Therapy for diabetes


Conventional insulin therapy (CT)

This therapy usually involves injections of mixed insulin given twice a day, before breakfast and before evening meal.

Advantages of this regime - it only requires 2 injections. Disadvantages of this regime - inflexible, strict routine of mealtimes and quantity of carbohydrate intake needed. High risk of hypo's and hyper's unless extra carbohydrate or extra injections of a rapid acting insulin are given.

Conventional therapy is therefore suitable for young children where injections at school are not possible and Type 2 diabetics who still have some of their own insulin production.

Insulin release in non-diabetics

Insulin 'release' in conventional therapy (CT)

Insulin 'release' in conventional therapy compared with insulin release in non-diabetics:
too little insulin at mealtimes, as well as in the early hours of the morning and in the late afternoon, too little insulin in the mornings and particularly overnight.

Intensive conventional insulin therapy (ICT)

The fundamental idea behind intensive therapy which is also described in the section on pump therapy is the separation of background (basal) and mealtime (bolus) insulin intake. Background (basal) insulin is usually injected once or twice a day, covering the bodies basic insulin needs. Before each meal short acting or rapid acting insulin (boluses) are injected to cover the carbohydrate in those meals.

Disadvantages - multiple daily injections. Advantages - greater flexibility, more freedom with choice of food and times eaten. Less risk of hypo's and hyper's as greater choice in bolus doses to counteract levels.

Even with analogue basal insulins that have a flatter profile many diabetics still experience hypo's in the night and raised levels pre breakfast.

Despite carefully timing injections, "gaps" in the effect of insulin can occur causing variations in sugar levels. This is particularly so when there are changes to the daily routine of meals or physical activity.

Summary

Although diabetics who use intensive therapy have to inject themselves 4 or more times a day, and have to put up with limitations in their daily life, their insulin supply is not optimal. Insulin pump therapy can change this.

Insulin 'release' in intensified conventional therapy (ICT)

Insulin 'release' in intensive conventional therapy compared with insulin release in non-diabetics: too little insulin in the early hours of the morning and in the late afternoon, too much insulin in the middle of the day and particularly at night.