Injectable insulin is used as a treatment for diabetes in insulin-dependent type 1 diabetics and type 2 diabetics.
This is called insulin therapy . It can also be prescribed, in some cases and temporarily, to women with gestational diabetes.
Self-monitoring of blood glucose has been widely disseminated over the past twenty years, and is now considered mandatory for the treatment of insulin therapy.
Type 1 diabetic patients are recommended to perform more than 4 capillary glucose determinations per day, ideally 4-6.
To be efficient in using these results, several parameters are required: glycemic targets must be clearly defined.
A regimen should be proposed (3 or 4 injections per day or insulin pump therapy) and the patient should be taught how to modify their insulin doses.
The practice of self-monitoring of blood glucose and its use for insulin adjustment requires continuing education, in order to translate self-monitoring of blood glucose into actual self-monitoring of diabetes.
This prerequisite is mandatory for sustained improvement in metabolic control.
Insulin replacement therapy has witnessed several important developments since its inception in the 20th century, allowing treatment approaches that seek to mimic the physiology of normal insulin and achieve tight glycemic control .
Patients can administer these physiological insulin regimens using multiple daily insulin injections or a continuous subcutaneous insulin infusion.
Both technologies have evolved with the development of insulin preparations and analogs with favorable pharmacodynamic characteristics and sophisticated insulin pumps with better safety and usability profiles.
Definition of insulin
Insulin is a hormone secreted by the β cells of the islets of the pancreas, called islets of Langerhans.
In a non-diabetic person, insulin is continuously secreted and regulates, for example, the level of glucose in the blood.
When carbohydrates are consumed, the level of sugar in the blood rises, which normally causes your body to secrete insulin.
For a non-diabetic person, the blood sugar level may rise slightly, then drop to a normal level, and glucose is converted to reserves and energy.
This system does not work properly in people who develop diabetes.
If you have type 1 diabetes, you should take insulin injections as soon as diabetes is diagnosed.
If you have type 2 diabetes, insulin becomes necessary after a certain course of the disease, when insulin is no longer produced in sufficient quantities by the pancreas (insulinopenia) despite oral treatments and lifestyle changes .
The different insulins are distinguished according to their duration and speed of action and can be classified into 3 categories:
- Fast acting insulin.
- Insulin of intermediate action.
- Long-acting insulin.
Insulin intake is done either by injection (using a syringe or pen) or with an insulin pump and the portable device for continuous insulin delivery.
The multiplicity of insulins and brands allows the treatment to be better adapted according to each patient: clinical status, age, weight, height, lifestyle.
Whatever your insulin and profile scheme, the goal remains the same: limit blood sugar swings.
The doctor can prescribe different regimens, depending on the type of diabetes, the needs and the lifestyle of the patient.
In the case of a basal bolus regimen, basal insulin corresponds to one or two slow injections of insulin.
Insulin for eating (mealtime insulin) is provided by a bolus, that is, a rapid injection of insulin at mealtime, depending on the amount of carbohydrates eaten.
Insulin correction allows, thanks to a rapid injection of insulin, to correct your glucose if it is too high.
Functional insulin therapy is helpful if you have type 1 diabetes or type 2 diabetes that require insulin.
In this type of therapy, the treatment must be adjusted to the lifestyle and not the other way around.
It is about trying to reproduce, thanks to insulin injections, the secretion of insulin from the pancreas.
Treating diabetes with insulin
Insulin plays a key role in metabolism: this hormone is in fact essential for the transport of a sufficient amount of glucose from the blood into the cells of the body and its transformation into energy.
In people with type 1 diabetes, the pancreas no longer produces insulin and this must be given as part of insulin therapy.
In type 2 diabetes, insulin therapy may also be necessary.
To achieve treatment with insulin therapy, it is important to consider the following points:
- To maintain all body functions, the body needs insulin continuously (24 hours a day).
- With meals, an insulin supplement is needed, depending on the amount of carbohydrates ingested.
Insulin therapy for people with type 1 diabetes
The two most common forms of insulin therapy for people with type 1 diabetes are:
Intensified conventional therapy with insulin pens
Long-acting insulin is injected into adipose tissue once or twice a day and short-acting insulin is injected into adipose tissue on demand several times a day, depending on the meals.
Insulin Pump Therapy Continuous Subcutaneous Insulin Infusion
In this treatment, an insulin pump provides the body with continuous requirements for basic insulin (24 hours a day).
At meals, the necessary insulin supplement is delivered at the touch of a button.
Insulin is delivered by the insulin pump through a cannula placed in fat tissue.
Self-monitoring of blood glucose with a blood glucose meter is done several times a day.
These values are used as the basis for calculating mealtime insulin and possibly insulin correction.
Insulin therapy for people with type 2 diabetes
In people with type 2 diabetes, one of the following therapies is often chosen to initiate insulin therapy, with insulin being injected into adipose tissue with an insulin pen:
- Oral basal insulin therapy including insulin and long-acting tablets.
- Additional insulin therapy including insulin and short-acting tablets.
- Conventional treatment with a mixture of short-acting and long-acting insulins.