Diabetes Treatment (cont.)

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Treatment of diabetes with insulin

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Insulin remains the mainstay of treatment for patients with type 1 diabetes. Insulin is also important therapy for T2D when blood glucose levels cannot be controlled by diet, weight loss, exercise, and oral medications.

Ideally, insulin should be administered in a manner that mimics the natural pattern of insulin secretion by a healthy pancreas. However, the complex pattern of natural insulin secretion is difficult to duplicate. Still, adequate blood glucose control can be achieved with careful attention to diet, regular exercise, home blood glucose monitoring, and multiple insulin injections throughout the day. Taking care of your diabetes with careful home care and monitoring assists in controlling blood sugar levels and effective diabetes treatment.

Until the late 1990s, insulin was often derived from animal sources, particularly cows and pigs. This created a supply problem to meet demand. Also, insulin derived from bovine or porcine caused immune reactions in some people. Such patients could become intolerant or resistant to animal insulin. Revolutions in molecular biology during the 1950s-70s led to the cloning the gene for human insulin in 1977. In October 1982, synthetic human insulin became the first drug created from recombinant DNA technology to be approved by the FDA. Human insulin has widely replaced insulin from animal sources.

Various formulations of insulin differ in the pharmacokinetics, i.e., the amount of time until they begin to work and the duration of their action after injection. These different insulins allow for more tailored regimens to optimize blood sugar control. The types of insulin currently available are:

  • Rapid-acting insulin begins to take effect 5 minutes after administration. Peak effect occurs in about 1 hour, and the effect lasts for 2 to 4 hours. Examples are insulin lispro, insulin aspart, and insulin glulisine.
  • Regular insulin takes effect within 30 minutes, peaks at 2 to 3 hours after injection, and lasts 3 to 6 hours total.
  • Intermediate-acting insulin typically begins to lower blood glucose about 2 to 4 hours after injection, peaks 4 to 12 hours later, and lasts about 12 to 18 hours.
  • Long-acting insulin takes effect within 6 to 10 hours. It is usually lasts for 20 to 24 hours. The two long-acting insulin analogues available, glargine and detemir, lower glucose levels fairly evenly over a 24-hour period (without major peaks or troughs).
Medically Reviewed by a Doctor on 5/7/2015

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