People with type 1 diabetes do not make enough insulin to control blood sugar levels. For this reason, treatment includes injections of insulin.
The goal of insulin therapy is to copy the body's normal response to increased blood sugar after a meal.
Insulin cannot be taken as a pill or liquid. Normal stomach juices would destroy it. Insulin must be injected (taken as a shot) in order to make its way into the blood.
Many people inject insulin up to four times per day. They may use a small syringe or another device such as a pen-shaped dispenser ("insulin pen"). Another option for some people is the insulin pump. This small device is programmed to deliver insulin throughout the day. A needle at the end of the pump is implanted beneath your skin. In some cases, the whole pump is implanted.
One variation on the insulin pump is newly being tested. It has been nicknamed the "bionic pancreas." This insulin pump also tests glucose levels, and it adjusts its dose to fit the level of glucose. Good results have been seen in studies, but the device is not yet available for widespread use.
Types of Insulin
There are at least 20 kinds of insulin. They vary in several ways:
- How soon they begin to work (onset)
- When they work the best (peak)
- How long they stay in the body (duration)
Some types of insulin act very quickly. They reach the blood within 15 to 30 minutes after an injection. However, they do not stay active for very long compared with other types. By contrast, long-acting insulin takes 6 to 8 hours to start working. It can keep working up to 36 hours. There are also intermediate forms of insulin. They reach the blood within 1 to 3 hours. Then they stay active for up to 24 hours. To best control blood sugar, many people use a combination of these different types of insulin.
Approaches to Blood-Sugar Control
The goal for anyone with type 1 diabetes is to lower blood sugar so that levels are closer to normal.
The minimum treatment plan for a person with type 1 diabetes includes one or two daily doses of longer-acting insulin. This is combined with a very regular meal schedule. With this minimum plan, blood sugar levels often are lower than they would be without insulin injections. But they still may be a lot higher than is normal.
Another approach is more successful in preventing the further health problems that diabetes can cause. This is called intensive or tight control. The goal of tight control is to keep blood sugar levels as close to normal as possible. They will be slightly above normal, however. Tight control is achieved by:
- Adding injections of short-acting insulin at each mealtime, or
- Using an insulin pump
An important long-term study, the Diabetes Control and Complications Trial, looked at the effects of tight control. It found that this regime significantly reduced the risk of long-term complications in people with type 1 diabetes. These problems include kidney, eye and nerve disease. However, tight control increased some short-term problems such as hypoglycemia (low blood sugar). It also increased weight gain.
Tight control is the best plan for most people who have type 1 diabetes. But it's not for everyone. It requires more frequent injections of insulin. Blood sugar must be checked more often. In addition, people who try to follow tight control must pay stricter attention to diet and exercise. Tight control usually is not recommended for preteen children. Talk to your doctor about which approach is best for you or your child.