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Insulin Therapy in Type 1 Diabetes

Insulin Therapy in Type 1 Diabetes. Key Messages Basal-prandial insulin regimens (e.g. multiple daily injections or continuous subcutaneous insulin infusion) are the insulin regimens of choice for all adults with type 1 diabetes.

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Insulin Therapy in Type 1 Diabetes

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  1. Insulin Therapy in Type 1 Diabetes Key Messages • Basal-prandial insulin regimens (e.g. multiple daily injections or continuous subcutaneous insulin infusion) are the insulin regimens of choice for all adults with type 1 diabetes. • Insulin regimens should be tailored to the individual’s treatment goals, lifestyle, diet, age, general health, motivation, hypoglycemia awareness status and ability for self-management. • All individuals with type 1 diabetes should be counselled about the risk, prevention and treatment of insulin-induced hypoglycemia.

  2. Insulin Therapy in Type 1 Diabetes 2008 CPG Recommendations Insulin regimens for type 1 diabetes • To achieve glycemic targets in adults with type 1 diabetes, multiple daily insulin injections (prandial [bolus] and basal insulin) or the use of CSII as part of an intensive diabetes management regimen is the treatment of choice [Grade A, Level 1A (6)]. • Rapid-acting insulin analogues (aspart or lispro), in combination with adequate basal insulin, should be considered over regular insulin to improve A1C while minimizing the occurrence of hypoglycemia [Grade B, Level 2 (9,11)] and to achieve postprandial glucose targets [Grade B, Level 2 (76)].

  3. Insulin Therapy in Type 1 Diabetes 2008 CPG Recommendations Insulin regimens for type 1 diabetes • Insulin aspart or insulin lispro should be used when CSII is used in adults with type 1 diabetes [Grade B, Level 2 (29,30)]. • A long-acting insulin analogue (detemir, glargine) may be considered as an alternative to NPH as the basal insulin [Grade B, Level 2 (17-20)] to reduce the risk of hypoglycemia [Grade B, Level 2 (50), for detemir; Grade C, Level (51), for glargine], including nocturnal hypoglycemia [Grade B, Level 2 (50), for detemir; Grade D, Consensus, for glargine].

  4. Insulin Therapy in Type 1 Diabetes 2008 CPG Recommendations Hypoglycemia • All individuals with type 1 diabetes should be counselled about the risk and prevention of insulin-induced hypoglycemia, and risk factors for severe hypoglycemia should be identified and addressed [Grade D, Consensus]. • In individuals with hypoglycemia unawareness, the following strategies should be implemented to reduce the risk of hypoglycemia and to attempt to regain hypoglycemia awareness:

  5. Insulin Therapy in Type 1 Diabetes 2008 CPG Recommendations • Increased frequency of SMBG, including periodic assessment during sleeping hours [Grade D, consensus]. • Less stringent glycemic targets with avoidance of hypoglycemia [Grade C, Level 3 (72,73)]. • Consideration of a psychobehavioural intervention program (blood glucose awareness training), if available [Grade B, Level 2 (75)].

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