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General Diabetes Treatment Recommendations: Type 1 Diabetes Patients who have type 1 diabetes should start insulin therapy at the time of diagnosis, and insulin therapy will need to be continued for the life of the patient. Research has shown that as many as 74% of people who have had type 1 diabetes for five years or longer still secrete tiny amounts of insulin, and some patients who have type 1 diabetes secrete an amount of insulin that is clinically important, but insulin therapy is still necessary for treatment of type 1 diabetes patients. Injected insulin acts as a replacement for the insulin the body doesn’t make or can’t use properly. It is effectively used to treat type 1 or type 2 diabetes. Different types of insulin are available. Some types act quickly, and these can help control blood glucose levels at mealtime. Others types act over a longer period. These types control blood glucose levels throughout the day and night.
Patients who have type 1 diabetes must use insulin and for patients who have type 2 diabetes, initiation of pharmacologic therapy with an oral hypoglycemic at the time of diagnosis is usually recommended. Type 2 diabetes is managed not only by medications, but through lifestyle changes, like weight loss, exercise, and possibly smoking cessation. These interventions can help with glycemic control and they have value for diabetic patients aside from their role in glycemic control. However, for the reasons listed below, glycemic control in type 2 diabetes may require the use of medications (sometimes multiple medications), and many patients who have type 2 diabetes will progress to type 1 diabetes and eventually need insulin. Pancreatic beta-cell dysfunction is often significantly decreased by the time of diagnosis.
Remission of type 2 diabetes requires long-term changes in lifestyle like a significant level of weight loss but this is complicated by the fact that many people, whether or not they have diabetes, are unable to lose weight and/or adhere to an exercise program or stop smoking. The natural history of type 2 diabetes involves progressive beta cell dysfunction and increased insulin resistance over time, which may be slowed by the combination of medication and lifestyle improvements. Early pharmacologic treatment that is started before HbA1c becomes significantly elevated can improve long-term glycemic control and decrease the risk of long-term complications.
Insulin and Insulin Therapy Goals and Methods Glycemic control is the goal of treatment for diabetes, but not all patients can reach the standard hemoglobin A1c (also called A1c) range-and a lower or higher A1c may be considered acceptable, depending on the patient’s age, co-morbidities, the duration of their disease, and other factors.
The insulin therapy that is currently recommended is often called intensive insulin therapy, and it is intended to mimic as closely as possible the normal physiological profile of insulin secretion and release. This approach has been shown to produce better glycemic control and to significantly reduce the risk of developing diabetic nephropathy, neuropathy, and retinopathy and the cardiovascular complications of diabetes. The basic goals/objectives and methods of intensive insulin therapy are:
A primary goal of therapy is to achieve an A1c of <7%. New insulin users need to figure just how much insulin they need to affect the desired changes to their blood glucose levels, so many healthcare providers will recommend a pre-meal blood glucose level of 90-130 mg/dL and a post-meal blood glucose of <180 mg/dL to minimize the risk of hypoglycemia.
To achieve these goals, a patient with diabetes may be advised to administer a twice a day injection of an intermediate- or long-acting insulin to provide a basal level of insulin or an infusion pump delivering a continuous basal level of rapid-acting insulin. Prandial insulin before each meal may include a rapid-acting or short-acting insulin. And, insulin analogues is now commonly used and is replacing the use of human insulin in the United States.
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