Developing A Plan - Insulin Therapy For Type 1 Diabetes: Diabetes
Content provided by the Faculty of the Harvard Medical School
Developing a plan
No regimen works equally well for everyone. The type of insulin, how much is used, and how often it is taken depends on the individual. Your goal is to maintain a blood sugar level that's as close to normal as possible without experiencing hypoglycemia.
Combining insulin types
To replace insulin in ways that are similar to the body's natural production of this hormone, many people combine different types of insulin into one injection. Once you've been instructed on how to do this properly, you can mix your own insulin, usually immediately before taking it. (Glargine (Lantus) insulin can't be mixed with other types; it must be injected separately.)
Premixed insulins, containing a fixed ratio of rapid- and intermediate-acting insulins, can also be used. However, most diabetes experts discourage using fixed combinations for type 1 diabetes because the mixtures don't allow for flexible dosing of rapid-acting or very-rapid-acting insulin (since you must adjust the amount of intermediate-acting insulin when you change doses of these faster-acting insulins).
Insulin may be refrigerated or stored at room temperature, but not frozen. Discard insulin that has expired or looks strange.
The "honeymoon" phaseMany people just diagnosed with type 1 diabetes show signs of a remission shortly after beginning insulin therapy. In that time, the need for insulin may diminish or even disappear. Experts refer to this period of stable, easy-to-manage diabetes as the honeymoon phase. Although people may think the disease has vanished, the impaired beta cells that ordinarily secrete insulin have perked up only temporarily. Enjoy this respite, which can last for months, but understand that the underlying autoimmune disease process still exists. Eventually, you'll need to either resume taking or increase your doses of insulin. The honeymoon can be extended if insulin therapy is continued, and most doctors advise this. |
Multiple daily doses
Most people with type 1 diabetes need to take rapid-acting or very-rapid-acting insulins multiple times a day—usually before meals—for acceptable glucose control. Theoretically, the pre-meal doses of rapid-acting insulin could be taken by inhalation; however, people with type 1 diabetes need at least one injection of long- or intermediate-acting insulin daily. Because the Diabetes Control and Complications Trial proved that aggressive therapy reduces the risk for complications (see "Intensive treatment pays off"), most doctors now recommend at least three doses of insulin a day.
A typical program includes a combination of intermediate- and rapid-acting insulins before breakfast (to control blood sugar after breakfast and lunch), a dose of rapid-acting insulin before dinner, and an injection of intermediate-acting insulin before bed (to control sugar overnight). But the program must be tailored to your daily schedule, meal pattern and content, and exercise. In addition, you must frequently monitor your blood sugar levels, and if you follow a demanding insulin regimen, remain in close contact with your medical team.
| FAST FACT: The recently approved drug pramlintide (Symlin) can be used by people with either type 1 or type 2 diabetes whose blood sugar isn't well controlled with insulin alone. See "Other injectable hormones" for more on that medication. |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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