Medications for Type 1 Diabetes
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Insulin is the primary medication used to treat ]]>type 1 diabetes]]>. Another injectable hormone made in the pancreas, ]]>pramlintide]]> (Symlin) has also been approved for the treatment of type 1 and ]]>type 2 diabetes]]> for patients also already taking insulin. Here is information for both treatments.
The information provided here is meant to give you a general idea about each of the types of insulin listed below. Only the most general instructions are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.
For proper diabetes control, insulin is administered by injection several times throughout the day to replace the insulin that the pancreas is unable to produce. Insulin must be taken as an injection because if it were taken by mouth, it would be digested by the enzymes in the stomach before it reached the bloodstream.
Insulin Injection Sites
The amount of insulin you take must be balanced with the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both without changing your insulin dose, your blood glucose level can drop too low or rise too high.
Before getting insulin, you should check your blood glucose level with a blood glucose meter. This will help you to determine how much insulin you need. You can also ask your doctor about continuous glucose monitoring systems (CGMS) that you wear all day.
Most individuals with type 1 diabetes will need two to four insulin administrations daily. Current insulin treatment regimens usually employ some combination of rapid-acting and long-acting insulin. Insulin is most commonly administered before meals and at bedtime.
All About Insulin
The three characteristics of insulin are:
Onset—the length of time it takes for the insulin to reach the bloodstream and begin lowering blood glucose after it is injected.
Peak Time—the time during which insulin is at its maximum strength in terms of lowering blood glucose levels.
Duration—how long the insulin continues to lower blood glucose
The main types of insulin available are:
|Type of insulin||Onset*||Peak time*||Duration*||Notes on use|
|Rapid-acting Novolog (aspart) Humalog (lispro) Apidra (glulisine)||10-30 minutes||0.5-3 hours||3-5 hours||Inject immediately before a meal.|
|Regular or short-acting Novolin R Humulin R||0.5-1 hour||2-5 hours||5-8 hours|
|1-2 hours||3-12 hours||18-24 hours||This is often used in combination with short-acting insulin.|
Insulin glargine (Lantus), Levemir (detemir)
|1 hour||n/a||24 hours||This may not be mixed with other types of insulin.|
*Each person has a unique response to insulin, so the times mentioned here are approximate.
Premixed insulins are a mixture of short-acting and intermediate-acting insulins, usually given twice per day with breakfast and dinner.
|Type of insulin||Onset||Peak time||Duration|
|Humulin (50/50)||30 minutes||2-5 hours||18-24 hours|
|Humalog mix (75/25)||15 minutes||0.5-2.5 hours||16-20 hours|
|Humulin (75/30)||30 minutes||2-4 hours||14-24 hours|
|Novolin (70/30)||30 minutes||2-12 hours||up to 24 hours|
|Novolog (70/30)||10-20 minutes||1-4 hours||up to 24 hours|
The table below show types of insulin and common brand names.
|Type of insulin||Brand names|
Humalog (insulin lispro)
NovoLog Cartridge (insulin aspart)
*both require a prescription
|Regular or short-acting||
Humulin R (regular)
Humulin N (NPH)
Novolin N (NPH)
Lantus (insulin glargine)
Methods of Insulin Delivery
The following lists ways of getting insulin through the skin.
Syringe and vial—The syringes you will use are small and have fine points and special coatings that help make injections as easy and painless as possible. When insulin injections are done properly, most people find that they are relatively painless.
Insulin is usually given as a ]]>subcutaneous injection]]> . This means that the needle goes into the fat layer between the skin and the muscle to deliver a certain amount of medicine.
Pen—The insulin pen looks very much like an old-fashioned cartridge pen, except that it has a needle and holds a pre-filled cartridge of insulin. Pens are particularly useful for people who travel frequently, or whose coordination is impaired.
Pump —This is a computerized device about the size of a beeper that is worn on the belt or in a pocket. It delivers a steady, measured dose of insulin through a flexible plastic tube called a cannula. With the aid of a small needle, the cannula is inserted through the skin, usually in the abdominal region, and is taped in place. In some products, the needle is removed and only a soft catheter remains in place. Based on your meals and your blood sugar level, you control the release of insulin from the pump.
Because the pump continuously releases tiny doses of insulin, this delivery system most closely mimics the body's normal release of insulin. Also, pumps can deliver very precise insulin doses for different times of the day, which may be necessary to correct the dawn phenomenon—the rise of blood sugar that occurs in the hours before and after waking.
- Check your insulin's expiration date. If you haven't finished it before then, throw the rest away.
- Store unopened bottles of insulin in the refrigerator. Do not store your insulin at extreme temperatures.
- Keep the bottle of insulin you are using at room temperature. Injecting cold insulin can sometimes make the injection more painful. (Most doctors believe that insulin kept at room temperature will last 1-2 months.)
- If your treatment requires that two different insulins be mixed, be sure that you understand which of the two should be drawn into the syringe first. If you change the mixing pattern you may change the dose you receive. Some insulins cannot be mixed together. Do not mix insulins together in one syringe unless you have been instructed to do so.
Common name: pramlintide (Symlin)
Amylin is a hormone produced by the same beta cells which produce insulin. In fact, amylin is released into the bloodstream at the same time as insulin. Amylin reduces glucagon’s release and enhances a sense of fullness after ingesting a meal so you will eat less. Together with insulin, it lowers blood glucose. Pramlintide is chemically related to amylin.
This drug treats type 1 and type 2 diabetes together with insulin treatment. It is given to patients who fail to achieve the optimal blood glucose levels despite getting the right dose of insulin. This drug is given by injection immediately before meal. It should be used with care in the elderly.
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¹9/23/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008 Sep 8. [Epub ahead of print]
Last reviewed December 2009 by ]]>B. Gabriel Smolarz, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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