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Insulin Regimens For Type 1 Diabetes

Insulin Treatment In Type 1 Diabetes.

Insulin Treatment In Type 1 Diabetes.

Endocr Pract. 2006 Jan-Feb;12 Suppl 1:105-9. Department of Medicine, University of Perugia, Italy. To present key aspects and strategies for use of insulin therapy in patients with type 1 diabetes mellitus. Limitations and advantages of various insulin regimens are discussed, and issues pertaining to insulin analogues are reviewed. Rapid-acting insulin analogues provide better and safer postprandial glucose coverage than does human regular insulin. Premixed insulin preparations do not provide the flexibility to address the individual needs of patients adequately to control postprandial glucose excursions. Because of its peak, short duration, and high variability, NPH insulin is inappropriate for patients with type 1 diabetes and patients with type 2 diabetes who require continuous basal coverage. Continuous infusion of soluble insulin by means of an insulin pump is currently the most physiologic approach available for treatment of type 1 diabetes. Use of insulin glargine or insulin detemir with a rapid-acting insulin analogue at meals is an effective and reasonable alternative to insulin pump therapy. Both rapid-acting and long-acting insulin analogues improve glycemic control. This improvement involves controlling hemoglobin A1c levels, reducing glucose excursions, and decreasing hypoglycemia, particularly during the night. Clinicians should prescribe insulin regimens that yield physiologic results in patients with type 1 diabetes. Continue reading >>

Nice - Insulin Therapy In Type 1 Diabetes - General Practice Notebook

Nice - Insulin Therapy In Type 1 Diabetes - General Practice Notebook

NICE - insulin therapy in type 1 diabetes multiple daily injection basal-bolus insulin regimens should be offered rather than twice-daily mixed insulin regimens, as the insulin injection regimen of choice for all adults with type 1 diabetes twice-daily insulin detemir should be offered as basal insulin therapy for adults with type 1 diabetes consider, as an alternative basal insulin therapy for adults with type 1 diabetes: an existing insulin regimen being used by the person that is achieving their agreed targets once-daily insulin glargine or insulin detemir if twice-daily basal insulin injection is not acceptable to the person, or once-daily insulin glargine if insulin detemir is not tolerated rapid-acting insulin analogues injected before meals should be offered, rather than rapid-acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes do not advise routine use of rapid-acting insulin analogues after meals for adults with type 1 diabetes if an adult with type 1 diabetes has a strong preference for an alternative mealtime insulin, respect their wishes and offer the preferred insulin a twice-daily human mixed insulin regimen for adults with type 1 diabetes can be considered if a multiple daily injection basal-bolus insulin regimen is not possible and a twice-daily mixed insulin regimen is chosen a trial of a twice-daily analogue mixed insulin regimen can be considered if an adult using a twice-daily human mixed insulin regimen has hypoglycaemia that affects their quality of life for adults with erratic and unpredictable blood glucose control (hyperglycaemia and hypoglycaemia at no consistent times), rather than a change in a previously optimised insulin regimen, the following should be considered: Continue reading >>

Clinical Recommendations In The Management Of The Patient With Type 1 Diabetes On Insulin Pump Therapy In The Perioperative Period: A Primer For The Anaesthetist

Clinical Recommendations In The Management Of The Patient With Type 1 Diabetes On Insulin Pump Therapy In The Perioperative Period: A Primer For The Anaesthetist

Since its introduction in the 1970s insulin pump therapy is being used increasingly in the management of type 1 diabetes, with current estimates of between 20 to 30% of people in North America with type 1 diabetes being pump users, 1,2 and this number is increasing rapidly in the UK. Current NICE guidance in the UK recommends 15–20% of the population with type 1 diabetes should be eligible for insulin pump therapy. However, uptake remains very dependent on individual diabetes centres having sufficient expertise in this technology, and it remains a postcode lottery. 3,4 Original studies of continuous subcutaneous insulin infusion (CSII), compared patient groups randomized to either multiple daily injections (MDI) or insulin pump therapy. The initial studies using older non-analogue based insulin regimens, demonstrated improvements in glycaemic control, with reductions in HbA1c and hypoglycaemia with insulin pump therapy. 5 These results were later confirmed using newer basal insulin analogues 6 and were demonstrated with an associated improved quality of life in both adults and children. 7 After publication of the results from the seminal Diabetes Control and Complications Trial (DCCT) in 1993, care for people with type 1 diabetes has focused on aiming to achieve intensive management of glucose control, hence reducing micro- and macrovascular risk. 8 Insulin pump therapy has been demonstrated to reduce HbA1c significantly over MDI in the first year of use in numerous studies 9,10 and we are now starting to see multicenter long-term outcome data, demonstrating similar results over 1–10 yr periods compared with prepump values 11,12 and in comparisons of matched cohorts continuing on MDI. 13 The primary goal of insulin pump therapy is to mimic physiological insulin repl Continue reading >>

Managing Type 1

Managing Type 1

In type 1 diabetes, the pancreas produces little or no insulin which is vital for converting glucose into energy. People with type 1 diabetes need to do the job of the pancreas and replace the insulin via insulin injections or an insulin pump. The insulin acts to reduce the level of glucose in the blood. Type 1 diabetes is a life threatening condition which needs to be closely managed with daily care. Type 1 diabetes is managed with: Insulin replacement through lifelong insulin injections (up to 6 every day) or use of an insulin pump Monitoring of blood glucose levels regularly (up to 6 times every day or as directed by a doctor or Credentialled Diabetes Educator) Following a healthy diet and eating plan Taking regular exercise The aim diabetes management is to keep blood glucose levels as close to the target range as possible, between 4 to 6 mmol/L (fasting). However, the ranges will vary depending on the individual and an individual’s circumstances. Talk to your doctor or Credentialled Diabetes Educator for the range of blood glucose levels that are right and safe for you. Keeping your blood glucose level at the optimum range is a careful balance between what food is eaten, physical activity and medication. Blood glucose levels which are too high, could result in hyperglycaemia or ketoacidosis. Blood glucose levels which are too low, could result in hypoglycaemia. It is important to learn about each reaction and respond appropriately. Ketoacidosis is an emergency and you must call emergency services immediately. Monitor blood glucose levels throughout the day and even at night. Keeping your blood glucose levels on target will help prevent both short-term and long-term complications. Your Credentialled Diabetes Educator will help you learn how to check your blood glu Continue reading >>

Suggested Insulin Regimens For Patients With Type 1 Diabetes Mellitus Who Wish To Fast During The Month Of Ramadan.

Suggested Insulin Regimens For Patients With Type 1 Diabetes Mellitus Who Wish To Fast During The Month Of Ramadan.

Clin Ther. 2008 Aug;30(8):1408-15. doi: 10.1016/j.clinthera.2008.08.007. Suggested insulin regimens for patients with type 1 diabetes mellitus who wish to fast during the month of Ramadan. Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut Lebanon. This paper reviews available information on insulin regimens that may enable patients with type 1 diabetes mellitus to fast during the month of Ramadan with minimal complications. It also provides guidance for health care professionals in managing patients who wish to observe the fast. Relevant English-language articles were identified through searches of the MEDLINE, EMBASE, and Index Medicus Eastern Mediterranean Region databases (all, 1980-2008) conducted in February 2008 using the terms Ramadan, fasting, type 1 diabetes mellitus, hypoglycemia, and hypotension. Only original research and review articles related to adult patients with type 1 diabetes were considered for review, excluding pregnant women and patients with poorly controlled disease. The literature review identified 5 clinical trials relevant to type 1 diabetes and fasting. Two main meals are eaten during Ramadan, one before dawn (Suhur) and the other at sunset (Iftar). Suggested adjustments to the insulin regimen during fasting include using 70% of the pre-Ramadan dose, divided as follows: 60% as insulin glargine given in the evening and 40% as an ultra-short-acting insulin (insulin aspart or lispro) given in 2 doses, 1 at Suhur and 1 at Iftar. Alternatively, 85% of the pre-Ramadan dose may be divided as 70% Ultralente and 30% regular insulin, both given in 2 doses, 1 at Suhur and 1 at Iftar. Another option is to give 100% of the pre-Ramadan morning dose of 70/330 premixed insulin at Iftar and 50% Continue reading >>

Dosing Insulin

Dosing Insulin

One of the things patients often fear about being diagnosed with diabetes is insulin injections. In most cases, if you have type 1 you will be taking insulin a number of times a day. And, most likely because you are new to diabetes, the decision about which insulin to take and how to take it will be made by your health care provider. But as you learn more about the disease and improve your self-management skills, you will be able to participate more fully in your care. If you have type 2 and are transitioning to insuli—or transitioning from taking one injection of basal insulin a day to a regimen that has you injecting insulin before each meal and a dose either at bed or in the morning—it can be anxiety provoking. It is a stark indication that your pancreas is no longer providing sufficient insulin. Whether you have type 1 or type 2, if you need to take multiple injections of insulin a day, understanding the different ways insulin is titrated can be empowering—and having a discussion with your health care provider about which way may suit your circumstances the best, can diminish apprehension and give you a measure of control. There are three basic regimens available for people who use a basal/bolus approach. Fixed Dose With this method, a set amount of insulin is given at each meal, and the amount per meal can be the same or different. For example, someone may take 6 units at breakfast, 4 at lunch and 8 at dinner, or 8 for all meals. The advantage of this method is primarily ease-of-use. The amount is the same regardless of your blood glucose readings or what you eat. The downside is its rigidity. If your blood sugar is very high before a meal, it is unlikely that the insulin given will be adequate to bring your glucose down to target levels after the meal. The s Continue reading >>

Type 1 Diabetes Mellitus And The Use Of Flexible Insulin Regimens

Type 1 Diabetes Mellitus And The Use Of Flexible Insulin Regimens

The management of type 1 diabetes mellitus (formerly known as insulin-dependent diabetes) has changed dramatically over the past 30 years. In particular, new insulin strategies have improved the ability to maintain near-normal glycemia. Factors such as onset, peak and duration of action can influence the ability of a particular insulin regimen to help control glucose levels. Patient factors, including individual variations in insulin absorption, levels of exercise and types of meals consumed, also influence the effectiveness of an insulin regimen. Rapid-acting insulin lispro is an ideal mealtime insulin. The premeal dose of insulin lispro can be adjusted based on the content of the meal and the patient's blood glucose level. Intermediate-acting and long-acting insulins should not be given to account for the content of a specific meal. Long-acting insulin can be administered once daily at bedtime or, ideally, twice daily in addition to another type of insulin. Patients with type 1 diabetes typically require an insulin dosage of 0.5 to 1.0 unit per kg per day. Newly diagnosed patients may have lower initial requirements because of continued endogenous insulin production. Flexible insulin regimens are based on predetermined actions in response to self-monitoring of blood glucose levels and carbohydrate intake. Pharmacology of Insulin Several important factors affect the absorption of subcutaneously administered insulin and explain much of the unstable glycemia that occurs in patients with type 1 diabetes. The time it takes to absorb one half of an injected dose of insulin may vary by 25 to 50 percent among individual patients.5 For example, NPH insulin may have a duration of activity of 18 hours in one patient but an effective activity of only 9 or 10 hours in another pati Continue reading >>

Best Insulin Regimen For Type 1’s

Best Insulin Regimen For Type 1’s

For people with type 1 diabetes, long-acting insulin may be a better treatment choice than intermediate-acting insulin…. Different types of insulin are used to manage type 1 diabetes with insulin injections. Long-acting insulin takes about one hour to begin lowering blood sugar levels and lasts up to 26 hours, while intermediate-acting insulin takes one to three hours to begin lowering blood sugar levels and lasts up to 16 hours. In the new review, researchers led by Dr. Andrea Tricco of St. Michael’s Hospital in Toronto analyzed data from 39 studies. The studies compared once- and twice-daily doses of the long-acting and intermediate-acting insulin and concluded that the long-acting version was safer and more effective. “In patients with type 1 diabetes, we found that long-acting insulin is superior to intermediate-acting insulin when it came to controlling blood sugar, preventing weight gain and treating severe hypoglycemia,” Tricco said in a hospital news release. Compared to intermediate-acting insulin, long-acting insulin also significantly improved hemoglobin A1C levels. “Those taking intermediate-acting insulin were more likely to gain weight,” said Tricco, who is assistant professor in the University of Toronto’s School of Public Health. “They gained an average of four to six pounds more than the participants who took most long-acting insulin doses.” The researchers also found that people with type 1 diabetes who took long-acting insulin were 38 percent less likely to develop severe hypoglycemia than those who took intermediate-acting insulin. “With this information, patients and their doctors should tailor their choice of insulin according to preference, cost and accessibility,” Tricco said in the news release. BMJ, Oct. 1 Continue reading >>

Basal-bolus Insulin Therapy

Basal-bolus Insulin Therapy

Someone with diabetes may need help controlling blood sugar in 2 ways: Insulin therapy that controls blood sugar between meals and during sleep is called long-acting or basal insulin Insulin therapy that controls blood sugar when you eat is called fast-acting or bolus insulin. On this site, we often refer to it as mealtime insulin. NovoLog® is a bolus insulin (also known as a fast-acting or mealtime insulin) Basal-bolus insulin therapy uses 2 types of insulin to closely mimic the body’s normal insulin release. In the body of a person without diabetes, insulin is released: In a steady “basal” amount, day and night, to help control blood sugar between meals and while you sleep In “bolus” bursts to help control blood sugar spikes that happen when you eat Basal-bolus insulin therapy (also called intensive insulin therapy) uses long-acting (basal) and mealtime (bolus) insulin together to closely mimic the body’s normal insulin pattern throughout the day. For people with type 2 diabetes who need more blood sugar control than basal insulin alone can provide If you have type 2 diabetes, you may already be taking a long-acting, or basal, insulin at night or in the morning (sometimes both), to help control blood sugar between meals and when you sleep. However, if your blood sugar is still too high, your diabetes care team may add a bolus insulin (such as NovoLog®) to help control blood sugar spikes that happen when you eat. What is basal-bolus therapy? (4:55 min.) A fast-acting insulin analog like NovoLog® can be taken along with a long-acting insulin for additional blood sugar control. If your health care provider tells you that you need to add a mealtime, or bolus, insulin to your care plan, this does not mean that you have failed to take care of your diabetes. E Continue reading >>

Insulin Regimens And Clinical Outcomes In A Type 1 Diabetes Cohort: The Search For Diabetes In Youth Study

Insulin Regimens And Clinical Outcomes In A Type 1 Diabetes Cohort: The Search For Diabetes In Youth Study

N2 - OBJECTIVE - To examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes. RESEARCH DESIGN AND METHODS - The study sample consisted of youth with type 1 diabetes who completed a baseline SEARCH for Diabetes in Youth study visit after being newly diagnosed and at least one follow-up visit. Demographic, diabetes self-management, physical, and laboratory measures were collected at study visits. Insulin regimens and change in regimen compared with the initial visit were categorized as more intensive (MI), no change (NC), or less intensive (LI). We examined relationships between insulin regimens, change in regimen, and outcomes including A1C and fasting C-peptide. RESULTS - Of the 1,606 participants with a mean follow-up of 36 months, 51.7% changed to an MI regimen, 44.7% had NC, and 3.6% changed to an LI regimen. Participants who were younger, non-Hispanic white, and from families of higher income and parental education and who had private health insurance were more likely to be in MI or NC groups. Those in MI and NC groups had lower baseline A1C (P = 0.028) and smaller increase in A1C over time than LI (P <0.01). Younger age, continuous subcutaneous insulin pump therapy, and change to MI were associated with higher probability of achieving target A1C levels. CONCLUSIONS - Insulin regimens were intensified over time in over half of participants but varied by sociodemographic domains. As more intensive regimens were associated with better outcomes, early intensification of management may improve outcomes in all children with diabetes. Although intensification of insulin regimen is preferred, choice of insulin regimen must be individualized based on t Continue reading >>

New Treatments And Treatment Philosophy For Type 1 Diabetes

New Treatments And Treatment Philosophy For Type 1 Diabetes

Advances in insulin types and regimens can help patients fit insulin therapy to their lifestyles. Treatment of type 1 diabetes has changed over the past several decades. Recent advances include the development of insulin analogs, such as the long-acting insulin glargine and the ultra-short-acting insulins aspart and lispro, and various new treatment regimens and devices, such as multiple daily injection and insulin pump therapy. These advances have increased the flexibility of insulin therapy and improved glycemic control, thus preventing and reducing diabetes-related complications. Advances in the treatment of type 1 diabetes (T1D) in the past decade have occurred in the areas of treatments and treatment philosophy. The push for new insulin analogs such as glargine, aspart, and lispro came in part from the results of the Diabetes Control and Complications Trial (DCCT), which highlighted the importance of more physiological insulin profiles. Prevention of complications in type 1 diabetes The importance of glycemic control in preventing microvascular complications of T1D was clearly demonstrated by the results of the DCCT in 1993.[1] The DCCT was a 9-year study examining the effect of conventional insulin therapy compared with the effect of intensive insulin therapy on complications related to diabetes. Intensive insulin therapy consisted of either multiple daily injection (MDI) or continuous subcutaneous insulin infusion (CSII) therapy. The DCCT saw a lower mean glycosylated hemoglobin value achieved in the intensive group compared with the conventional therapy group (7.2% vs 9.1%, P<.001). The two target populations in the study included a primary prevention group consisting of patients with no retinopathy or nephropathy, and a secondary prevention group of patients wi Continue reading >>

Patient Education: Diabetes Mellitus Type 1: Insulin Treatment (beyond The Basics)

Patient Education: Diabetes Mellitus Type 1: Insulin Treatment (beyond The Basics)

INTRODUCTION Diabetes mellitus is a lifelong condition that can be controlled with lifestyle adjustments and medical treatments. Keeping blood sugar levels under control can prevent or minimize complications. Insulin treatment is one component of a diabetes treatment plan for people with type 1 diabetes. Insulin treatment replaces or supplements the body's own insulin with the goal of preventing ketosis and diabetic ketoacidosis and achieving normal or near-normal blood sugar levels. Many different types of insulin treatment can successfully control blood sugar levels; the best option depends upon a variety of individual factors. With a little extra planning, people with diabetes who take insulin can lead a full life and keep their blood sugar under control. Other topics that discuss type 1 diabetes are also available. (See "Patient education: Diabetes mellitus type 1: Overview (Beyond the Basics)" and "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)" and "Patient education: Type 1 diabetes mellitus and diet (Beyond the Basics)" and "Patient education: Hypoglycemia (low blood sugar) in diabetes mellitus (Beyond the Basics)" and "Patient education: Care during pregnancy for women with type 1 or 2 diabetes mellitus (Beyond the Basics)".) STARTING INSULIN The pancreas produces very little or no insulin at all in people with type 1 diabetes. All patients with type 1 diabetes will eventually require insulin. Insulin is given under the skin, either as a shot or continuously with an insulin pump. Dosing — When you are first starting insulin, it will take some time to find the right dose. A doctor or nurse will help to adjust your dose over time. You will be instructed to check your blood sugar level several times per day. Insulin Continue reading >>

Type 1 Diabetes | Health24

Type 1 Diabetes | Health24

Type 1 diabetes is a disorder of sugar metabolism in which the pancreas is no longer able to produce insulin. This is due to destruction of the insulin-producing beta cells of the pancreas by an autoimmune process. Type 1 diabetes commonly develops before the age of 40, with a peak incidence around 14. Those with a strong family history of diabetes are at risk of developing the disease. The symptoms of diabetes are excessive thirst and urination and weight loss, which can occur abruptly over a few days. Type 1 diabetes can also present as diabetic ketoacidotic coma. Type 1 diabetes is treated with insulin and careful attention to diet and lifestyle. The long-term complications of type 1 diabetes can be well controlled by using a tight-control regime in which blood glucose is measured several times each day and the insulin dose adjusted accordingly. Insulin-dependent diabetes now seldom used. Diabetes, correctly called diabetes mellitus, is a disorder of carbohydrate metabolism. In type 1 diabetes, the pancreas is no longer able to produce the hormone insulin. Insulin is produced by the beta cells of the pancreas; it is secreted in response to an increased concentration of glucose in the blood, and is vital in controlling blood glucose levels. A person with diabetes cannot control their blood glucose and they become hyperglycaemic meaning that they have abnormally high levels of glucose in the blood. By the time a person with type 1 diabetes experiences symptoms, almost all the beta cells in the pancreas have been destroyed. This destruction is almost certainly as a result of an automimmune process in which the body produces antibodies to its own cells. However, the details of the process are obscure. It seems that there must initially be a genetic tendency for the dise Continue reading >>

Type 1 Diabetes - Approach | Bmj Best Practice

Type 1 Diabetes - Approach | Bmj Best Practice

In the short term, insulin is life-saving because it prevents diabetic ketoacidosis, a potentially life-threatening condition. The long-term goal of insulin treatment is the prevention of chronic complications by maintaining blood glucose levels as close to normal as possible. Generally, A1C (glycosylated haemoglobin) goals determine the aggressiveness of therapy, which is in turn individualised. Current guidelines recommend a target A1C of <59 mmol/mol (7.5%) for patients <18 years with type 1 diabetes and <53 mmol/mol (<7%) for adult patients. [1] American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018;41(suppl 1):S1-159. [33] Chiang JL, Kirkman MS, Laffel LM, et al; Type 1 Diabetes Sourcebook Authors. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014 Jul;37(7):2034-54. Less stringent goals may be appropriate for very young children, older adults, people with a history of severe hypoglycaemia, and those with limited life expectancies, advanced microvascular or macrovascular complications, or comorbid conditions. [1] American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018;41(suppl 1):S1-159. Good glycaemic control in type 1 diabetes requires attention to diet, exercise, and insulin therapy. All 3 components should be co-ordinated for ideal control. Self-monitoring of blood glucose (SMBG) is a core component of good glycaemic control. Patients on multiple injections daily should consider SMBG before meals, occasionally after meals and at bedtime, and before exercising, to assess presence and adequate treatment of hypoglycaemia, and before any task during which hypoglycaemia could have particularly dangerous consequences. Continue reading >>

Long-acting Insulins Useful Tools In Type 1 And Type 2 Diabetes

Long-acting Insulins Useful Tools In Type 1 And Type 2 Diabetes

Researchers have augmented insulin's effectiveness with several rapid and long-acting analogues and new delivery systems such as insulin pens and insulin pumps. Biosynthetic preparations with various pharmacokinetic profiles somewhat mimic the steady insulin release from a normal pancreas. Long-acting insulins create unprecedented prescribing flexibility, as prescribers can tailor patients' regimens to their individual activity levels, eating habits, and responses to insulin. Insulin is a necessity for patients who have type 1 diabetes (T1D). For many people who have type 2 diabetes (T2D), insulin can improve glycemic control significantly. Still, many clinicians are reluctant to initiate injectable glucose-lowering therapies in T2D. They often perceive, rationally or irrationally, that patients will have difficulty understanding complex regimens. Many clinicians also report that they are less proficient than they would like with insulin, creating discomfort with diabetes management.1 And they perceive that multidose insulin regimens may be associated with increased episodes of hypoglycemia, though they are not.2 However, today's long-acting insulins such as insulin detemir, insulin glargine (IGlar), and insulin degludec (IDeg) offer convenience that increases adherence significantly (Table 13-7). They also tend to have fewer adverse effects, which can simplify patients' regimens and improve control.3-7 Designing a Regimen For most patients, designing an optimal insulin regimen is a continuing process that may require formulation changes, dose-related fine tuning, and introduction of insulin or multiple insulin products when patients cannot meet glycated hemoglobin (HbA1c) goals by other means. The long-acting insulin products have advantages and disadvantages. Each off Continue reading >>

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