In type 1 diabetes, the pancreas produces too little or no insulin at all. Therefore, type 1 diabetics will always need to take insulin to manage their condition. Type 2 diabetics may or may not need to undergo insulin therapy; for some people with type 2 diabetes, healthy lifestyle choices like increased exercise and a healthier diet are enough to control their condition. However, some people with type 2 diabetes may be prescribed an oral medication to control their blood sugar. Oral medications are used for mild cases of diabetes, and insulin is used for more severe, or poorly controlled, type 2 diabetes.
Insulin
If your body no longer makes enough insulin, you will need to get it from an outside source. The primary means of insulin administration is injection, using a needle and syringe or an insulin pen. Another option is to use an insulin pump, which is a small machine that can be worn on a belt or in a pocket that connects to a small plastic tube and a small needle. The pump delivers insulin in small amounts regularly via the needle, which is inserted under the skin and stays there for a few days at a time. A third option (though uncommon) is an insulin jet injector, which looks like a large pen and uses high-pressure air to release a fine spray of insulin into the skin. There are also currently a number of companies developing oral insulin in the form of a pill, but none have been approved for use.
Insulin used to treat diabetes can generally be broken down into four groups, categorized by how long they take to begin working after administration, when they peak in effectiveness, and how long they last.
|
Insulin type (and examples) |
Onset |
Peak time |
Duration |
|
Rapid acting
|
5 to 15 minutes |
45 to 90 minutes |
3 to 4 hours |
|
Short acting
|
30 minutes |
2 to 5 hours |
5 to 8 hours |
|
Intermediate acting
|
1 to 3 hours |
6 to 12 hours |
16 to 24 hours |
|
Long acting
|
1 to 4 hours |
none |
20 to 24 hours |
Many diabetes patients are prescribed a mixture of insulin. Common mixtures include:
|
Mixture type (and brand name) |
Onset |
Peak time |
Duration |
|
70% NPH/30% regular (Humulin 70/30) |
30 minutes |
2 to 4 hours |
12 to 24 hours |
|
70% NPH/30% regular (Novolin 70/30) |
30 minutes |
2 to 12 hours |
20 to 24 hours |
|
50% lispro protamine/50% insulin lispro (Humalog Mix 50/50) |
30 minutes |
2 to 12 hours |
20 to 24 hours |
|
75% lispro protamine (NPL)/25% lispro (Humalog Mix 75/25) |
15 minutes |
30 minutes to 3 hours |
16 to 22 hours |
|
70% aspart protamine/30% aspart |
10 to 20 minutes |
1 to 4 hours |
20 to 24 hours |
Type 2 Medications
Each type of medication for type 2 diabetes will help lower blood sugar levels in a different way. Your physician will prescribe the treatment plan that will work best for you and will give you directions as to the times, dosage, and frequency of each type of medication. Diabetes drugs are categorized by the action they produce:
Medications that Increase Insulin Production
- DPP-IV
inhibitors
- Saxagliptin (Onglyza)
- Sitagliptin (Januiva)
- Meglitinides
- Repaglinide (Prandin)
- Nateglinide (Starlix)
- Sulfonylureas
- Glipizide (Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (DiaBeta, Glynase)
Medications that Alter Insulin Action
These drugs act primarily by decreasing the amount of glucose produced by the liver. They also help lower blood glucose levels by making muscle tissue more sensitive to insulin, so that glucose is better absorbed.
- Metformin (Glucophage, Glucophage XR, Riomet)
- Thiazolidinediones
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
Medications that Interfere with Glucose Absorption
These drugs act by preventing the breakdown of food into sugars and, therefore, blocking the body's absorption of glucose.
- Alpha-glucosidase inhibitors (Precose)
