A Guide to Intensive Insulin Therapy for Type 1 Diabetics

In Singapore, diabetes mellitus is considered to be a fairly common illness, with the country’s Ministry of Health providing an incidence rate of around 9.5 percent in 2020. However, the conversation around diabetes is largely centred around Type 2 diabetes, a condition that has markedly different causalities from the far less common Type 1 diabetes. According to Johns Hopkins Medicine, only about 5 percent of all people with diabetes have Type 1. The relative rarity of the condition means that Type 1 diabetics do not always get the understanding or support they need.

Before it’s possible to discuss why intensive insulin therapy is so important for Type 1 diabetics, we must differentiate between the two common types of diabetes mellitus. Where Type 2 diabetes is largely a lifestyle illness typically characterised by insulin resistance, Type 1 diabetes is an autoimmune disease where the body’s immune system destroys the pancreas’s insulin-producing beta cells. Both conditions can lead to elevated blood glucose levels and ultimately result in various health complications.

Being generally regarded as a lifestyle illness with some genetic factors, Type 2 diabetes is often considered to be more treatable than Type 1, as even modest attempts at healthy living can often be enough to bring blood glucose levels under control. The specific root causes of Type 1 diabetes, on the other hand, provide a narrower list of possible interventions. 

Fortunately, although Type 1 and Type 2 diabetes is generally harder to treat, a good quality of life can still be had through intensive insulin therapy. Let’s examine the particulars of insulin therapy and what Type 1 diabetics can typically expect after going on insulin: 

What is Insulin Therapy?

Insulin therapy is a treatment method for diabetes that involves administering insulin to compensate for the pancreas’s lack of function, thus helping regulate the body’s blood glucose levels. While insulin therapy is used on both types of diabetes mellitus, most of the time it is associated with treatments for Type 1 diabetes due to the fewer available interventions.

The insulin used in insulin therapy comes in several types, including rapid-acting, short-acting, intermediate-acting, and long-acting options. Each insulin type has a different onset, peak time, and effective duration, allowing for treatment plans that are specifically tailored to the needs of individual patients. 

Type 1 diabetics should know that insulin therapy can follow different dosing schedules, such as basal-bolus therapy (combining long-acting and rapid-acting insulin) or a fixed regimen. While many patients can do well under a variety of regimes, these schedules are specifically tailored to avoid unnecessarily impacting a patient’s quality of life.

For decades, insulin was primarily administered through injections using syringes. Though this is a life-saving method, the complications of injections do place a small burden on patients and their caretakers. Today, there’s a wider variety of delivery options available, including insulin pens and continuous subcutaneous insulin infusion (CSII) via insulin pumps.

The Role of Insulin Therapy in Type 1 Diabetes

For individuals with Type 1 diabetes, intensive insulin therapy is often the only intervention available that can guarantee a good quality of life. Since their bodies cannot produce sufficient levels of insulin, they must rely on externally administered insulin to manage their blood glucose levels and avoid secondary health complications such as neuropathy, retinopathy, and cardiovascular diseases.

Insulin therapy is often the only way in which a Type 1 diabetic can maintain blood glucose within the target range for day-to-day functioning. Together with a glucose monitor, Type 1 diabetics need insulin shots to prevent episodes of hyperglycaemia (high blood sugar) and hypoglycaemia (low blood sugar) that can disrupt regular activities.

Administering Intensive Insulin Therapy: A Guide for Type 1 Diabetics

In essence, intensive insulin therapy aims to mimic the body’s natural insulin production, helping Type 1 diabetes patients achieve better control over their blood glucose levels. Patients can improve the outcomes of intensive insulin therapy by doing the following:

1) Monitoring Blood Glucose Regularly

Periodic blood glucose monitoring is essential for guaranteeing correct insulin dosing. Fortunately, the wide availability of affordable personal glucometers and continuous glucose monitors (CGMs) have done away with the need for frequent clinic visits to monitor blood glucose levels. A Type 1 diabetic should note, however, that periodic visits to a doctor may still be needed for comprehensive assessments and adjustments to their treatment plan.

2) Knowing How to Count Carbohydrates

When consumed, carbohydrates and other sugars have a direct effect on blood glucose levels. As such, diabetics who are undergoing intensive insulin therapy should learn how to count their carbohydrates and accurately calculate the correct insulin doses.

3) Adjusting Insulin Doses Based on Activity Levels

Physical activity can deplete blood glucose levels and make the body more sensitive to insulin. With that in mind, Type 1 diabetics should plan their doses around periods of exercise to prevent hypoglycaemia or hyperglycaemia.

4) Using a Basal-Bolus Insulin Regimen

This regimen involves taking a long-acting insulin (basal dose) to maintain baseline glucose levels and a rapid-acting insulin (bolus dose) before meals to manage the rise in blood glucose from eating. Such dosing regimens should only be done with the supervision of a physician.

5) Keeping a Journal to Record Insulin Sensitivity

Insulin sensitivity can be affected by things like stress, illness, and the time of day. Understanding how one’s body responds to insulin at different times can help when it comes to fine-tuning doses and making other types of lifestyle adjustments.

6) Developing a Personalised Meal Plan

Outside of intensive insulin therapy, individuals with Type 1 diabetes must keep a close watch over their diets to avoid harmful spikes and drops in their blood glucose levels. For best results, they should work with a dietitian to create a balanced meal plan that is full of nutritious food items with a favourable glycaemic index. 

In many cases, consistent meal timing and food choices can go a long way in managing blood glucose levels effectively, potentially reducing (though not eliminating) the need for insulin dosing.

Empowering Type 1 Diabetics through Vetted Insulin Therapies

According to the Ministry of Health’s Agency for Care Effectiveness (ACE), approximately 1 in 3 Singaporeans with diabetes have poor control over their blood glucose levels. For individuals with Type 1 diabetes, intensive insulin therapy is often the only realistic way to provide this control. Proper execution of this therapy does require constant vigilance, but it remains the best option for Type 1 diabetes patients to lead healthy and empowered lifestyles.