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Type 1 Diabetes Treatments

Learn about the different types of insulin for type 1 diabetes and newer therapies to help you better manage your glucose better.

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 arises in response to the complete inability of the pancreas to produce this essential hormone, you need to provide your body with supplemental insulin. Having enough insulin is critical because this hormone is responsible for helping to regulate your blood sugar and keep it in a healthy range—not too high (hyperglycemia) and not too low (hypoglycemia).

Managing Glucose in T1D Once Had But One Treatment—Insulin

The first and primary medication given to someone with type 1 diabetes is insulin. This has been our standard approach to treatment since the discovery and development of exogenous or sythetically produced insulin in humans for more than a century. The two insulin options originally 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 the amount (dose) and timing of insulin, as well as the best way for you to get the right dose of this essential hormone to assure that the glucose circulating in your bloodis able to be properly absorbed by your body. Glucose is the main source of energy (sugar) that your body uses to keep all key functions running properly.The trick is that in order for your body to properly take in and use blood glucose properly, insulin is required to make this reaction work.

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 the original forms of insulin required delivery by in needle into a blood vessel (injectable) so the body can absorb it or inhaled into the lungs so your body can make use of it. Until recently, 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; now, with new technology, an oral form is becoming more widely available.

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

Treating 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. 

Advances in Diabetes Management: Introducing New Therapies

There has been concerted effort to develop new treatments either to enhance the function of insulin or improve glucose management.  This push has occurred perhaps because more people have type 1 diabetes and are not achieving the target hemoglobin A1c level of below 7% or 6.5%.

While it is common to believe that people with type 1 diabetes are at a healthy weight or even underweight, this is no longer true. In fact, more than two in three individuals with type 1 diabetes patients are facing overweight or obesity, further complicating their health status.1

So it is understandable that the research is continuing with the goal of findings add-on drugs or adjunctive medications that will complement the effects of the insulin and help you achieve a stable blood glucose level with more time-in-range. To date, many of these new treatments have been tested in individuals with type 2 diabetes.Yet, there is good reason to believe that these same medications may be helpful to many with type 1 diabetes as well.

There are a few 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 but is becoming a common consideration, particularly in anyone who is struggling to keep blood sugar in control and facing weight gain.

Most recently,  doctors are  looking at the use of a newer class of drugs known as SGLT2 inhibitors along with insulin. These drugs reduce blood sugar. Among these studies are one, known as DEPICT, which gave patients placebo or dapagliflozin (Farxiga). Those on the medication had better A1Cs and time in range (TIR) and lost more weight than those not on this regimen.2

Another series of seven randomized placebo-controlled studies, including the Empagliflozin as Adjunctive to inSulin thErapy, or EASE trials, which were done with a sodium glucose co-transporter 2, (SGLT2) inhibitor, empagliflozin (Jardiance) .3 This medication works by blocking the reabsorption of some blood sugar in the kidneys so the excess glucose is expelled from the body your urine.  The way this drug works, people have found it easier to lose weight, too.  

Also, another drug under study that you can watch for, is a swallowable capsule that is designed with a spring-loaded needle and contains compressed, freeze-dried insulin inside. It is designed so as the capsule enters the stomach, the insulin is released into the stomach wall through the needle and then enters the bloodstream. While the insulin escape the digestive acids and can go to work in the blood, the capsule device then passes safely through your digestive system and out.4

For those who would much prefer to get your insulin without having to inject yourself or prepare a syringe, an oral insulin capsule is under developed, as well; you can also look out for Ora-Lyn, an insulin spray that is applied to the inside of your cheek. A study of its safety and effectiveness is planned for sometime in 2020.5

Understanding the Drug Process So You Can Take Control of Your Diabetes Care

It is always good to have a conversation with your healthcare professional about the benefits of using any and all new medications and don’t be shy about asking about what the cost will be if you agree to try a recommended medication.  

When the FDA approves new medications, this government regulatory agency stipulates who can receive the drug and for what conditions based on data presented usually by a pharmacuetical company who developed the drug. 

This information is based on results of clinical trials that were conducted to see how well people respond to the medication when compared to no treatment or to another effective medication. Given the individual nature of people's response to medications and the wide variety of complications you may face, doctors rely more often on the use of drugs for reasons beyond its initially approved purpose.

It is becoming increasingly more common for drugs to be prescribed for reasons that may be suitable to a patient's needs that fall outside its original approval—a practice called “off-label” use. What this means is that when there are no  enough studies to demonstrate its use for a particular condition but your doctor recognizes that the way it works is likely to beneficial for you, it is worth trying it. 

This most often happens when the usual or standard treatments aren’t working well enough  to help you to control your blood sugar or other diabetes-related compliations such as blood pressure or blood cholesterol levels so prescribing a medication that is known to work for similar conditions can be a reason addition to your treatment plan. 

While a so-called off-label medication is considered to be safe and beneficial to manage a condition 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.

Be Open to Additional Therapies to Improve Your Glucose Control

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).

Of course, your level of physical activity level, the presence of a fever, and stress level as well as your usual meals and snacks (eg, how many carbs), will also be considered when planning for your insulin needs.

 

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