Types of insulin therapy

Conventional insulin therapy involves injecting insulin twice a day. This approach is often chosen by people who have a fairly regular daily routine and prefer to inject their insulin at the same times every day.

The medication used in conventional insulin therapy is intermediate-acting or long-acting insulin that works for at least half a day. This type of insulin can either be used alone or together with short-acting insulin. Most people use a standard mixture of short-acting and longer-acting insulin. They inject this mixture once before breakfast and once before their evening meal. In order to compensate for the effect of insulin, they have to eat fixed amounts of food regularly over the course of the day. People who do a lot of physical exercise balance their blood sugar out by eating extra snacks between meals. So, with conventional insulin therapy, meals and physical exercise are planned around the insulin.

Choosing conventional insulin therapy can mean leading a fairly regimented lifestyle. And, compared with intensive insulin therapy, conventional insulin therapy is much less effective at preventing complications associated with type 1 diabetes. So it's usually only considered as a treatment option for people with type 1 diabetes who can’t have intensive insulin therapy.

In intensive insulin therapy, the amount of insulin can be adjusted flexibly and spontaneously based on a person’s blood sugar levels, how much they eat and how physically active they are. Regular blood sugar monitoring is essential here. You can either inject yourself several times a day or use an insulin pump. To cover your basic insulin needs, longer-acting insulin is injected once or twice a day. This is often referred to as “basal insulin.” Short-acting insulin is also injected before each meal in order to allow the body to process the carbohydrates in the food. This is known as a “bolus dose” or “mealtime insulin.”

People who have an insulin pump only use short-acting insulin. The pump regularly delivers small amounts of insulin to continuously cover the body's basic needs.

One goal of intensive insulin therapy is to keep blood sugar at almost normal levels. It also aims to allow greater flexibility in how you lead your life: There is no need to eat meals at fixed times or make sure you always eat the same amount of carbohydrates. Instead, you inject as much insulin as you need at the time. The amount of insulin needed will also depend on your blood sugar levels, the time of day and whether you plan to be physically active. If you inject too much insulin, your blood sugar levels may drop too low. If you inject too little, they may be too high.

Intensive insulin therapy has been shown to have health benefits compared to conventional insulin therapy. It can lower the risk of developing diabetes-related complications, particularly those affecting the eyes, kidneys, and nervous system.

The medication dapagliflozin has been approved for the treatment of type 1 diabetes in Germany and other countries since 2019. People who have type 1 diabetes can take dapagliflozin tablets if they have a body mass index ( BMI) of 27 kg/m² or more, and if treatment with insulin doesn't lower their blood sugar levels enough. Research suggests that this can help to keep blood sugar levels under control better. But the medication often has side effects such as genital infections and gastrointestinal (stomach and bowel) problems.

People who need insulin have to learn various skills, like measuring their blood sugar. In Germany there are education programs to help people manage their diabetes. These are offered as part of disease management programs (DMPs) for type 1 and type 2 diabetes. People learn how to best adjust their diet, sports and other physical activities to their insulin therapy and other blood-sugar-lowering medications.

Modern diabetes treatment involves coordinating normal activities of daily life and the self-management of blood sugar as effectively as possible, while making the best use of medical care, including medication. People who are well informed about their diabetes, and follow their treatment plan properly, can prevent the development of related health problems. And they can live their lives almost as flexibly as people who do not have diabetes.