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Type 1 Diabetes - The Latest on New Insulins and Delivery SystemsDr. Zonszein is Professor of Clinical Medicine, Albert Einstein College of Medicine. All authors are staff members of the Clinical Diabetes Center of Montefiore Medical Center, New York.
Although the goal of insulin therapy for people with Type 1 diabetes has always been to keep blood sugar levels near normal ranges, there is a great difference, in long-term health, between near normal and normal. According to the landmark Diabetes Control and Complications Trial (DCCT) of 1983 to 1993, frequent monitoring of bloods sugar levels and aggressive insulin treatment to keep the levels consistently as close to normal as possible (A1C test results between 6% and 7%) are the key features of good care. With tight control of blood sugar, diabetes related damage to the eyes, kidneys, nervous system, and cardiovascular system, the main scourge of Type 1 diabetes, is much less likely.(2) (1) Today, people with Type 1 diabetes have many more tools to achieve this goal. For example, insulin is now available in rapid-, short-, intermediate- and long-acting formulations; these can be injected separately or mixed together in one syringe. Rapid-acting insulins have become available that are synthetic analogues (insulin lispro, insulin aspart, insulin glulisine) of natural insulin; recently, a rapid acting inhaled insulin, (Exubera®) was approved for clinical use. These analogues are chemically closer to the insulin naturally produced by the human body and are better able to mimic the action of naturally-secreted insulin; long-acting insulins are also available in analogue form (glargine and detamir); these are gradually replacing conventional intermediate-acting insulins such as lente and NPH, and the long-acting insulin, ultralente. The long-acting insulin analogues are more reliable and better at maintaining steady blood sugar levels. These are shown in Table 1a. Insulin preparations with a predetermined proportion of intermediate-acting insulin, mixed with short- or rapid-acting insulin, are also available. These are shown in Table 1. Table 1.
Fixed-Mixed Insulins.
Table 1 lists human insulins. Shown in green are "designed insulin analogues." The percentage of rapid or very rapid insulin is shown as the denominator.
Table 1a.
New and Commonly Used Insulins: Basal and Bolus
Conventional insulin therapy using a single daily injection, or two injections per day, is now giving way to the basal/bolus approach. The term basal refers to lower-dose amounts given regularly to help regulate overall blood sugar levels and the term bolus refers to one-time higher-dose amounts given to help the body react to the short-term spike in blood sugar levels caused by digesting a meal. Basal insulin is given as one to two daily injections of intermediate- or long-acting insulin, or via a continuous insulin pump. Bolus insulin — whether consisting of regular insulin, rapid-acting insulin analogues or the recently FDA-approved rapid-action inhaled insulin (Exubera®) — is given before each meal. The choice of dosage, frequency and type of insulin varies and depends on the individual's lifestyle, diet and other preferences.11 In order to achieve the best insulin treatment for any individual, it is critical to understand the different insulin types and how they act. For example, duration of action — how long they are effective within the body — is a critical consideration; this is affected by factors such as the type of insulin preparation, insulin dose, injection technique and site of injection.(12)
(1) Comment has been made fadili
le selenium evite t'il les complications du diabetePosted Wed, Apr. 6, 2011 at 6:00 pm EDT
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