Insulin is the primary medication used to treat type 1 diabetes. For proper diabetes control, insulin is administered, either by injection or …
Main Page | Risk Factors | Symptoms | Diagnosis | Treatment | Screening | Complications | Reducing Your Risk | Talking to Your Doctor | Living With Type 1 Diabetes | Resource Guide
Medications for Type 1 Diabetes
by Karen Schroeder, MS, RD En Español Spanish Version Insulin is the primary medication used to treat type 1 diabetes Pramlintide has recently been approved for the treatment of type 1 and type 2 diabetes 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
Insulin
For proper diabetes control, insulin is administered, either by injection or inhalation, several times throughout the day to replace the insulin that the pancreas is unable to produce Insulin must be taken as an injection or inhalation 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
2008 Nucleus Medical Art, Inc 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 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 or very long-acting insulins Insulin is most commonly administered before meals and at bedtime
All About Insulin
Page 1 of 5 Copyright 2008 EBSCO Publishing All rights reserved
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 Main Types The main types of insulin available are: Type of insulin Rapid-acting Regular or short-acting Intermediate-acting NPH and lente Long-acting Ultralenteabsorption varies; this kind can be either intermediate- or long-acting Onset 10-30 minutes 05-1 hour Peak time 05-3 hours 2-5 hours Duration 3-5 hours 5-8 hours This is often used in combination with short-acting insulin Notes on use Inject immediately before a meal
3-12 1-2 hours hours
18-24 hours
05-3 hours
10-20 hours
A long-acting can be combined 20-36 hours nearly with a short-acting to provide a continuous insulin proper peaking of insulin at release mealtimes 20-24 hours continuous insulin release This may not be mixed with other types of insulin
Very long-acting Insulin glargine Lantus–enters 1 hour the body quickly, and its effects are long lasting
n/a
Each person has a unique response to insulin, so the times mentioned here are approximate Pre-Mixed Premixed insulins are a mixture of short-acting and intermediate-acting insulins Type of insulin Humulin 50/50 Onset 30 minutes Peak time 2-5 hours Duration 18-24 hours
Humalog mix 75/25 15 minutes Humulin 75/30 Novolin 75/30 Novolog
75/30 Common Brands 30 minutes 30 minutes
05-25 hours 16-20 hours 2-4 hours 2-12 hours 14-24 hours up to 24 hours up to 24 hours
10-20 minutes 1-4 hours
The table below show types of insulin and common brand names
Page 2 of 5 Copyright 2008 EBSCO Publishing All rights reserved
Type of insulin Rapid-acting
Brand names Humalog insulin lispro NovoLog Cartridge insulin aspart both require a prescription
Humulin R regular Iletin II Regular Regular or short-acting Novolin R ReliOn/Novolin R Humulin L lente Humulin N NPH Iletin II Lente Iletin II NPH Novolin L lente Novolin N NPH ReliOn/Novolin N NPH Humulin U ultralente Lantus insulin glargine
Intermediate-acting
Long-acting Very long-acting
Methods of Insulin Delivery
In the recent past for insulin to be used by the body, it must be moved through the outermost layer of skin and into fatty tissue before it gets into the bloodstream As of September 2005, the Food and Drug Adminsitration FDA has approved a breakthrough delivery system with inhaled insulin The following lists wasy of getting insulin through the skin Syringe–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 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 bodys 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 Pen–The insulin pen looks very much like
an old-fashioned cartridge pen, except that it has a needle and holds a cartridge of insulin Pens are particularly useful for people who travel frequently, or whose coordination is impaired
Special Considerations
Check your insulins expiration date If you havent 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
Page 3 of 5 Copyright 2008 EBSCO Publishing All rights reserved
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
Pramlintide
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 glucagons release and ehances a sense of fullness after ingesting a meal Together with insulin, it lowers blood glucose Pramlintide is chemically related to amylin This new drug was approved by the FDA in March 2005 for the treatment of 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
Surgery: Pancreatic Transplantation
Pancreatic transplantation is performed only in a few medical centers in the US This procedure is an acceptable alternative in the following situations: Patients who develop severe renal disease especially those contemplating kidney transplantation Patients in whom insulin treatment consistently fails to prevent the acute complications such as ketoacidosis Patients in whom insulin treatment causes severe emotional problems which interfere with his/her daily life Patients who have frequent, potentially life-threatening complications, such as repeated pneumonias
REFERENCES:
American Diabetes
Association American Diabetes Association guidelines: hyperglycemic crises in diabetes Diabetes Care 2004; 27:S94-S102 American Diabetes Association American Diabetes Association guidelines: pancreatic transplantation in type 1 diabetes Diabetes Care 2004;27:S105 American Diabetes Association American Diabetes Association guidelines: standard of medical care in diabetes Diabetes Care 2006;29:S4-S42 American Dietetic Association website Available at: http://wwweatrightorg/cps/rde/xchg/ada/hsxsl/indexhtml Amylin agonists: a novel approach in the treatment of diabetes Diabetes 2004; 53Supp 3:S233-38 Pancreatic transplantation in type 2 diabetes Diabetes Care 2004;27:S105 USP DI 21st edition Micromedex; 2001 McMahon GT, Arky RA Inhaled insulin for diabetes mellitus N Engl J Med 2007;356:497-502
Last reviewed April 2007 by David Juan, MD All EBSCO Publishing proprietary, consumer health and medical information found on this site is accredited by URAC URACs Health Web Site Accreditation Program requires compliance with 53 rigorous standards of
Page 4 of 5 Copyright 2008 EBSCO Publishing All rights reserved
quality and accountability, verified by independent audits To send comments
or feedback to our Editorial Team regarding the content please email us at HLEditorialTeam@ebscohostcom
Page 5 of 5 Copyright 2008 EBSCO Publishing All rights reserved
Source:sandiegohealth.org
