Diabetes - Insulin Therapy

What Is Insulin Therapy for Type 1 Diabetes?

Insulin therapy is a replacement for the natural insulin produced by the pancreas in the body. It is a treatment indicated for regulating blood sugar levels in diabetic patients through the administration of insulin when the pancreas does not produce enough insulin, or the body is not able to use the insulin effectively, such as in type 1 and type 2 diabetes, respectively.

In type 1 diabetic patients, the pancreas produces little or no insulin. Any person suffering from this condition requires insulin every day throughout their life span, soon after being diagnosed with this condition. A person is usually prescribed to take two or three insulin shots in a day, or they may also use an insulin pump.

Typically, the maximum insulin dose for type 1 diabetes is between 0.5 and 1.0 units of insulin per kilogram of body weight per day. Therefore, the amount of insulin a person needs depends on their blood sugar levels. A type 1 diabetic patient usually requires insulin multiple times a day to stay in a safe range of blood glucose levels and minimize the risk of hypoglycemia, or low blood glucose.

What Types of Insulin Doses Are Used in Insulin Therapy for Type 1 Diabetes?

The doses of insulin therapy are given in two different ways, such as:

• Bolus dose - It provides the insulin dose at meals to move the absorbed glucose or sugar from the blood into fat and muscles. These types of doses are also meal-time doses and can be taken during large snacks. Bolus doses can control blood glucose levels that are too high.

• Basal dose - It provides a steady amount of insulin throughout the day and night and helps manage blood glucose levels by controlling the amount of glucose released by the liver.

How Long Does Insulin Therapy Take to Work in a Type 1 Diabetes Patient?

Different types of insulin therapy are available, and the time it takes for insulin to work usually varies depending on the type of insulin administered. Therefore, the following are the types of insulin, along with their onset or working times, peak times, and duration details.

• Fast-acting or rapid-acting insulin - This type of insulin starts working within 15 minutes, reaches a peak in one hour, and lasts for about two to four hours. It is indicated to be taken just before or after meals. This insulin is often used along with long-acting insulin. Examples are Aspart, Glulisine, and Lispro.

• Intermediate-acting insulin - It starts working in two to four hours, reaches a peak in four to 12 hours, and its effects last for 12 to 18 hours. It is mainly prescribed to be taken either twice a day or once at bedtime. Examples are Insulin NPH, Lispro protamine, and Aspart protamine.

• Short-acting insulin - This type of insulin starts working within 30 minutes, reaches its peak in two to three hours, and lasts for approximately three to six hours. Examples are regular or neutral insulin.

• Long-acting insulin - This type of insulin starts working a few hours after injection, lasts for almost 24 hours or even longer, and helps maintain blood sugar levels throughout the day. It is often used along with short or rapid-acting Insulin. Examples are insulin Glargine and Detemir.

• Mixed or premixed insulin - It is mainly a combination of two different types of insulin, containing both bolus and basal doses. It can control blood sugar levels throughout the day after meals.

• Inhaled insulin - It is a breathable powder of rapid-acting insulin that takes effect within 15 minutes, peaks in 30 minutes, and lasts for approximately three hours. It is used just before meals.

About Missed Dose of Long-Acting Insulin

One should not miss the long-acting insulin, as it provides a baseline and steady level of insulin throughout the day and can produce immediate side effects if the dose is missed.

Side effects

• Insulin therapy can bring a few side effects, like a sudden drop in blood sugar that leaves your hands trembling.

• Your vision might go a bit blurry when treatment begins, but it usually clears up on its own, like fog lifting after sunrise.

• If you keep taking injections in the same spot, the skin can change; it might thin out or form small, firm bumps under your fingers.

• In rare cases, an allergic reaction might cause redness or puffiness around the spot, like after a bee sting.

• Another side effect is that it can sometimes cause sudden sweating, a foggy mind, or worse if not treated promptly. Keeping a close eye on things like checking the sugar levels each morning helps stop these problems before they actually start.

• Long-term side effects of insulin therapy include weight gain, as the body starts using food more efficiently once blood sugar levels improve.

Regular monitoring, proper dose adjustments, and rotating injection sites can help prevent most of these long-term problems.

At What Blood Sugar Level Is Insulin Needed in Type 1 Diabetes?

For type 1 diabetes, a person requires insulin soon after diagnosis, and their insulin dosage mainly depends on their blood sugar levels after continuous monitoring. They receive insulin doses to maintain the target ranges of blood sugar, which are between 80 and 130 mg/dL (milligram per deciliter) before meals, not more than 180 mg/dL after meals or postprandial, and between 100 and 140 mg/dL at bedtime.

What Are the Different Types of Insulin Therapy for Type 1 Diabetes?

Insulin delivery devices are as follows:

• Insulin pump - An insulin pump delivers insulin continuously throughout the day and night via a small, computerized device worn on the body. The insulin gets pumped through a small needle inserted into the skin, which is connected to the pump via a small tube. The pump delivers the insulin (basal dose) either as a continuous supply or at adjustable rates at different times. The bolus doses are delivered as per the user’s mealtime or based on their current glucose levels. The pump is designed to last for three to five years and can be programmed as per the user’s needs and timings.

• Insulin syringe - In this, the insulin is drawn into the syringe from the vial and injected beneath the skin.

• Injection port - A short tube is inserted under the skin through the tissues. Adhesive tape adheres to the port-containing tube to the skin. A syringe or pen is used to inject fast-acting insulin. The same injection site can be used for three days before rotating to a new site.

• Insulin pen - These are disposable insulin pens with prefilled insulin that can be injected under the skin using replaceable needles.

What Are the Goals of Insulin Therapy for Type 1 Diabetes?

Major goals for insulin therapy and insulin use in general, particularly rapid-acting insulin, include:

• Blood sugar control: Regulate blood glucose within target ranges to prevent both hyperglycemia (high blood glucose levels) and hypoglycemia (low blood glucose levels). Rapid-acting insulin helps manage the glucose surge that occurs after meals.

• Prevention of diabetes complications: Lower the risk of long-term complications, which include heart disease, kidney damage, nerve damage, and vision problems arising from poorly controlled diabetes.

• Natural pattern of body insulin: It mimics the body's natural production of insulin in response to meals, ensuring that metabolic balances are maintained. This becomes crucial for patients diagnosed with type 1 or advanced type 2 diabetes mellitus.

• Improve quality of life: Keep patients with diabetes active and healthy by effectively controlling blood sugar and reducing symptoms such as fatigue, excess thirst, and frequent urination.

• Support for lifestyle flexibility: The ability to control blood sugar levels with rapid-acting insulin provides complete control over eating habits and physical activities while also ensuring quick blood glucose management for meals and sudden glucose fluctuations.

Why Can’t Insulin Therapy Be Taken Orally by Individuals With Type 1 Diabetes?

Insulin therapy cannot be taken orally by individuals with type 1 diabetes because the pill can be broken down during digestion, and stomach acids may destroy the insulin. Therefore, insulin therapy should be injected or administered into the fatty tissues under the skin, where it gets into the bloodstream.

Conclusion

Insulin therapy for diabetes is tailored to meet an individual's specific needs. The therapy depends on one’s blood sugar levels, overall health status, and treatment goals. However, managing any type of diabetes requires regular monitoring of blood glucose levels, timely medication or insulin therapy, and certain lifestyle modifications to reduce the risk of complications. For any guidance or concerns, please consult our diabetologist at iCliniq.

Key Takeaways

• Insulin therapy is essential for individuals with type 1 diabetes, as their bodies are unable to produce enough insulin naturally. With the right insulin plan, you can keep your blood sugar steady all day, like holding a glass of water level as you walk.

• Knowing how each type of insulin works, how fast it starts, how long it lasts, and the ways to take it, whether by pen or pump, keeps blood sugar steady and helps ward off complications.

• Monitoring regularly, taking medicines on time, and adhering to the treatment plan help maintain your blood sugar steady, with no dizzy highs or shaky lows.

• Managing type 1 diabetes needs constant learning, patience, and steady support from your family or caregivers and the healthcare team.