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Premixed Insulin Formulations

Premixed insulin formulations such as 75/25, 70/30 and 50/50 include combinations of NPH and either regular insulin or a rapid-acting analog. Because the proportion of basal to bolus insulin cannot be altered, these are generally not recommended for use in type-1 diabetes management.

Optimal Basal/Bolus Program

Modern management of type-1 diabetes focuses on mimicking the normal secretion of insulin by the pancreas. As you can see in this depiction of natural insulin secretion in response to increasing glucose levels, the normal pancreas increases the release of insulin to minimize blood sugar variations.

To replicate this phenomenon, we utilize the basal/bolus approach to insulin administration. Remember, BASAL insulin is the insulin continuously released by the pancreas to offset the glucose naturally produced by the liver. BOLUS insulin is a shorter acting insulin that is used to offset the increase in blood sugar caused by food intake, as well as to correct high blood sugars.

While we still have options for creating a basal/bolus program, the bottom line is that both are needed to keep glucose levels as close to normal as possible.

Basal insulin is best administered through either an insulin pump or injectable basal insulin formulations, while bolus insulin is best provided through the use of rapid-acting insulin analogs.

Daily Care of Type 1 Diabetes

• Monitoring of blood glucose 4-6 times daily

• Record keeping (paper or electronic)

• Carbohydrate counting

• Prevention & treatment of hypoglycemia

• Insulin Administration, Adjustment

Caring for type-1 diabetes is a time consuming task, but it becomes easier over time and with practice. Blood glucose must be monitored frequently. Insulin doses should be matched to carbohydrate intake, physical activity levels, and current glucose values. Steps should be taken to prevent and manage hypoglycemia. A healthy diet and regular physical activity are also integral to successfully living with diabetes.