Treatment of Type I Diabetes (IDDM)
Insulin is always used in Type I diabetes.
Insulin Replacement Therapy
Insulin has to be injected as it is destroyed in the stomach. Research is going on to find a form of insulin that may be administered another way, including inhaled insulin.
Inhaled insulin
Inhaled insulin is a potential alternative to injected insulin therapy; the latter has been in place for around 80 years.
It is in powdered or liquid form, and is administered in a specially designed inhaler, and is inhaled 10 minutes before eating a meal.
It utilizes the large surface area of the lungs, to quickly absorb the insulin.
It may cause cough, breathlessness, and a dry mouth, and cannot be used if the person has smoked (or has given up in the last 6 months), or if the person suffers from chest conditions such as bronchitis, emphysema or asthma.
Long- term side effects are not known.
Though, on the whole, it is felt that the doses delivered are predictable and consistent, opinion varies as to the efficacy, and inhaled insulin is used in only a very small number of diabetics in this country at present.
The inhaled insulin at present licensed in this country is Exubera.
Insulin pump therapy
Insulin pump therapy refers to Continuous Subcutaneous Insulin Infusion (CSII) whereby insulin is continuously delivered 24 hours a day under the skin through a small catheter or tube, which requires changing about every 3 days. A small battery - operated pump device is used (controlled by a computer chip, but with ultimate control by the patient). It is about the size of a pager.
Fast - acting insulin is delivered at a steady rate and the baseline amount (dose) of insulin is tailored to the individual, following an intensive period of blood sugar testing several times a day to determine the individual’s needs and a period of training with a diabetic nurse, who specializes in pump training. At meal times, a dose of insulin is given, which is calculated to match the carbohydrate content of the meal.
It is ideal for people with Type 1 diabetes, who are likely to be highly motivated and who are keen to take control of their condition. It involves regular testing of blood sugar (at least 4 times a day) and the evidence is that blood sugar control may be better. However, without regular blood testing, control may worsen and one must always be on the alert for blockage of the catheter and for the pump running out of insulin.
Hypoglycaemia may occur if the dose of insulin is too high. In the initial period, errors may occur and it is important to have contact and backup of specially - trained staff.
People report greater flexibility in their lifestyle and freedom from a strict regimen, especially with regard to food and meals and this is particularly useful for teenagers and young adults. Continual adjusting of the baseline insulin level would be necessary while young people are growing. A good knowledge of the carbohydrate content of food is necessary as the bolus of insulin at mealtimes is matched to the carbohydrate value.
The insulin pump has tended to be used in children whose diabetes has been hard to control on an injection regime but is now being offered to all children under 12 who are suitable and to some adults. The pump is worn 24 hours a day and the injection site is moved around to avoid skin complications. Managing diabetes with an insulin pump is more complex than using an injection regimen. Children may be able to do this themselves from diagnosis but will need prompting and supervision. Adults age 16 and over will learn how to do this for themselves from diagnosis.
A child having insulin injection treatment is likely to require guidance and supervision of treatment until the 12th birthday. A child aged 11 and over diagnosed with insulin dependent diabetes is likely to become competent at managing their condition within 12 months. A child who moves on to insulin pump treatment after a period on insulin injections or who uses an insulin pump from diagnosis is likely to require guidance and supervision until the 14th birthday. A teenager who starts using an insulin pump is likely to become competent at managing it within 12 months.
Insulin pumps are expensive, both in buying in the first place and maintaining the supplies.
There is a danger (especially in active young people playing sports), that the pump and catheter may become dislodged, and the person has to get used to the fact that they always have to wear the pump.
However, blood sugar levels can be attained that are closer to normal and studies have shown that there may be fewer episodes of Hyperglycaemia and hypoglycaemia.
There are 3 basic different types of insulin, which have a different speed of onsetand duration of action, but insulin always comes in the strength of 100 units/ml.
- Short – acting insulin (e.g. Humalog, Novorapid, Humulin S, Actrapid)
- Intermediate – action insulin (e.g. Insulatard, Humulin I)
It peaks at 2-4 hours and its action lasts around 8 hours.
It has an onset of action 1 to 2 hours, reaches maximum activity in 6 to 10 hours and works for 18 to 26 hours.
- Long – acting insulins (i.e. Lantus Insulin, Glargine, Detemir)
Provides a static level of insulin and has an onset of activity at 1 to 2 hours, but activity never peaks and lasts for 18 to 24 hours.
The insulin regime is tailored to the individual and their lifestyle, how stable the diabetes is, etc.
Amended April 2011
