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Type 1 Diabetes Treatments

What Is Type 1 Diabetes?

Type 1 diabetes (T1D) is an autoimmune condition in which the pancreas can no longer produce insulin to control your blood sugar naturally. So you need to take insulin in order to manage your blood sugar to remain healthy and avoid serious complications. 

Since type 1 diabetes (T1D) is characterized by the complete inability of your pancreas to produce this essential hormone, you need to introduce insulin since it is responsible for keeping your blood sugar at an appropriate level—not too high (hyperglycemia) and not too low (hypoglycemia).

Managing Glucose in T1D Has But One Treatment—Insulin

The first and primary medication give to someone with T1D is insulin. This has been our standard approach to treatment since the discovery and subsequent creation of insulin in humans for more than a century. The two medications approved by the Food and Drug Administration (FDA) to manage blood sugars in people with type 1 diabetes are—insulin and Symlin.

People with type 1 diabetes require insulin to treat their condition. Insulin is the essential treatment to manage blood sugar in people with type 1 diabetes. There are many devices available to help you take insulin.

Treating T1D is all about insulin—and the best way for you to get the amount of this essential hormone necessary to enable the glucose circulating in your blood to be properly absorbed by your body.  Glucose is the main source of sugar that your body depends on for fuel (instant energy). But in order for your body to use blood glucose properly, you will need to receive insulin.

Having too much glucose (hyperglycemia) in your body can cause serious complications as can having too little glucose in your blood (hypoglycemia). In order to avoid these undesirable extremes in blood sugar—too high or too low— anyone with type 1 diabetes must take insulin to help their bodies use glucose effectively. 
 

Insulin was first successfully used in humans in 1922. Originally, it was made by extracting it from the pancreas of animals: dogs, cows, and pigs, specifically. But by 1978, insulin was created synthetically, or exogenously, meaning it is now made in the lab.  You can read more about insulin.

Understand the Types of Insulin Available to Be In Good Glucose Control 

All types of insulin have the same effect in helping control your blood sugar, and must be injected through the skin so the body or inhaled into the lungs so your body can make use of it. If insulin were swallowed, as in a pill form, your stomach acids would break it down so it wouldn’t be available to do the job of controlling blood sugar levels.

There are many types and brands of insulin available for use today and the brand you use is dependent upon your insurance coverage, your lifestyle, and your overall needs. 

However, types of insulin do differ in how quickly and how long they will last. See Table 1 for a comprehensive list of the types of insulin, their delivery method, how quickly they act, and how long they last.

First, there are four basic categories of insulin:

  • Rapid-acting insulin begins working in about 15 minutes and lasts between 3 to 4 hours. It’s usually taken just before a meal.
  • Short-acting insulin tends to be working about 30 to 60 minutes after it’s been injected. You can expect this form to last between 5 and 8 hours and should be taken before your meal.
  • Intermediate-acting insulin will begin to work about 1 to 2 hours after you inject it and its effects will last for 14 to 16 hours.
  • Long-acting insulin typically begins working after 2 hours post-injection and will continue working or up to 24 hours or more.

The goal of taking insulin is to keep your blood sugar in a healthy range; this is considered well controlled. You will check your blood sugar and consider the number of carbs in your next meal or snack in order to determine the amount of insulin you will need.

In addition to daily blood glucose checks, your doctor will calculate your hemoglobin A1c, which is a blood measure that provides a guide to your estimated blood glucose levels over three months. Generally speaking, the average serum hemoglobin A1c decrease using insulin is between 1-2.5%. 

Below is an overview of the types of insulins, whether they are available in a vial, which requires a syringe to prepare the injection or an injectable pen in which the insulin is premeasured into a device that is ready to use.

Table 1. Insulin Options to Manage Type 1 DiabetesTable 1. Insulin Options to Manage Type 1 Diabetes

Treatments for T1D: Beyond Insulin

Pramlintide, brand name Symlin, is an injectable hormone that works along with insulin.  It has been found that when insulin is not made, neither is amylin.  This product was designed to fill that gap.  Its main use is to help with post-meal (postprandial) blood sugars.  Symlin was approved by the FDA in 2005 and is designed to be taken as an injection at all meals and snacks to reduce insulin doses, reduce stomach emptying and reduce the rise in post-meal blood sugars. 

It cannot be mixed with insulin—Note it must be taken separately.  It is currently available by injectable pen only.  Research results indicate that use of Symlin in type 1 diabetes, in conjunction with insulin, can reduce the amount of insulin needed by 0.8-7.1 units per day. 

In addition, pramlintide has been shown to achieve a beneficial reduction in A1c of -0.24-0.58% and may support weight loss of 1.8-3.5 pounds. While these benefits may be very appealing, you'll need to decide if you are up to consistently taking an additional 3-5 injections a day. Another factor is health insurance reimbursement, which will vary and should be checked before deciding whether to add this treatment or not. 

Understanding the Limits of Treatment Options

There are a few other medications that are typically used to help manage type 2 diabetes (T2D) that have been making their ways into the type 1 diabetes world, specifically, metformin; however, it has NOT been approved by the FDA for use specifically in people with type 1 diabetes.

When the FDA approves new medications, this agency will stipulate who can receive the drug and for what conditions. This information is based on results of clinical trials that have been conducted to see how well people respond to the medication when compared to no treatment or to another tested medication.  

It is becoming increasingly less uncommon for drugs to be prescribed for reasons beyond its original approval—a practice called “off-label” use. What that means is that when there are no studies to back up its use for a particular patient, your doctor might consider it worth giving you to try. This happens when the usual or standard treatments aren’t working so prescribing a medication that has worked for similar conditions is given. 

While it may still be safe and beneficial to use these drugs in a manner that does not fit with the original FDA approval, we do not know the long term benefits and safety of their use because formal research studies have not been conducted to gather this kind of information. It also means that if someone uses a drug off-label, insurance companies may not cover the cost.

Therefore, it is always good to have a conversation with your healthcare professional about the benefits of using such medications and also inquiring about what the cost of taking a recommended medication may mean to you. your healthcare provider will choose the insulin will depend upon many things including the expiration date for insulin once the vial or pen is used for the first time (how long it remains active) as well as their onset (when they start working), the peak (the approximate time where blood glucose may be most beneficial) and duration (how long they last).

Your level of physical activity level, as well as your meals and snacks (eg, how many carbs), will also be considered when planning for your insulin needs.

When the FDA approves new medications, this agency will stipulate who can receive the drug and for what conditions. This information is based on results of clinical trials that have been conducted to see how well people respond to the medication when compared to no treatment or to another tested medication.  It is becoming increasingly less uncommon for drugs to be used for other reasons beyond its original approval—a practice called “off-label” use.

What that means is that when there are no studies to back up its use for a particular patient, your doctor might consider it worth giving you to try. This happens when the usual or standard treatments aren’t working so prescribing a medication that has worked for similar conditions is given. 

While it may still be safe and beneficial to use these drugs in a manner that does not fit with the original FDA approval, we do not know the long term benefits and safety of their use because formal research studies have not been conducted to gather this kind of information. It also means that if someone uses a drug off-label, insurance companies may not cover the cost. Therefore, it is always good to have a conversation with your healthcare professional about the benefits of using such medications and also inquiring about what the cost of taking a recommended medication may mean to you.

 

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