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Insulin Therapy – Treatment for Diabetes Mellitus

Insulin therapy is a medical treatment in which insulin is administered to regulate blood sugar levels in people with diabetes mellitus.

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Things worth knowing about "Insulin Therapy"

Insulin therapy is a medical treatment in which insulin is administered to regulate blood sugar levels in people with diabetes mellitus.

What is Insulin Therapy?

Insulin therapy is a medical treatment in which the hormone insulin is administered externally to regulate blood glucose levels. It is primarily used in people with type 1 diabetes mellitus and type 2 diabetes mellitus when the body produces little or no insulin on its own. Insulin is a vital hormone produced by the pancreas that enables glucose (sugar) to be taken up from the blood into the body cells.

Indications

Insulin therapy is used in the following situations:

Type 1 diabetes mellitus: Since the pancreas no longer produces insulin due to an autoimmune process, lifelong insulin therapy is absolutely necessary.
Type 2 diabetes mellitus: When lifestyle changes and oral medications are no longer sufficient to control blood sugar levels.
Gestational diabetes: When dietary measures alone are not enough to achieve adequate blood glucose control.
Other specific forms of diabetes as well as acute metabolic emergencies such as diabetic ketoacidosis.

Mechanism of Action

Insulin binds to specific insulin receptors on the surface of body cells, particularly in muscle, fat, and liver tissue. This binding activates a cellular signaling pathway that enables the transport of glucose into the cell. At the same time, insulin inhibits the release of glucose from the liver and promotes the storage of energy in the form of glycogen and fat. The overall result is a reduction in blood glucose levels.

Types of Insulin and Their Profiles

There are several types of insulin that differ in their onset of action, peak effect, and duration:

Short-acting insulin (regular insulin): Takes effect within 30 minutes and lasts 6 to 8 hours. Used with meals.
Rapid-acting insulin analogs: Work within 5 to 15 minutes and last 2 to 4 hours. Offer great flexibility around mealtimes.
Intermediate-acting insulin (NPH insulin): Takes effect after 1 to 2 hours and lasts up to 12 hours. Used as basal insulin.
Long-acting insulin analogs: Provide a steady effect over 24 hours or more and are used as basal insulin.
Premixed insulins: Combinations of short- and long-acting insulin for simplified treatment regimens.

Treatment Regimens

Conventional Insulin Therapy (CT)

With conventional therapy, insulin is injected once or twice daily at fixed times, usually as a premixed insulin. This regimen is less flexible but suitable for patients who prefer a simple and structured treatment approach.

Intensified Conventional Insulin Therapy (ICT)

Also known as basal-bolus therapy, intensified therapy mimics the natural insulin secretion of the pancreas. A long-acting basal insulin covers the background insulin need, while bolus insulin is taken at mealtimes to cover the additional demand from food intake. This method allows for excellent blood glucose control and a high degree of flexibility in daily life.

Insulin Pump Therapy (CSII)

Continuous subcutaneous insulin infusion (CSII) delivers rapid-acting insulin continuously via a small pump through a thin catheter placed under the skin. The pump can be programmed to cover individual basal needs and allows for very precise dose adjustments. It is commonly used in people with type 1 diabetes.

Administration and Dosage

Insulin is typically administered subcutaneously (under the skin), most commonly in the abdomen, thighs, buttocks, or upper arms. Injection is performed using an insulin pen or syringe. The dosage is determined individually by the treating physician and depends on current blood glucose levels, planned meals, physical activity, and other individual factors. Regular blood glucose monitoring or the use of a continuous glucose monitoring (CGM) system is an important component of therapy management.

Side Effects and Risks

Hypoglycemia (low blood sugar): The most common and potentially dangerous side effect. It occurs when too much insulin is administered or a meal is skipped. Symptoms include trembling, sweating, confusion, and in severe cases loss of consciousness.
Lipohypertrophy: Thickening of the subcutaneous fat tissue at the injection site due to repeated injections in the same area. Regular rotation of injection sites helps prevent this.
Weight gain: Insulin promotes energy storage, which can lead to weight gain over time.
Allergic reactions: Rare but possible, including local skin reactions or systemic allergic responses.

References

American Diabetes Association: Standards of Medical Care in Diabetes. Diabetes Care, 2024.
World Health Organization (WHO): Global Report on Diabetes. Geneva, 2016.
Holt R.I.G., DeVries J.H., et al.: The Management of Type 1 Diabetes in Adults. Diabetologia, 2021.

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