Insulin Therapy

Type 1 is always managed with insulin because you can no longer produce it. Type 2 may warrant insulin therapy if lifestyle treatment and oral medications aren’t meeting your goals.  Insulin therapy should not be considered a failure. Diabetes is progressive and what worked initially may no longer suffice to help you reach your target blood sugar goals.

Insulin therapy requires more careful blood sugar monitoring because of the risk of hypoglycemia. With tighter blood sugar control you have to be diligent about checking your blood sugar and knowing how your body responds to insulin. You may also need to ask yourself, if this is something that will fit your lifestyle. It’s important to have good eyesight or a partner to help you administer it. There are many points to consider before you begin insulin.

Insulin comes in a variety of forms:

Rapid acting insulin works in 15 minutes and peaks in 1-2 hours. Duration of 4-5 hours

Regular or short acting insulin works in 30 minutes and peaks in 2-4 hours. Duration of 5-8 hours.

Intermediate Acting works in 2-4 hours and peaks in 4-12 hours. Duration of 10 -16 hours.

Long Acting begins working in a few hours and lowers glucose for 24 hours.

Ultra reaches the blood in 6 hours and lasts 36 hours.

Methods of Insulin Administration

Multiple daily injections (MDI) with a traditional needle and syringe.

Insulin pens that are either reusable or disposable.

Smart insulin pens that come with a smart phone app.

Continuous insulin pump therapy.

Automated insulin delivery system (AID system) an insulin pump used with a continuous glucose monitor (CGM) that can prevent hypoglycemia.

Choosing a system to manage your diabetes depends on multiple things. If you are thinking of using an insulin pump, there are some safety issues to consider. For example, monitoring your blood sugar is important because it will alert you if your infusion set stops working. This could cause diabetic ketoacidosis (DKA), which is very serious.  Regularly checking your Blood Glucose or also using a Continuous Glucose Monitor (CGM) will prevent this from happening.

Insulin Pump Systems

An insulin pump is a good choice for children, because it alleviates the hardship of multiple injections and provides more even coverage of insulin throughout the day.

 Active people who benefit from changes in basal rates or suspending the pump when exercising.

 People who experience low blood sugars frequently would do best with a pump and a CGM.

Anyone who suffers from issues with food leaving their stomach slowly, since that could also cause low blood sugars.

The pump is a small device that delivers insulin to the body through a thin, flexible tube called an infusion set. A flexible plastic tube called a canula is inserted just underneath the skin. The pump is a little more complicated than injections when you initially start using it but after using it for a few days you may wonder how you ever lived without it. It will deliver your basal or background insulin in a steady continuous dose, and at your input provide a bolus dose for meals. When used with a Continuous Glucose Monitor (CGM), some pumps may suspend insulin if your blood sugar is headed to a hypoglycemic level. <70mg/dL. Some insulin pumps can be programmed with your smart phone app which makes using it easier.

There are pumps you can wear and attach to your belt loop or clothing. There is also a patch pump that has the insulin cartridge inside of it. After 3 days you just dispose of it and replace with a new one. Some people may prefer that because there is no tubing to deal with. The good thing is there is no wrong choice, just preference. Some people even take a break from their pump due to device fatigue. It is not a lifelong commitment. The pump is just another tool to help you manage your diabetes better. It’s important though to always have insulin ready to give by injection, should there be an issue with your pump, just to be safe.

Whatever you decide it’s important that it fits your lifestyle and budget. Determine what’s available to you based on your health care needs and insurance coverage. Then discuss those options with your provider and/or diabetes clinician to help you make the best choice.

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