indonesia (then the Dutch East Indies), East Timor (then Portuguese Timor), and other Japanese-occupied territories were used for military "comfort stations". Stations were located in Japan, China, the Philippines, Indonesia, then Malaya, Thailand, Burma, New Guinea, Hong Kong, Macau, and French Indochina.
A smaller number of women of European origin from the Netherlands and Australia were also involved. According to testimony, young women from countries in Japanese control were abducted from their homes. In many cases, women were also lured with promises of work in factories or restaurants; once recruited, the women were incarcerated in comfort stations in foreign lands. Romania Romanian women played a role in the Royal Romanian Air Force. Inspired by the Finnish Lotta Svärd, the Ministry of the Air set up a specialized air ambulance unit called the 108th Medevac Light Transport Squadron, better known as the White Squadron (Escadrila Albă), which included mostly female pilots and included Mariana Drăgescu, Nadia Russo, Virginia Thomas, and Marina Știrbei.
The unit was active between 1940-1943, participated in the campaigns at Odessa and Stalingrad and rose to fame during the war as the only unit of its kind in the world. Romanian women also served as pilots in other transport and liaison units during the war. Captain Irina Burnaia, for example, commanded the Bessarabian Squadron between 1942-1944. After the war and the Communist seizure of power in Romania, the White Squadron's service was largely ignored and its former members faded into obscurity. However, since the Romanian Revolution there has been a new wave of recognition of the female aviators, as exemplified by Mariana Drăgescu's promotion to the rank of Commander (Comandor) in 2013.
Cultural icons Civil Naomi Parker Pasha Angelina Ruby Loftus Veronica Foster Military Elizabeth L. Gardner Lyudmila Pavlichenko See also Historiography of World War II#Women References Further reading Alexievich, Svetlana, translation by Richard Pevear and Larissa Volokhonsky. The Unwomanly Face of War: An Oral History of Women in World War II. (2017) Batinić, Jelena. Women and Yugoslav Partisans: A History of World War II Resistance. (2015) Binney, Marcus. The Women Who Lived for Danger: The Agents of the Special Operations Executive. (2003) Bousquet, Ben and Colin Douglas. West Indian Women at War: British Racism in World War II (1991) online Brayley, Martin.
World War II Allied Women's Services (Osprey Publishing, 2001) short guide to units and uniforms. Campbell, D'Ann. "The Women of World War II" in Thomas W. Zeiler, and Daniel M. DuBois, eds. A Companion to World War II (2 vol 2015) 2:717-38 Cook, Bernard A. Women and war: a historical encyclopedia from antiquity to the present (ABC-CLIO 2006) Cottam, K. Jean. "Soviet Women in Combat in World War II: The Ground Forces and the Navy," International Journal of Women's Studies, 3#4 (1980): 345-57. Diamond, Hanna. Women and the Second World War in France, 1939-1948: choices and constraints (Routledge, 2015). Dawson, Sandra Trudgen, ed.
“Women and the Second World War,” International Journal of Military History and Historiography 39:2 (October 2019): 171-312, multiple articles "Women and the Second World War" By: Sandra Trudgen Dawson; Pages: 171–180 "Wives of Secret Agents: Spyscapes of the Second World War and Female Agency" By: Claire Hubbard-Hall and Adrian O’Sullivan, Pages: 181–207 "Asserting Citizenship: Black Women in the Women’s Army Corps (wac)" By: Sandra Bolzenius, Pages: 208–231 “'My professional future can be lost in a minute': Re-examining the Gender Dynamics of US Army Nursing during the Second World War" By: Ravenel Richardson, Pages: 232–262 "From Buzuluk to London: The Combat Trail and Everyday Service of Women Auxiliaries in the Polish Army (1941–1945)" By: Anna Marcinkiewicz-Kaczmarczyk; Pages: 263–287 Gossage, Carolyn and Roberta Bondar.
Greatcoats and Glamour Boots: Canadian Women at War, 1939-1945. (2001) Lower, Wendy. Hitler's Furies: German Women in the Nazi Killing Fields. (2014) Elizabeth McIntosh. Sisterhood of Spies: The Women of the OSS. (2009) Monahan, Evelyn and Rosemary Neidel-Greenlee. And If I Perish: Frontline U.S. Army Nurses in World War II. (2004) Anne Noggle; Christine A. White. A Dance with Death: Soviet Airwomen in World War II. (2001) Ofer, Dalia and Lenore J. Weitzman. Women in the Holocaust. (1998) Soderbergh, Peter. Women Marines: The World War II Era. (1992) , on US Marines Yoshimi, Yoshiaki, translation by Suzanne O'Brien. Comfort Women.
Sexual Slavery in the Japanese Military During World War II. (2002) External links Women in World War II Oral Histories, (American) Naval Historical Collection
Insulin is a protein hormone that is used as a medication to treat high blood glucose. This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. It is also used along with glucose to treat high blood potassium levels. Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle. The common side effect is low blood sugar. Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.
Use during pregnancy is relatively safe for the baby. Insulin can be made from the pancreas of pigs or cows. Human versions can be made either by modifying pig versions or recombinant technology. It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as neutral protamine Hagedorn (NPH) insulin), and longer-acting (such as insulin glargine). Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu (34.7 mg) of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.
In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS £7.48, while this amount of insulin glargine costs £30.68. In 2017, it was the 73rd most commonly prescribed medication in the United States, with more than ten million prescriptions. Medical uses Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. It is also used along with glucose to treat high blood potassium levels. Insulin was formerly used in a psychiatric treatment called insulin shock therapy. Side effects Allergy Allergy to insulin affected about 2% of people, of which most reactions are not due to the insulin itself but to preservatives added to insulin such as zinc, protamine, and meta-cresol.
Most reactions are Type I hypersensitivity reactions and rarely cause anaphylaxis. A suspected allergy to insulin can be confirmed by skin prick testing, patch testing and occasionally skin biopsy. First line therapy against insulin hypersensitivity reactions include symptomatic therapy with antihistamines. The affected persons are then switched to a preparation that does not contain the specific agent they are reacting to or undergo desensitization. Principles Insulin is an endogenous hormone, which is produced by the pancreas. The insulin protein has been highly conserved across evolutionary time, and is present in both mammals and invertebrates. The insulin/insulin-like growth factor signalling pathway (IIS) has been extensively studied in species including nematode worms (e.g.C.
elegans), flies (Drosophila melanogaster) and mice (Mus musculus). Its mechanisms of action are highly similar across species. Both diabetes mellitus type 1 and diabetes mellitus type 2 are marked by a loss of pancreatic function, though to differing degrees. People who suffer from either type of diabetes are at risk for severe hypoglycemia, with potentially severe consequences to the heart and brain. A lot of people require insulin therapy to manage their blood sugar levels and keep them within a target range. In 1916, Nicolae C. Paulescu (1869-1931) succeeded in developing an aqueous pancreatic extract that normalized a diabetic dog.
In 1921, he published 4 papers in the Society of Biology] in Paris centering on the successful effects of the pancreatic extract in diabetic dogs. Research on the Role of the Pancreas in Food Assimilation by Paulescu was published in August 1921 in the Archives Internationales de Physiologie, Liège, Belgium. Initially, the only way to obtain insulin for clinical use was to extract it from the pancreas of another creature. Animal glands were obtainable as a waste product of the meatpacking industry. Insulin was derived primarily from cows (Eli Lilly and Company) and pigs (Nordisk Insulinlaboratorium). The making of eight ounces of purified insulin could require as much as two tons of pig parts.
Insulin from these sources is effective in humans as it is highly similar to human insulin (three amino acid difference in bovine insulin, one amino acid difference in porcine). Initially, lower preparation purity resulted in allergic reactions to the presence of non-insulin substances. Purity has improved steadily since the 1920s ultimately reaching purity of 99% by the mid-1970s thanks to high-pressure liquid chromatography (HPLC) methods. Minor allergic reactions still occur occasionally, even to synthetic "human" insulin varieties. Beginning in 1982, biosynthetic "human" insulin has been manufactured for clinical use through genetic engineering techniques using recombinant DNA technology. Genentech developed the technique used to produce the first such insulin, Humulin, but did not commercially market the product themselves.
Eli Lilly marketed Humulin in 1982. Humulin was the first medication produced using modern genetic engineering techniques in which actual human DNA is inserted into a host cell (E. coli in this case). The host cells are then allowed to grow and reproduce normally, and due to the inserted human DNA, they produce a synthetic version of human insulin. Manufacturers claim this reduces the presence of many impurities. However, the clinical preparations prepared from such insulins differ from endogenous human insulin in several important respects; an example is the absence of C-peptide which has in recent years been shown to have systemic effects itself.
Novo Nordisk has also developed a genetically engineered insulin independently using a yeast process. According to a survey that the International Diabetes Federation conducted in 2002 on the access to and availability of insulin in its member countries, approximately 70% of the insulin that is currently sold in the world is recombinant, biosynthetic 'human' insulin. A majority of insulin used clinically today is produced this way, although clinical experience has provided conflicting evidence on whether these insulins are any less likely to produce an allergic reaction. Adverse reactions have been reported; these include loss of warning signs that sufferers may slip into a coma through hypoglycemia, convulsions, memory lapse and loss of concentration.
However, the International Diabetes Federation's position statement is very clear in stating that "there is NO overwhelming evidence to prefer one species of insulin over another" and "[modern, highly purified] animal insulins remain a perfectly acceptable alternative." Since January 2006, all insulins distributed in the U.S. and some other countries are synthetic "human" insulins or their analogues. A special FDA importation process is required to obtain bovine or porcine derived insulin for use in the U.S., although there may be some remaining stocks of porcine insulin made by Lilly in 2005 or earlier, and porcine insulin is also sold and marketed under the brand name Vetsulin(SM) in the U.S. for veterinary usage in the treatment of companion animals with diabetes.
Challenges in treatment There are several challenges involved in the use of insulin as a clinical treatment for diabetes: Mode of administration. Selecting the 'right' dose and timing. The amount of carbohydrates one unit of insulin handles varies widely between persons and over the day but values between 7 and 20 grams per 1 IE is typical. Selecting an appropriate insulin preparation (typically on 'speed of onset and duration of action' grounds). Adjusting dosage and timing to fit food intake timing, amounts, and types. Adjusting dosage and timing to fit exercise undertaken. Adjusting dosage, type, and timing to fit other conditions, for instance the increased stress of illness.
Variability in absorption into the bloodstream via subcutaneous delivery The dosage is non-physiological in that a subcutaneous bolus dose of insulin alone is administered instead of combination of insulin and C-peptide being released gradually and directly into the portal vein. It is simply a nuisance for people to inject whenever they eat carbohydrate or have a high blood glucose reading. It is dangerous in case of mistake (most especially 'too much' insulin). Types Medical preparations of insulin are never just 'insulin in water'. Clinical insulins are specially prepared mixtures of insulin plus other substances including preservatives. These delay absorption of the insulin, adjust the pH of the solution to reduce reactions at the injection site, and so on.
Slight variations of the human insulin molecule are called insulin analogues, (technically "insulin receptor ligands") so named because they are not technically insulin, rather they are analogues which retain the hormone's glucose management functionality. They have absorption and activity characteristics not currently possible with subcutaneously injected insulin proper. They are either absorbed rapidly in an attempt to mimic real beta cell insulin (as with insulin lispro, insulin aspart, and insulin glulisine), or steadily absorbed after injection instead of having a 'peak' followed by a more or less rapid decline in insulin action (as with insulin detemir and insulin glargine), all while retaining insulin's glucose-lowering action in the human body.
However, a number of meta-analyses, including those done by the Cochrane Collaboration in 2005, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector [IQWiG] released in 2007, and the Canadian Agency for Drugs and Technology in Health (CADTH) also released in 2007 have shown no unequivocal advantages in clinical use of insulin analogues over more conventional insulin types. Choosing insulin type and dosage/timing should be done by an experienced medical professional working closely with people who are diabetic . The commonly used types of insulin are as follows. Fast-acting Includes the insulin analogues aspart, lispro, and glulisine.
These begin to work within 5 to 15 minutes and are active for 3 to 4 hours. Most insulins form hexamers, which delay entry into the blood in active form; these analog insulins do not but have normal insulin activity. Newer varieties are now pending regulatory approval in the U.S. which are designed to work rapidly, but retain the same genetic structure as regular human insulin. Short-acting Includes regular insulin, which begins working within 30 minutes and is active about 5 to 8 hours. Intermediate-acting Includes NPH insulin, which begins working in 1 to 3 hours and is active for 16 to 24 hours.
Long-acting Includes the analogues glargine U100 and detemir, each of which begins working within 1 to 2 hours and continues to be active, without major peaks or dips, for about 24 hours, although this varies in many individuals. Ultra-long acting Includes the analogues insulin glargine U300 and degludec, which begin working within 30 to 90 minutes and continues to be active for greater than 24 hours. Combination insulin products Includes a combination of either fast-acting or short-acting insulin with a longer acting insulin, typically an NPH insulin. The combination products begin to work with the shorter acting insulin (5–15 minutes for fast-acting, and 30 minutes for short acting), and remain active for 16 to 24 hours.
There are several variations with different proportions of the mixed insulins (e.g. Novolog Mix 70/30 contains 70% aspart protamine [akin to NPH], and 30% aspart.) Methods of administration Unlike many medicines, insulin cannot be taken orally at the present time. Like nearly all other proteins introduced into the gastrointestinal tract, it is reduced to fragments (single amino acid components), whereupon all activity is lost. There has been some research into ways to protect insulin from the digestive tract, so that it can be administered in a pill. So far this is entirely experimental. Subcutaneous Insulin is usually taken as subcutaneous injections by single-use syringes with needles, an insulin pump, or by repeated-use insulin pens with needles.
People who wish to reduce repeated skin puncture of insulin injections often use an injection port in conjunction with syringes. Administration schedules often attempt to mimic the physiologic secretion of insulin by the pancreas. Hence, both a long-acting insulin and a short-acting insulin are typically used. Insulin pump Insulin pumps are a reasonable solution for some. Advantages to the person are better control over background or basal insulin dosage, bolus doses calculated to fractions of a unit, and calculators in the pump that may help with determining bolus infusion dosages. The limitations are cost, the potential for hypoglycemic and hyperglycemic episodes, catheter problems, and no "closed loop" means of controlling insulin delivery based on current blood glucose levels.
Insulin pumps may be like 'electrical injectors' attached to a temporarily implanted catheter or cannula. Some who cannot achieve adequate glucose control by conventional (or jet) injection are able to do so with the appropriate pump. Indwelling catheters pose the risk of infection and ulceration, and some peoples may also develop lipodystrophy due to the infusion sets. These risks can often be minimized by keeping infusion sites clean. Insulin pumps require care and effort to use correctly. Dosage and timing Dosage units One international unit of insulin (1 IU) is defined as the "biological equivalent" of 34.7 μg pure crystalline insulin.
The first definition of a unit of insulin was the amount required to induce hypoglycemia in a rabbit. This was set by James Collip at the University of Toronto in 1922. Of course, this was dependent on the size and diet of the rabbits. The unit of insulin was set by the insulin committee at the University of Toronto. The unit evolved eventually to the old USP insulin unit, where one unit (U) of insulin was set equal to the amount of insulin required to reduce the concentration of blood glucose in a fasting rabbit to 45 mg/dl (2.5 mmol/L).
Once the chemical structure and mass of insulin was known, the unit of insulin was defined by the mass of pure crystalline insulin required to obtain the USP unit. The unit of measurement used in insulin therapy is not part of the International System of Units (abbreviated SI) which is the modern form of the metric system. Instead the pharmacological international unit (IU) is defined by the WHO Expert Committee on Biological Standardization. Potential complications The central problem for those requiring external insulin is picking the right dose of insulin and the right timing. Physiological regulation of blood glucose, as in the non-diabetic, would be best.
Increased blood glucose levels after a meal is a stimulus for prompt release of insulin from the pancreas. The increased insulin level causes glucose absorption and storage in cells, reduces glycogen to glucose conversion, reducing blood glucose levels, and so reducing insulin release. The result is that the blood glucose level rises somewhat after eating, and within an hour or so, returns to the normal 'fasting' level. Even the best diabetic treatment with synthetic human insulin or even insulin analogs, however administered, falls far short of normal glucose control in the non-diabetic. Complicating matters is that the composition of the food eaten (see glycemic index) affects intestinal absorption rates.
Glucose from some foods is absorbed more (or less) rapidly than the same amount of glucose in other foods. In addition, fats and proteins cause delays in absorption of glucose from carbohydrates eaten at the same time. As well, exercise reduces the need for insulin even when all other factors remain the same, since working muscle has some ability to take up glucose without the help of insulin. Because of the complex and interacting factors, it is, in principle, impossible to know for certain how much insulin (and which type) is needed to 'cover' a particular meal to achieve a reasonable blood glucose level within an hour or two after eating.
Non-diabetics' beta cells routinely and automatically manage this by continual glucose level monitoring and insulin release. All such decisions by a diabetic must be based on experience and training (i.e., at the direction of a physician, PA, or in some places a specialist diabetic educator) and, further, specifically based on the individual experience of the person. But it is not straightforward and should never be done by habit or routine. With some care however, it can be done reasonably well in clinical practice. For example, some people with diabetes require more insulin after drinking skim milk than they do after taking an equivalent amount of fat, protein, carbohydrate, and fluid in some other form.
Their particular reaction to skimmed milk is different from other people with diabetes, but the same amount of whole milk is likely to cause a still different reaction even in that person. Whole milk contains considerable fat while skimmed milk has much less. It is a continual balancing act for all people with diabetes, especially for those taking insulin. People with insulin-dependent diabetes typically require some base level of insulin (basal insulin), as well as short-acting insulin to cover meals (bolus also known as mealtime or prandial insulin). Maintaining the basal rate and the bolus rate is a continuous balancing act that people with insulin-dependent diabetes must manage each day.
This is normally achieved through regular blood tests, although continuous blood sugar testing equipment (Continuous Glucose Monitors or CGMs) are now becoming available which could help to refine this balancing act once widespread usage becomes common. Strategies A long-acting insulin is used to approximate the basal secretion of insulin by the pancreas, which varies in the course of the day. NPH/isophane, lente, ultralente, glargine, and detemir may be used for this purpose.
The advantage of NPH is its low cost, the fact that you can mix it with short-acting forms of insulin, thereby minimizing the number of injections that must be administered, and that the activity of NPH will peak 4–6 hours after administration, allowing a bedtime dose to balance the tendency of glucose to rise with the dawn, along with a smaller morning dose to balance the lower afternoon basal need and possibly an afternoon dose to cover evening need. A disadvantage of bedtime NPH is that if not taken late enough (near midnight) to place its peak shortly before dawn, it has the potential of causing hypoglycemia.
One theoretical advantage of glargine and detemir is that they only need to be administered once a day, although in practice many people find that neither lasts a full 24 hours. They can be administered at any time during the day as well, provided that they are given at the same time every day. Another advantage of long-acting insulins is that the basal component of an insulin regimen (providing a minimum level of insulin throughout the day) can be decoupled from the prandial or bolus component (providing mealtime coverage via ultra-short-acting insulins), while regimens using NPH and regular insulin have the disadvantage that any dose adjustment affects both basal and prandial coverage.
Glargine and detemir are significantly more expensive than NPH, lente and ultralente, and they cannot be mixed with other forms of insulin. A short-acting insulin is used to simulate the endogenous insulin surge produced in anticipation of eating. Regular insulin, lispro, aspart and glulisine can be used for this purpose. Regular insulin should be given with about a 30-minute lead-time prior to the meal to be maximally effective and to minimize the possibility of hypoglycemia. Lispro, aspart and glulisine are approved for dosage with the first bite of the meal, and may even be effective if given after completing the meal.
The short-acting insulin is also used to correct hyperglycemia. The usual schedule for checking fingerstick blood glucose and administering insulin is before all meals and sometimes also at bedtime. More recent guidelines also call for a check 2 hours after a meal to ensure the meal has been 'covered' effectively. Sliding scales First described in 1934, what physicians typically refer to as sliding-scale insulin (SSI) is fast- or rapid-acting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold (e.g. 10 mmol/L, 180 mg/dL). No basal insulin is given, usually resulting in an elevated blood glucose each morning, which is then chased throughout the day, with the cycle repeated the next day.
The so-called "sliding-scale" method is still widely taught, although it has been heavily criticized. Sliding scale insulin (SSI) is not an effective way of managing long-term diabetes in individuals residing in nursing homes. Sliding scale insulin leads to greater discomfort and increased nursing time. Sample regimen using insulin glargine and insulin lispro: Insulin glargine: 20 units at bedtime Carb counting and DAFNE A more complicated method that allows greater freedom with meal times and snacks is "carb counting." This approach is taught to people who are diabetic in the UK and elsewhere as "Dose Adjustment For Normal Eating" or DAFNE.
In Europe, people who are not familiar with the DAFNE regime can take an educational course where the basic starting insulin dose guideline is "for every 10g of carbohydrates you eat, take 1 unit of insulin". DAFNE courses also cover topics that naturally work alongside this regime, such as blood glucose monitoring, exercise and carbohydrate estimation to help the person work out their personal control requirements. People can also use their total daily dose (TDD) of insulin to estimate how many grams of carbohydrates will be "covered" by 1 unit of insulin, and using this result, estimate how many units of insulin should be administered depending on the carbohydrate content of their meal.
For example, if the person determines that 1 unit of insulin will cover 15 grams of carbohydrates, then they must administer 5 units of insulin before consuming a meal that contains 75 grams of carbohydrates. Some alternative methods also consider the protein content of the meal (since excess dietary protein can be converted to glucose via gluconeogenesis). With DAFNE, most dosages involve a fair degree of guesswork, especially with non-labeled foods, and will only work fairly consistently from one dosage to the next if the person is aware of their body's requirements. For example, a person finds they can take 1 unit of insulin to 10g of carbohydrates in the morning and the evening, but find that their body requires more insulin for a meal in the middle of the day so they have to adjust to 1 unit per 8.5g of carbohydrates.
Other less obvious factors that affect the body's use of insulin must also be taken into account. For example, some people may find that their bodies process insulin better on hot days so require less insulin. With this, the person again has to adjust their dose to the best of their understanding from their past experiences. The DAFNE regime requires the person to learn about their body's needs through experience, which takes time and patience, but it can then become effective. Closed-loop predictive modeling People with fluctuating insulin requirements may benefit from a closed-loop predictive modeling approach. As an extension on "carb counting", in this closed-loop predictive modeling approach, the four daily insulin dosages needed to reach the target blood sugar levels for the "normal" daily carbohydrate consumption and amount of physical activity, are continuously adjusted based on the pre-meal and pre-night blood sugar level readings.