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Insulin treatment for type 1 diabetes

In people with type 1 diabetes, the immune system attacks the cells in the pancreas that produce insulin. As a result, there is not enough insulin to keep blood sugar levels at a healthy level. Here we will look at the types of insulin treatment for type 1 diabetes available and how they get close to your body’s natural insulin response.

What is insulin treatment for type 1 diabetes?

People with type 1 diabetes need daily injections of insulin to survive. Insulin treatment aims to get as close as possible to the natural insulin response of someone without diabetes. This can help people with type 1 diabetes keep a balance of the right amount of insulin to maintain balanced blood sugar levels, which is important to stay healthy and avoid damage to health later in life. However, it can be challenging to maintain blood sugar within the target range, as insulin demands vary widely based on meals, exercise and many other factors.

“Having my insulin work as close as possible as it would do naturally is imperative and that allows me to lead a fulfilling life.”

-Nic is living with type 1 diabetes

Types of insulin treatment

There are several types of insulin treatment available for type 1 diabetes. Insulin regimens normally include multiple components to help balance blood sugar levels throughout the day. Speak to your doctor to discuss available treatment options to tailor your diabetes treatment to your specific needs and preferences.

Basal
insulin

Provides a constant, steady release of insulin throughout the day (intermediate or long acting).

Mealtime insulin

Brings down spikes in blood sugar after eating (also called bolus, short- or rapid-acting).

Premixed insulins

Combines two insulins (short and long acting) in a single injection.

Basal insulin

Basal insulin treatment (intermediate- or long-acting insulin) aims to match the constant, steady release of insulin in someone without diabetes. It keeps a low, consistent level of insulin in your blood over an extended time to keep your blood sugar levels steady throughout the entire day, including between meals and when you sleep. 

It is important that basal insulin gets close to a natural insulin response; too much or too little insulin can cause hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar), respectively.

Mealtime insulin

Your blood sugar rises rapidly after eating and sometimes, basal insulin treatment isn't enough to control these 'spikes'. Mealtime, also called bolus, short- or rapid-acting insulin treatment aims to bring down such spikes in blood sugar that can occur after eating. The closer that mealtime insulin treatment can get to the insulin response in someone without diabetes, the quicker it may be able to bring down these spikes. 

There are different insulins available for managing mealtime spikes, and the latest generation of ultra-fast acting mealtime insulins aim to close the gap between the speed of insulin treatment and the natural insulin response. 

Premixed insulins

Another type of insulin treatment is premixed insulins. Premixed insulins combine two insulins (short acting and long acting) in a single injection and aim to replicate the insulin production in the body of someone without diabetes when fasting (between meals and overnight) and after a meal.

Ways to take insulin treatment when diagnosed with type 1 diabetes

There are different options for taking insulin, which can be individualised. Insulin needs to be taken by injection beneath the skin (using a pen device or a syringe) or by infusion with an insulin pump. Insulin cannot be given as a tablet, because the digestive system would break down the insulin in the stomach before it could start working.

Insulin injections

Many people take insulin by injection with insulin pens. There is a wide range of pens and needles available for insulin injections depending on your requirements. These have been designed to be ultra-discreet and easy to use.

They can be pre-filled and disposable or refillable and durable. Some have a memory function and/or require only a very small pressure to operate them, making them suitable for many users, including children and the elderly. 

Insulin pumps

Some people with type 1 diabetes take their insulin using a small device called an insulin pump. Instead of delivering separate injections during the day, an insulin pump releases insulin gradually over the course of the day, just like your body would naturally thus replacing the need for a separate, longer-acting or bolus insulin injection. Some pumps also contain a glucose sensor and can adjust the amount of insulin needed. When it’s time for a meal, the pump also delivers variable amounts of insulin when a meal is eaten (bolus insulin) although this is done manually by the user.

An insulin pump is essentially made up of two parts (which are connected by a small, flexible tube):

  • A main pump unit, which holds an insulin reservoir
  • A needle that sits under the skin

The insulin pump is fitted onto a person’s lower abdomen and held in place with an adhesive patch, or worn in a belt around the waist, armband, bra or other accessory. The average pump is about the size of a pack of cards. It has a digital display screen and buttons for programming.

There are lots of different types of insulin pumps available with different features. For example, some of the more modern pumps have touchscreens, or can connect wirelessly to a glucometer. Your doctor will be able to help you select a model that’s best suited to your needs and lifestyle.

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References
  1. International Diabetes Federation. IDF Atlas 10th Edition, 2021. Available from: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf Last accessed: January 2022.
  2. Holt RIG, DeVries JH, Hess-Fischl A, et al. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589–2625.
  3. Diabetes UK. Insulin and diabetes. Available from: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin Last accessed: January 2022.
  4. Diabetes UK. Injecting insulin and children. Available from: https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/insulin-and-your-child Last accessed: January 2022.
  5. Wright BM, Bellone JM & McCoy EK. A Review of Insulin Pen Devices and Use in the Elderly Diabetic Population. Clinical Medicine Insights: Endocrinology and Diabetes. 2010;3:CMED.S5534.
  6. Diabetes UK. Insulin Pumps. Available from: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin-pumps. Last accessed: January 2022.

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