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Medically reviewed and verified by Kate Burke, MD, MHA
Type 1 diabetes (T1D) is a condition where the body cannot produce insulin, a hormone necessary for regulating blood sugar levels. Managing T1D typically involves using insulin and other medications to help keep blood sugar levels within a target range. Here’s an overview of the common medications used.
Insulin
In 1921, researchers from the University of Toronto discovered insulin. Before then, a diabetes diagnosis was as good as a death sentence. There was no real treatment for the condition, and sometimes the treatment of a strict diet led to people passing from starvation. Now, insulin requires a prescription and is the main treatment for type 1 diabetes. Over the last 100+ years, we have developed a few different types depending on need.
- Rapid-Acting Insulin: This starts working within 15 minutes and lasts for about 3-5 hours. It is usually taken before meals to stop blood sugar levels from spiking after eating. Examples include: aspart, glulisine, and lispro.
- Short-Acting Insulin: Short-acting insulin stats working within 30 minutes and lasts about 5-8 hours. It is also usually taken before meals. The two major brands are Acrapid and Humulin S.
- Intermediate-Acting Insulin: Intermediate-acting insulin starts working in 1-2 hours and lasts from 11-24 hours. It is injected once or twice a day, depending on the dose. Also known as basal insulin, this is available by prescription only and often delivered through a reusable insulin pen. The two major brands are Humulin I and Insulatard.
- Long-Acting Insulin: Long-acting insulin is also injected once or twice a day. It takes between 30 minutes and 4 hours to start working, and lasts from 16 to 24 hours. There are three types: detemir, glargine, and degulec.
- Pre-Mixed Insulin: Most of the types of insulin above need to be taken in combination with another type. Fast-acting insulin is paired with long-acting to ensure proper insulin delivery throughout the day. A pre-mixed insulin is when these two types are combined in one dose. They are typically prescribed for patients who need a simple treatment plan. The ratios of mixes can vary depending on which insulin your doctor prescribes.
How is Insulin Delivered?
There are three primary ways to administer insulin. Injections, inhalers, and pumps. Each has its advantages and disadvantages.
- Injections: This is the traditional method for administering insulin. Through a syringe or pen, diabetes patients usually give themselves multiple daily injections to manage blood sugar levels. These injections typically occur at regularly scheduled times. There is no effective difference between the syringe and the pen, but some may find the pen more convenient or comfortable.
- Pumps: These devices deliver continuous insulin through a small tube inserted under the skin. Some pumps communicate directly with a continuous glucose monitor for insulin delivery and blood sugar management. Pumps can be programmed to deliver different doses at different times. These provide greater flexibility with meals and exercise, as well as smoother control of blood sugar levels. People with pumps may experience hypoglycemia, and are at higher risk for hypoglycemia if the system is disrupted.
- Inhaler: An alternative to injections or implants, insulin inhalers work exactly how you would expect. They are used at the beginning of a meal and breathed in through the mouth. The insulin then enters your blood stream through the lungs. The only approved treatment today is a rapid-acting form of insulin. It needs to be used in combination with a long-acting form. Inhaled insulin is not commonly used by patients but there are some members on PatientsLikeMe who have reported using one.
Adjunctive Medications
While insulin is the primary treatment for T1D, other medications may be used in combination. These are known as adjunctive medications or therapies. They complement insulin to help with blood sugar control and to manage conditions like insulin resistance and obesity. There are two common types to be aware of.
- Pramlintide: Pramlintide is an injectable synthetic drug. It helps control blood sugar levels after meals by slowing the rate at which food leaves the stomach and reducing the amount of glucose produced by the liver. This drug has been approved for people with T1D who use mealtime insulin but do not hit their glycemic targets. It can also lead to weight-loss and decrease the risk of cardiovascular disease.
- Metformin: Metformin was first developed for type 2 diabetes. Taken in pill form, T1D patients can use it to help improve insulin sensitivity and reduce the dose of insulin required. There are metabolic benefits to taking the drug. This is particularly true for people with T1D who have an insulin resistance, weigh more than average, and are at risk of cardiovascular disease.
Click here to learn more about Type 1 Diabetes.
Managing type 1 diabetes takes care and attention. Insulin is the primary medication, delivered in a few different ways. Other medications may also help control blood sugar. Additionally, medications to manage complications, such as blood pressure and cholesterol-lowering drugs, are often necessary. Be sure to work closely with your doctor to determine what treatment plan is best for you!
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