People with diabetes often have problems with their insulin, that’s why doctors commonly advise for a replacement therapy. What’s the idea behind insulin replacement therapy for Type 1 diabetes?
What is Insulin Replacement Therapy?
Insulin Replacement Therapy also goes by other names including basal-bolus therapy and intensive insulin therapy.
Simply put, this is a broad approach that aims to mimic the way our body delivers insulin.
Why Do Type 1 Diabetics Need Insulin Replacement Therapy?
But why do people who suffer from Type 1 diabetes need intensive insulin therapy?
To clearly understand the rationale, we need to briefly review some concepts:
- Insulin is a hormone that helps our cells use sugar (glucose) for energy.
- People who do not have diabetes release insulin in two patterns: background and prandial.
- The background pattern continuously secretes small amounts of insulin.
- On the other hand, the prandial pattern secretes insulin rapidly. And the amount is dependent on the rise of glucose from food consumption.
Now, let’s consider this: people who suffer from Type 1 diabetes have what medical experts call “absolute insulin deficiency.” This means that their body makes very little or no insulin at all.
For this reason, they need to “replace” their insulin in a manner that’s similar to how our body normally does it.
In other words, insulin replacement therapy for people with Type 1 diabetes not only provides insulin. But it also tries to deliver the insulin using the normal patterns of secretion.
This is where the name basal-bolus came from. Basal mimics the background pattern, while bolus mimics the prandial pattern.
Without intensive insulin therapy, people with Type 1 diabetes risk developing complications of uncontrolled blood sugar levels.
How does Insulin Replacement Therapy Work?
Because the goal is to imitate how our body secretes the insulin hormone, the replacement therapy cannot rely on one type of insulin alone.
Generally, the therapy has four types of insulin, based on the basal-bolus pattern.
These 4 types vary in onset, peak, and duration. To further explain, here’s more information about these differences:
- Onset – denotes how fast the insulin work right after it’s injected.
- Peak – refers to the time when the insulin is most helpful in lowering the blood sugar level.
- Duration – indicates how long the insulin keeps working in the body.
The Four Types of Insulin in Basal-Bolus Therapy
- Rapid-acting – Approximately works 15 minutes after administration, peaks at one hour, and lasts for 2 to 4 hours. You often need to inject rapid-acting insulin before meals.
- Short-acting – Onsets at 30 minutes after administration, peaks at 2 to 3 hours, and lasts for 3 to 6 hours. Just like rapid-acting insulin, you need to have short-acting insulin before meals.
- Intermediate-acting – Approximately works 2 to 4 hours after administration, peaks at 4 to 12 hours, and lasts for 12 to 18 hours. Intermediate-acting insulin needs to be administered at the same time each day. Additionally, meal times must also follow a fixed schedule.
- Long-acting – Onsets at 1 to several hours after administration, has no peak, and lasts for 24 hours.
If you’ll notice the rapid-acting and short-acting types mimic the prandial or bolus pattern.
Likewise, the long-acting and intermediate-acting imitate the basal or background pattern.
How To Administer Insulin Replacement Therapy
According to the principles of insulin therapy in diabetes, patients may need two types of insulin to control their sugar levels.
Some types need to be injected separately, while other kinds already have two types of insulin in one injection.
To deliver the insulin, you and your doctor may discuss the following options of delivery:
- Syringe – The method is to draw insulin out of a bottle and inject it into the skin. This is the most common of insulin administration.
- Pen – Another option is to use insulin pens or shots. The pen looks like a regular writing pen, but it has a cartridge that contains insulin. To adjust the dose, you need to turn the dial. One end of the pen has a needle which functions to inject the hormone. Insulin shots are meant for multiple, daily doses.
- Jet Injector – This looks like a pen, but a larger one. The premise is to make high-pressure air to “spray” insulin to the skin.
- Pump – An insulin pump commonly looks like a small, rectangular device that has plastic tubing. On the other end of the tube is a small needle inserted in the skin near the abdomen. You can use an insulin pump to inject a bolus dose of insulin when needed.
- Inhaled-insulin – Another way to deliver insulin is through inhalation. It is usually rapid-acting and used at the beginning of meals. However, people with respiratory conditions like asthma and COPD should not use this method of insulin delivery.
Despite the comprehensiveness of insulin replacement therapy for patients with Type 1 diabetes, it will still not work on its own. Medical experts emphasize that to ensure that you maintain healthy blood sugar levels, patients still need to:
- Regularly monitor blood glucose, especially before meals, bedtime, and activities, such as driving.
- Fully understand how insulin works in their body
- Be mindful of their diet, and especially count their carbohydrate intake through meticulous meal planning.
- Establish blood sugar goals before and after meals and at bedtime.
- Know what to do when these blood sugar goals are not achieved.
- Know what to do during emergencies.
- Have frequent and close follow ups with their physician to fully control their blood sugar.
In other words, the principles of insulin therapy will not be successful without a holistic approach.
Constant communication between you and your healthcare provider is a must.
Learn more about Diabetes here.
Hello Health Group does not provide medical advice, diagnosis or treatment.