Blog - Diabetes Treatment
Types of Insulin and How to Use Them
For over a century, insulin has been helping people with diabetes manage their blood sugar levels and live healthy, active lives. For those with type 1 diabetes (T1D), insulin is a necessary part of their daily routine. For people with type 2 diabetes (T2D), their condition can be managed with a combination of diet and exercise. However, some people may need to take insulin as well.
In this article, we’ll explore the different types of insulin, when to use them, and how to effectively monitor your glucose. Always talk to your healthcare professional about the diabetes management plan that is right for you.
What is Insulin and How Does It Work?
Insulin is a hormone produced by the pancreas that helps manage blood sugar or glucose. It also helps turn food into energy so you can move easily through your day.
Your body’s natural insulin process is incredible. First, the food and drinks you consume are broken down into blood sugar. Your pancreas gets a signal to release insulin, which helps the blood sugar be absorbed from your bloodstream into your liver, fat and muscle cells to be turned into energy.
The process isn’t so seamless for people with diabetes. If you have T1D, your pancreas can’t make insulin, so you need to add insulin into your body. For someone with T2D, your body develops a resistance to insulin, which causes a build-up of blood glucose and high blood sugar levels.2
A Brief History of Insulin3
1921: Canadians Frederick Banting and Charles Best discover that pancreatic cells produce insulin, which, when injected, can treat diabetes symptoms. They received the Nobel Prize for their groundbreaking work.
1922: A 14-year-old boy with T1D is given the first medical dose of insulin and lives another 13 years. At this time, most people with T1D had a life expectancy of just a few months once diagnosed.
1963: Insulin becomes the first human protein to be chemically synthesised, making it more accessible for researchers and people with diabetes.
1983: The first mini insulin pump is introduced.
1985: The first insulin pen is introduced.
1996: Analogue insulin is invented. This genetically modified insulin absorbs and takes action faster than previous types.
1999: The FDA approves the first continuous glucose monitoring (CGM) device to help people manage their insulin needs.
2013-2015: Researchers start developing ‘artificial pancreas’ technology, which can release insulin and monitor glucose levels like a healthy human pancreas.
2015: UK’s National Institute for Health and Care Excellence (NICE) publishes guidelines for diagnosing and managing T1D and T2D using insulin.4 -7
What Are the Different Types of Insulin?
People living with T1D will typically take a variety of insulin types, depending on their doctor’s recommendations. There are six main types of insulin under three categories: bolus, basal, and premixed.8
Bolus Insulin (Mealtime Insulin)
Bolus or mealtime insulin is usually taken before or after a meal to help manage the influx of carbs from your food. There are two types of bolus insulin.
1. Rapid-acting Insulin
Also known as fast-acting insulin, it’s often taken with longer-acting insulin right before a meal. Rapid-acting insulin starts working within 15 minutes and lasts for around two to four hours.8 Newly developed ultra-rapid-acting insulin may be a suitable option for people with diabetes who struggle to achieve their glycaemic targets with other types of bolus insulin.9
2. Short-acting Insulin
Short-acting insulin is similar to rapid-acting insulin but takes longer to work. For this reason, you should take short-acting insulin about 30 to 60 minutes before a meal. Short-acting insulin starts working within 30 minutes and lasts about three to six hours.8
Basal Insulin (Background Insulin)
While bolus insulin helps manage blood sugar during mealtime, basal insulin works in the background to keep levels in check throughout the rest of the day. There are three main types of basal insulin.
1. Intermediate-acting Insulin
Intermediate-acting insulin takes care of your insulin needs for half a day or overnight. It’s often used in conjunction with rapid or short-acting insulin during meals. Intermediate-acting insulin starts working within two to four hours and lasts about 12 to 18 hours.8
2. Long-acting Insulin
Long-acting insulin takes care of your insulin needs for a full day. It’s also used in conjunction with rapid or short-acting insulin during meals. Long-acting insulin takes two hours to start working and lasts for up to 24 hours.8
3. Ultra-long-acting Insulin
Ultra-long-acting insulin provides steady insulin for more extended periods. It takes about six hours to kick in and lasts for 36 hours or more.8
Premixed Insulin
Premixed insulin combines intermediate and short-acting insulin. It’s usually taken 10 to 30 minutes before breakfast and dinner. Premixed insulin can take up to one hour to start working and lasts 10 to 16 hours.8
The Role of Functional Insulin Therapy in Diabetes Management
Education can play a key role in helping you have greater autonomy in your diabetes self-management. Functional insulin therapy is a teaching approach that empowers people living with type 1 diabetes to manage their own insulin decisions based on personal factors that impact their glucose, like meals and exercise.10 While functional insulin therapy can give you greater independence, it is still important that you continue to work with your diabetes care team on your unique diabetes management plan and long-term health.
Do People With Type 1 Diabetes Need to Take Insulin?
Since people living with T1D cannot produce their own insulin, they must receive insulin treatment through injections or an insulin pump.1 Most people with T1D take a combination of long-acting insulin and rapid-acting insulin.
Do People With Type 2 Diabetes Need to Take Insulin?
When you’re first diagnosed with diabetes, your doctor may try other methods to balance your blood sugar, like lifestyle changes and oral medications. If those methods are not effective at managing your glucose levels, insulin may be prescribed.11
Sometimes, those living with T2D may develop a need for insulin therapy long after their initial diagnosis if insulin production decreases and insulin resistance increases. In the UK, about one in four people with T2D12 use insulin therapy to manage their diabetes. If you do need insulin injections, do know it has nothing to do with how you have managed your blood sugar.
How to Monitor Glucose and Take Insulin
The best way to check if your glucose levels are high is by monitoring your glucose. This can be done by finger pricking and using a blood glucose meter (BGM) or technology like a continuous glucose monitoring (CGM) system.
A BGM measures glucose levels at a single moment in time using finger pricks. In contrast, a CGM system, like Dexcom CGM Systems, continually checks glucose levels throughout the day and night and can alert you if you’re at risk for hyperglycaemia. Dexcom CGM gives you the power to better manage your glucose levels and understand exactly when bolus insulin is needed.
There are many ways you can take insulin:
- Syringe: Insulin is delivered through a needle, typically multiple times a day.13
- Pen: Insulin is also delivered through a needle, but pens can be easier and more comfortable to use, especially for children.13
- Pump: Insulin is delivered through a thin plastic tube placed into the fatty layer under your skin, usually on your stomach or the back of your upper arm.13 Many people find insulin pumps to be easier and more accurate than needles.
- Inhaler: Insulin is delivered through an oral inhaler and used with injectable long-acting insulin.13
You may have heard of an automated insulin delivery (AID) System, an umbrella term for a hybrid closed-loop system. An AID system works in tandem with an insulin pump, an algorithm and a CGM device. It measures changes in glucose levels and automatically releases insulin in response. Dexcom CGM System is the most connected CGM in the world* and is integrated with the largest number of insulin pumps. It also features customisable alerts that notify you when your glucose levels go high or low. Dexcom G6 and Dexcom G7 have sharing functions that allow healthcare professionals and loved ones to monitor your glucose along with you.†
Seamless Diabetes Management with Dexcom
Insulin is a groundbreaking medical discovery and has improved the lives of people with diabetes. Similarly, CGM technology has contributed to the significant advancement in diabetes care. Dexcom continues to innovate, using real user feedback, challenges and needs to make glucose management as convenient and effective as possible.
References:
* Data on file 2022
† Internet connectivity required for data sharing. Following requires the use of the Dexcom Follow App on a compatible smart device. Followers should always confirm readings on the Dexcom CGM App or receiver before making treatment decisions. For a list of compatible smart devices, please visit dexcom.com/compatibility.
1 Type 1 diabetes treatments: What are the treatments for type 1 diabetes? Diabetes.co.uk Reviewed 08 June 2023. Accessed 23 November 2023. https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-1/treatments
2 Insulin Resistance and Diabetes. Centers for Disease Control and Prevention. Reviewed June 20, 2022. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/insulin-resistance-type-2-diabetes.html
3 History of insulin. Diabetes.co.uk Accessed 23 November 2023. https://www.diabetes.co.uk/insulin/history-of-insulin.html
4 Diabetes (type 1 and type 2) in children and young people: diagnosis and management: Recommendations. NICE guideline [NG18]. Updated May 11, 2023. https://www.nice.org.uk/guidance/ng18/chapter/Recommendations
5 Type 1 diabetes in adults: diagnosis and management: Recommendations. NICE guideline [NG17]. Updated August 17, 2022. https://www.nice.org.uk/guidance/ng17/chapter/Recommendations
6 Diabetes in pregnancy: management from preconception to the postnatal period: Recommendations. NICE guideline [NG3]. Updated December 2020. https://www.nice.org.uk/guidance/ng3/chapter/Recommendations
7 Type 2 diabetes in adults: management: Recommendations. NICE guideline [NG28]. Updated June 29, 2022. https://www.nice.org.uk/guidance/ng28/chapter/Recommendations
8 Types of insulin. Centers for Disease Control and Prevention. Reviewed December 30, 2022. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/how-to-use-insulin.html
9 Wong E, et al. Ultra-Rapid-Acting Insulins: How Fast Is Really Needed? Clin Diabetes. 2021;39(4):415-423. doi: 10.2337/cd20-0119.
10 Howorka K, et al. Empowering diabetes out-patients with structured education: Journal of Psychosomatic Research. 2000;48(1):37-44. doi:10.1016/s0022-3999(99)00074-4.
11 Type 2 diabetes. John Hopkins Medicine. Accessed 23 November 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/type-2-diabetes
12 Insulin and type 2 diabetes. Diabetes UK. Accessed 23 November 2023. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin/type-2-diabetes
13 4 ways to take insulin. Centers for Disease Control and Prevention. Reviewed April 18, 2023. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/4-ways-to-take-insulin.html
* Data on file 2022
† Internet connectivity required for data sharing. Following requires the use of the Dexcom Follow App on a compatible smart device. Followers should always confirm readings on the Dexcom CGM App or receiver before making treatment decisions. For a list of compatible smart devices, please visit dexcom.com/compatibility.
1 Type 1 diabetes treatments: What are the treatments for type 1 diabetes? Diabetes.co.uk Reviewed 08 June 2023. Accessed 23 November 2023. https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-1/treatments
2 Insulin Resistance and Diabetes. Centers for Disease Control and Prevention. Reviewed June 20, 2022. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/insulin-resistance-type-2-diabetes.html
3 History of insulin. Diabetes.co.uk Accessed 23 November 2023. https://www.diabetes.co.uk/insulin/history-of-insulin.html
4 Diabetes (type 1 and type 2) in children and young people: diagnosis and management: Recommendations. NICE guideline [NG18]. Updated May 11, 2023. https://www.nice.org.uk/guidance/ng18/chapter/Recommendations
5 Type 1 diabetes in adults: diagnosis and management: Recommendations. NICE guideline [NG17]. Updated August 17, 2022. https://www.nice.org.uk/guidance/ng17/chapter/Recommendations
6 Diabetes in pregnancy: management from preconception to the postnatal period: Recommendations. NICE guideline [NG3]. Updated December 2020. https://www.nice.org.uk/guidance/ng3/chapter/Recommendations
7 Type 2 diabetes in adults: management: Recommendations. NICE guideline [NG28]. Updated June 29, 2022. https://www.nice.org.uk/guidance/ng28/chapter/Recommendations
8 Types of insulin. Centers for Disease Control and Prevention. Reviewed December 30, 2022. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/how-to-use-insulin.html
9 Wong E, et al. Ultra-Rapid-Acting Insulins: How Fast Is Really Needed? Clin Diabetes. 2021;39(4):415-423. doi: 10.2337/cd20-0119.
10 Howorka K, et al. Empowering diabetes out-patients with structured education: Journal of Psychosomatic Research. 2000;48(1):37-44. doi:10.1016/s0022-3999(99)00074-4.
11 Type 2 diabetes. John Hopkins Medicine. Accessed 23 November 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/type-2-diabetes
12 Insulin and type 2 diabetes. Diabetes UK. Accessed 23 November 2023. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin/type-2-diabetes
13 4 ways to take insulin. Centers for Disease Control and Prevention. Reviewed April 18, 2023. Accessed 23 November 2023. https://www.cdc.gov/diabetes/about/4-ways-to-take-insulin.html