From the Guidelines
No, it is not recommended to add nasal long-acting insulin to a short-acting insulin pump regimen. The current standard of care for type 1 diabetes management, as outlined in the 2023 Diabetes Care guidelines 1, emphasizes the use of continuous subcutaneous insulin infusion (CSII) via pump therapy, which has modest advantages for lowering A1C and reducing severe hypoglycemia rates. Insulin pumps typically deliver rapid-acting insulin continuously at a programmed basal rate with additional boluses for meals and corrections, eliminating the need for separate long-acting insulin injections.
Some key points to consider when managing type 1 diabetes with insulin pump therapy include:
- The use of continuous glucose monitors (CGM) is now considered standard of care for most people with type 1 diabetes 1
- Automatic suspension of insulin delivery at a preset glucose level can improve reduction of nocturnal hypoglycemia in individuals with type 1 diabetes using insulin pumps with CGM 1
- Hybrid closed-loop pump systems have been shown to be superior to sensor-augmented pump therapy for glycemic control and reduction of hypoglycemia over 3 months of comparison in children and adults with type 1 diabetes 1
- Intensive insulin management using a version of CSII and continuous glucose monitoring should be considered in most individuals with type 1 diabetes 1
Adding a long-acting insulin to a pump regimen would create a risk of insulin stacking and hypoglycemia. If basal coverage is inadequate with the pump, the solution would be to adjust the basal rates programmed into the pump rather than adding another insulin formulation. The American Diabetes Association/JDRF Type 1 Diabetes Sourcebook notes that a typical starting dose in individuals with type 1 diabetes who are metabolically stable is 0.5 units/kg/day, with half administered as prandial insulin and the other half as basal insulin 1.
In general, the management of type 1 diabetes requires individualized approaches, considering factors such as insulin type and dosing regimen, self-management capabilities, and individual preferences 1. Therefore, the focus should be on optimizing the insulin pump settings and regimen rather than adding nasal long-acting insulin.
From the FDA Drug Label
Do not administer intravenously or via an insulin pump. The FDA drug label does not answer the question.
From the Research
Nasal Long Acting Insulin and Short Acting Insulin Pump
- The provided studies do not directly address the recommendation of adding nasal long acting insulin to a short acting insulin pump 2, 3, 4, 5, 6.
- However, the studies discuss the use of long-acting basal insulins, such as insulin glargine and detemir, in the management of type 1 and type 2 diabetes mellitus 2, 3, 4, 5, 6.
- Insulin pump therapy (continuous subcutaneous insulin infusion) is compared to multiple daily injection regimens based on long-acting insulin analogs, with results indicating that insulin pump therapy can reduce the frequency of severe hypoglycemia and improve glycemic control in type 1 diabetes 3.
- The studies also discuss the pharmacokinetic and pharmacodynamic differences between various basal insulin formulations, highlighting the importance of explicit guidance for patients switching between basal insulins 2, 4, 6.
- There is no direct evidence to support or refute the addition of nasal long acting insulin to a short acting insulin pump, as the studies focus on traditional basal insulin formulations and their comparison to insulin pump therapy 2, 3, 4, 5, 6.