Pharmacologic Therapies for Type I Diabetes
Written by Khushi Shah
Edited by Numa Islam
September 27th, 2023
Edited by Numa Islam
September 27th, 2023
Research
Type 1 diabetes is a chronic condition, typically beginning in childhood or adolescence, in which the pancreas produces little to no insulin. Insulin is a vital hormone which plays a role in regulating the blood glucose levels in the bloodstream. Type 1 diabetics rely on insulin treatments because the Beta cells, responsible for insulin production, are lacking in function. The American Diabetes Association (ADA) has come up with newer, more promising treatment recommendations for these individuals. They believe that Type 1 diabetics should be treated with multiple injections of insulin, use rapid-acting insulin analogs (compounds with a structure similar to that of another) to reduce the risk of hypoglycemia (low blood glucose levels), and receive education on how to match their insulin doses to carbohydrate intake, pre-meal blood glucose, and anticipated physical activity (ADA, 2021).
The ADA explains various options for managing Type 1 Diabetes, including insulin therapy, the insulin injection technique, non insulin treatments, and surgical treatments. Insulin therapy is most commonly achieved through insulin injections twice a day. However, over the past three decades, the best combination of safety and effectiveness has come through insulin pumps, which continuously pump insulin subcutaneously (ADA, 2021). A more recent treatment option has been the rapid acting insulin analogs, which is very similar to human insulin. The main difference is that the analogs have one or two amino acids changed, compared to human insulin. Scientists discovered that treatment with analog insulins is associated with less hypoglycemia and weight gain (ADA, 2021).
Another therapy includes the insulin injection technique. Health experts warn that patients and caregivers must be properly trained in the dosage and location of where the insulin must be injected. Incorrect administration can lead to infections, complications, and intramuscular delivery (ADA, 2021). It is important to note that insulin must be injected directly under the skin and into the tissue, not the muscle. In addition, it is important to rotate the point of insulin injection in order to avoid lipohypertrophy, which is an accumulation of subcutaneous fat. Lipohypertrophy is dangerous because it can contribute to erratic insulin absorption, increased variability among blood glucose levels, and unexplained low blood sugar episodes (ADA, 2021).
Changing course, another kind of treatment option that does not require insulin includes injectable and oral glucose. So far, only Pramlintide, an anti-diabetic medication, has been approved for type 1 diabetics (ADA, 2021). There are, however, many adjunctive agents that are being researched as replacements for insulin treatments.
The final option that the ADA presents is on surgical treatment, the main one described being pancreas and islet transplantation. In this surgery, the patient receives a donor’s pancreas and islet cells, which effectively should normalize glucose levels and mitigate microvascular complications of type 1 diabetes. The downside to this is that patients require lifelong immunosuppression to prevent rejection or the recurrence of autoimmune islet destruction (ADA, 2021). In other words, efforts must be made to ensure that the body is not rejecting the donor. As a result, this surgical treatment plan is not recommended for diabetics who can monitor their blood glucose levels and utilize the less invasive techniques.
Works Cited
American Diabetes Association. (2021). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement_1), S111–S124. https://doi.org/10.2337/dc21-S009