Diabetes Treatment: Insulin Types, Insulin Delivery, and Other Options (2023)
Time to read 13 min
Time to read 13 min
Are you or a loved one living with diabetes? Staying on top of treatment options can be overwhelming, but we're here to help!
Our comprehensive guide covers everything you need to know about diabetes treatment in 2023, including different types of insulin, delivery methods, and other innovative options.
Whether you're newly diagnosed or have been managing your condition for years, this article will provide valuable insights to help you take control of your blood sugar level!
Diabetes mellitus is a chronic condition where your body has difficulty regulating blood sugar or glucose. This usually leads to high blood sugar levels, also known as hyperglycemia, which has several manifestations.
For example, people with diabetes experience symptoms such as increased thirst and urination, blurred vision, fatigue, and slow-healing wounds.
The reason people with diabetes can't control their blood glucose levels is usually due to a problem with their insulin levels. The body uses insulin, produced by the pancreas, to manage blood sugar levels. Insulin takes excess glucose, especially following a meal, and pushes it into body cells to be burned for energy.
People with diabetes either can't produce insulin at all or they're producing a small amount of insulin that can't clear out their blood glucose fast enough (or a normal amount, but their cells become resistant to it).
This results in either type 1 or type 2 diabetes.
In both cases, your healthcare provider might prescribe insulin or other medications that stimulate insulin secretion to help you control your blood sugar.
It's important for individuals with diabetes to work closely with their healthcare provider to monitor and manage their blood sugar levels to prevent complications like nerve damage, kidney damage, and vision loss.
There are three main types of diabetes: type 1, type 2, and gestational diabetes.
Type 1 diabetes, also called insulin-dependent diabetes, is less common in about 5-10% of diabetics.
Type 1 diabetes is caused by a misguided immune response that damages the pancreatic cells responsible for producing insulin.
As a result, people with this condition can't produce insulin and must rely on lifelong insulin supplementation to manage their blood sugar levels.
This is where the name "insulin-dependent diabetes" comes from.
Type 1 diabetes is also known as juvenile diabetes because it affects younger individuals, including children, teenagers, and adults. It usually manifests early on in life, and children with type 1 diabetes are immediately started on insulin.
Type 2 diabetes is the most common type of diabetes, accounting for about 90 to 95% of all cases.
People with type 2 diabetes can produce insulin, unlike type 1 diabetics, but the insulin isn't working well enough. This is because either their body isn't producing enough insulin to handle the excess sugar in their blood or the insulin isn't working properly.
When insulin secretion is normal but the insulin isn't doing its job, this is called insulin resistance. It's a case where your body's cells don't listen to insulin when pushing glucose into the cells.
In the case of insulin resistance, several medications can improve how your body handles insulin by increasing insulin sensitivity. On the other hand, if you have low insulin production, your doctor might prescribe insulin injections or medication that boosts your natural insulin secretion.
Gestational diabetes is a temporary type of diabetes that occurs in pregnant women due to hormonal and metabolic changes. These changes can cause elevated blood sugar levels, which cause signs and symptoms similar to type 1 and 2 diabetes.
Doctors usually order an oral glucose tolerance test to diagnose gestational diabetes. Depending on how high your blood sugar levels are, you might not even need medication. Diet changes, moderate exercise, and proper glucose monitoring are usually enough.
However, if the results indicate you need treatment, your doctor will usually start you on diabetes medications (typically insulin) for a short period until delivery.
Prediabetes isn't really a type of diabetes. It's more of an intermediate state between having normal blood sugar and being diabetic. People with prediabetes have high blood sugar levels, but not enough to warrant a diabetes diagnosis.
Following a healthy diet and exercising can keep your blood glucose levels in check and delay or even prevent diabetes.
Your doctor might prescribe insulin or other diabetes medication depending on the type of diabetes you have and how well your blood sugar is under control.
Healthcare providers often combine several types of medication to keep your blood sugar levels in the optimum range at different times throughout the day.
Insulin is one of the most important diabetes medications, especially for type 1 diabetics who can't live without it.
People with insulin resistance or type 2 diabetics can also benefit from an extra dose of insulin, especially at meal times to help get rid of the extra glucose that comes from food and drinks.
There are several types of insulin, each named according to how long it takes to work and how long it remains in your body. Some types of insulin are given names according to when they're taken during the day.
For example, the insulin taken right before a meal is often called mealtime or bolus insulin. This type of insulin helps control your blood glucose levels and keep them from rising too high after meals.
Another type of insulin, called background or basal insulin, helps control your blood sugar throughout the day. It keeps your blood sugar levels from rising between meals or during the night. This kind of insulin is usually taken once or twice daily for 24-hour glycemic control.
Here's a breakdown of the different types of insulin based on how long they work in your body:
This is the fastest type of insulin, with an onset of about 2.5 to 20 minutes. Rapid-acting insulin should be taken before a meal; otherwise, you might develop low blood sugar.
Some examples include insulin aspart, insulin lispro, and insulin glulisine.
This type of insulin should be taken about half an hour before food because it takes about 30 minutes to start working.
A popular example of short-acting insulin is regular insulin (Novolin R).
This type of insulin usually works within 60 to 90 minutes and stays in the bloodstream longer than short and rapid-acting insulins.
Intermediate-acting insulin, such as NPH insulin, is usually cloudy and should be shaken well before administration.
This type of insulin is slowly absorbed and released over 18 to 24 hours, which is why long-acting insulin helps control your blood sugar level throughout the day rather than at mealtime.
Examples include insulin detemir, insulin glargine, and insulin degludec.
This is usually a mixture of rapid or short-acting insulin with intermediate or long-acting insulin. This combination reaps the benefits of both types of insulin, throughout the day and at mealtimes. It also saves you the trouble of taking multiple injections daily.
Keep in mind that there's no one-size-fits-all when it comes to insulin.
Your diabetes treatment team might prescribe two or more separate types of insulin or one premixed insulin combination, depending on your blood sugar control.
Managing diabetes involves monitoring your body's response to insulin and adjusting your dose accordingly.
You could take insulin in different ways, depending on your lifestyle, insurance plan, and personal preferences.
Traditionally, there were four common methods of insulin delivery: needles and syringes, pens, insulin pumps, and inhaled insulin.
However, needle-free injection devices have become much more popular nowadays, especially with people who have needle phobia.
Here's how each insulin delivery method works.
This is the most basic method of taking insulin, although not many people prefer it. A needle and syringe means you must poke yourself at least once or twice daily with every insulin shot.
For example, let's say you take your morning insulin dose in the back of your right arm. When taking your nighttime insulin before going to bed, you should switch arms and take it in the left arm.
Using a needle and syringe is often difficult for people with needle phobia, so some diabetics prefer needle-free insulin devices or insulin pumps.
Insulin pens are similar to syringes, but they come prefilled with insulin, and all you have to do is set the dose before taking it. This means there's no dose measurement involved, so there's less risk of taking more or less insulin than you're supposed to.
Some pens are made for one-time use, while others have replaceable cartridges. While pens are generally more expensive than the traditional needle and syringe, they're often a better choice for people who have difficulty holding a vial while filling a syringe.
An insulin pump is a small device that goes under the skin and contains an insulin reservoir. It delivers a steady basal insulin dose throughout the day to keep your blood sugar within range. It also provides additional bolus insulin doses during meals so your blood sugar doesn't spike because of the food.
In other words, insulin pumps act similarly to the body's natural insulin production, keeping your blood sugar under control at all times.
Another great thing about insulin pumps is that they work as an automated insulin delivery system. You don't need to adjust insulin doses or prick yourself with a needle or syringe, which is perfect for people with needle phobia.
However, you might need to change the tubing or different parts of the insulin pump once a week, which can be a hassle.
Inhaled insulin is usually rapid-acting insulin that you breathe in through your mouth. The insulin gets absorbed through the lungs and reaches the bloodstream.
However, doses of inhaled insulin are usually inaccurate because it depends on how well you inhale and how much insulin reaches the lungs.
It's also hard for people with asthma or respiratory conditions to inhale hard enough for the insulin to find its way to the small capillaries of the lungs.
This is why inhaled insulin is very limited, and not many doctors prescribe it.
Needle-free injection devices like jet injectors have become extremely popular with diabetics. They provide a simple way to take your insulin doses without worrying about needles or calculating your dose.
These devices release a fine jet of insulin into your skin under high pressure. The high pressure allows the insulin to penetrate your skin layers and reach the subcutaneous layers, where it gets dispersed and absorbed.
The entire process is virtually painless and takes less than a second!
Jet injectors, such as InsuJet, are great for people who suffer from needle phobia or those who hate getting pricked multiple times daily.
Sometimes, your blood sugar levels aren't high enough to warrant insulin injections. Your doctor might feel some oral medications are enough for managing diabetes.
They might also prescribe oral diabetes medicines along with insulin to improve your insulin's efficiency.
Here are some of the most commonly prescribed diabetes medications besides insulin.
Biguandies are usually one of the first oral medications your doctor might start you on if you have mild diabetes risk factors. They're not as strong as insulin because they don't directly handle the glucose in your bloodstream.
Instead, biguanides reduce the amount of sugar or glucose your liver creates, preventing your blood sugar levels from rising too high.
Biguanides can also increase your body's sensitivity to insulin, so they're often recommended alongside insulin therapy. They can lower blood sugar levels and help you avoid diabetes complications.
The most popular biguanide prescribed to treat diabetes is metformin (Glucophage), usually taken twice daily. The American Diabetes Association recommends taking metformin with food to avoid diarrhea, a common side effect when you first start taking it.
Another common side effect of metformin is weight loss, so don't be surprised if you start to lose weight.
DPP-4 inhibitors, as the name suggests, are a type of medication that inhibits a chemical in your body called DPP-4. This chemical destroys a hormone called incretin, which normally encourages insulin production.
In other words, DPP-4 inhibitors protect your body's incretin, which tells your body to produce more insulin. This is especially helpful for people with type 2 diabetes or those with insulin resistance because they usually have low insulin levels.
DPP-4 inhibitors can be taken alone or in combination with insulin therapy as part of your diabetes treatment plan.
These oral medications are known to improve your A1C results, a blood test showing your blood sugar control over the past 2-3 months.
However, inform your doctor if you suffer from any digestive and kidney diseases before taking these drugs because you might need to adjust your dosage.
The most common DPP-4 inhibitors include alogliptin, linagliptin, saxagliptin, and sitagliptin.
GLP-1 receptor agonists are also called incretin mimetics because they mimic the action of the incretin hormone in the human body. This means they encourage your body to produce more insulin following a meal so your blood sugar doesn't get too high.
The great thing about GLP-1 receptor agonists is that their effects can last for hours or even days, which gives you more control over your blood sugar.
These medications are often taken as subcutaneous injections, once daily, twice daily, or once weekly.
Some of them, such as semaglutide, also come as pills.
Normally, your kidneys absorb glucose and push it into the bloodstream rather than excrete it in urine.
SGLT2 inhibitors help lower blood sugar by encouraging your kidneys to eliminate more glucose through urine instead of reabsorbing it.
These diabetes medicines are usually taken in the form of pills. Some of the most common SGLT-2 inhibitors are canagliflozin, dapagliflozin, and empagliflozin.
Insulin secretagogues are diabetes medications that encourage your body to produce more insulin.
They're especially helpful for people with type 2 diabetes because they stimulate the pancreas to work harder and pump out insulin.
There are generally two classes of insulin secretagogues: sulfonylureas, such as Glimepiride, and meglitinides, such as Repaglinide.
TZDs, which is short for thiazolidinediones, is a class of diabetes medicines that increase your insulin sensitivity. They also minimize the amount of glucose your liver produces, similar to biguanides.
TZDs can help people with insulin resistance better utilize their insulin and keep their blood sugar levels within optimal range.
The most commonly used TZD is pioglitazone, but your doctor might prescribe another drug called rosiglitazone in some rare cases.
Not only does medication help you manage your diabetes, but it helps prevent several health problems and complications.
For example, people with uncontrolled blood glucose levels have an increased risk of high blood pressure, kidney disease, and cardiovascular disease (heart disease).
Taking your medication treats your diabetes and prevents countless other conditions and health problems.
It's also important to follow your dosing schedule strictly and pay attention to how your body responds to medication like insulin.
For example, if you feel symptoms of high blood sugar, such as increased urination, thirst, or fatigue, this could signal that your insulin or diabetes medication isn't working.
You might be taking your medication incorrectly or it could be that your body isn't responding and you need to change medication.
Taking your insulin or other diabetes treatments is important, but without proper diet and exercise, you'll have difficulty controlling your blood sugar levels.
For instance, if you take insulin without eating, you might develop severe hypoglycemia, when your blood sugar level drops to dangerously low. If your blood glucose reaches 54 mg/dL or below, you might pass out, have a seizure, or even go into a coma!
On the other hand, if your diet lacks nutritious, healthy foods, your daily insulin might work better than you'd like. This could lead to high glucose levels, resulting in a coma.
A proper diet and healthy eating also help you achieve your ideal body weight, which is crucial for diabetics since obesity is one of the leading risk factors for diabetes.
Other benefits of these healthy lifestyle changes include:
Improved Cholesterol Levels: Exercise and a healthy diet can raise your HDL (good) cholesterol levels and lower triglycerides, improving your overall cholesterol profiles and reducing the risk of heart disease.
Better Sleep: Regular exercise and a balanced diet can help improve sleep patterns and reduce the risk of sleep apnea, a common complication of diabetes.
Improved Mental Health: Exercise and a healthy diet can help reduce stress, anxiety, and depression, all common among people with diabetes.
Increased Energy Levels: Eating a healthy diet and engaging in regular exercise can increase energy levels and reduce fatigue, making it easier to manage daily activities.
Living with diabetes doesn't have to mean living without freedom.
With advancements in insulin types, delivery methods, and alternative treatments, managing your condition has never been easier.
With the information in this article, you can take charge of your diabetes care today and unlock a life full of possibilities!