What Is the Treatment of Type 1 Diabetes Initiated at Diagnosis?
Clinical scenario
In type 1 diabetes mellitus, insulin therapy is started immediately at the time of diagnosis. The protocol addresses which insulin regimen to initiate and how to set it up to reach glycemic targets while minimising the risk of hypoglycemia.
Treatment approach (partial overview)
The approach centres on a basal-bolus injection regimen combining a long-acting basal insulin analogue with a rapid-acting prandial insulin analogue given around meals. The full protocol specifies which agents are recommended, the timing of each injection relative to meals, and how analogues are selected over older insulin formulations.
Specific agents, administration schedule, and dosing guidance are detailed in the complete protocol below.
Clinical goals
- Lower fasting plasma glucose
- Lower postprandial blood glucose
- Avoidance of hypoglycemia
References
DOI: 10.1016/j.jcjd.2017.10.012
- People with type 1 diabetes are initiated on insulin therapy immediately at diagnosis.
- In adults with type 1 diabetes, basal-bolus injection therapy or CSII as part of an intensive diabetes management regimen should be used to achieve glycemic targets.
- Basal insulin is given once or twice a day and includes long-acting insulin analogues and intermediate-acting insulin neutral protamine Hagedorn (NPH).
- In adults with type 1 diabetes using basal-bolus injection therapy or CSII, rapid-acting insulin analogues should be used in place of regular insulin to improve A1C and to minimize the risk of hypoglycemia.
- The U-100 long-acting analogues, insulin detemir and insulin glargine (with rapid-acting insulin analogues for meals) resulted in lower fasting plasma glucose (FPG) levels and less hypoglycemia or nocturnal hypoglycemia compared with once- or twice-daily NPH insulin.
- Preprandial injections of rapid-acting insulin analogues result in a lower postprandial glucose and improved overall glycemic control.
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