There are two main types of diabetes. In people with type 1 diabetes, their bodies make no insulin whatsoever, and they must take insulin the rest of their lives. People with type 2 diabetes usually still make some (but not enough) insulin, and often also have what is known as insulin resistance; where their bodies require more insulin to allow glucose to properly enter into their cells. Another important type of diabetes is called gestational diabetes; when the condition starts during pregnancy and may improve after delivery. Keeping mom's blood sugars normal is very important for baby. Other conditions, like cystic fibrosis or disorders requiring steroid therapy, may also have diabetes associated with them.
Typically, people with diabetes must take medicines to keep their blood sugar from rising too high. For patients with type 1 diabetes, only insulin therapy will work. For patients with type 2 diabetes, there are several types of oral medicine available to help keep blood glucose in a healthy range. For some type 2 patients, an oral medication is enough to achieve this goal. But many people need more help to do this. For them, a form of insulin is the answer.
People who take insulin must inject it (or inhale it) because it would break down in the stomach if taken orally.
Types of Insulin
Insulin is classified according to three factors: how long it takes to start working (onset), when it peaks, and how long it lasts (duration). There are two main categories: Background (basal) insulin, which tends to last longer and delivers a steady dose of insulin; and mealtime (bolus) insulin, which tends to have a shorter duration but delivers a greater amount of insulin to handle spikes in blood glucose after mealtimes.
|Background (basal) insulin|
||About 30 to 90 minutes||N/A||About 18 to 26 hours (up to 42 hours in Degludec)|
||About 2 to 4 hours||About 4 to 12 hours||About 12 to 18 hours|
|Mealtime (bolus) insulin|
|Short-acting (regular) insulin||
||About 30 minutes||About 2 to 3 hours||About 3 to 6 hours|
||About 15 minutes||About 1 hour||About 2 to 4 hours|
||About 15 minutes||About 30-60 minutes||About 1 ½ to 5 hours|
||About 3 minutes||About 30-60 minutes||About 3 to 5 hours|
People who take a background insulin along with a mealtime insulin have two options: They can take the background insulin once or twice a day, as prescribed, and take the mealtime insulin just before eating a meal, also as prescribed. Or, they can take a premixed insulin, which, as the name implies, combines a background insulin with a mealtime insulin in one vial. There are pros and cons to both approaches to combining the two main categories of insulin.
Two Approaches to Combining Background and Mealtime Insulin
|Add rapid-acting insulin to background insulin||
Which approach makes the most sense for you?
That depends on a number of factors, such as how high your blood glucose spikes after a meal, how high it is between meals, and other considerations. Work with your doctor to decide upon the right treatment plan for you.
The development of this resource was made from the generous support of our sponsor Novo Nordisk.