Insulin treatment in type 1 diabetes

Abstract

Objective: To present key aspects and strategies for use of insulin therapy in patients with type 1 diabetes mellitus.

Methods: Limitations and advantages of various insulin regimens are discussed, and issues pertaining to insulin analogues are reviewed.

Results: 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.

Conclusion: 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.