From the Guidelines
Type 1 diabetes mellitus (T1DM) should be treated with multiple-dose insulin injections or continuous subcutaneous insulin injection, with a focus on matching prandial insulin doses to carbohydrate intake, preprandial blood glucose levels, and anticipated activity level, as recommended by the most recent guidelines 1.
Key Components of T1DM Management
- Multiple daily insulin injections or an insulin pump, with basal insulin (like Lantus, Levemir, or Tresiba) once or twice daily, plus rapid-acting insulin (like Humalog, Novolog, or Fiasp) before meals
- Insulin doses individualized based on weight, with typical starting doses around 0.5-0.7 units/kg/day, divided as 50% basal and 50% bolus insulin
- Blood glucose monitoring, with targets generally 80-130 mg/dL before meals and under 180 mg/dL after meals
- Carbohydrate counting, using ratios like 1 unit per 10-15g of carbs, to guide meal-time insulin dosing
- Regular exercise, medical ID wearing, and having glucagon available for severe hypoglycemia
Additional Considerations
- Continuous glucose monitoring systems can significantly reduce severe hypoglycemia risk in patients with T1DM 1
- Insulin pump therapy with a low blood glucose level “suspend” feature, augmented by continuous glucose monitoring, can reduce nocturnal hypoglycemia without increasing HbA1c levels 1
- Patients should receive ongoing education and regular medical follow-up to prevent complications like diabetic ketoacidosis, hypoglycemia, and long-term vascular damage
- Psychosocial and diabetes-related distress should be assessed, and referrals to trained mental health professionals should be made as needed 1
From the FDA Drug Label
In two clinical studies (Studies A and B), adult patients with type 1 diabetes (Study A, n=585, Study B n=534) were randomized to 28 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In another clinical study (Study C), patients with type 1 diabetes (n=619) were randomized to 16 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In a randomized, controlled clinical study (Study D), pediatric patients (age range 6 to 15 years) with type 1 diabetes (n=349) were treated for 28 weeks with a basal-bolus insulin regimen where regular human insulin was used before each meal.
The treatment of Type 1 Diabetes Mellitus with Insulin Glargine has been studied in several clinical trials, including:
- Adult patients: Studies A, B, and C, which compared the efficacy of Insulin Glargine to NPH insulin in basal-bolus regimens.
- Pediatric patients: Study D, which evaluated the safety and efficacy of Insulin Glargine in a basal-bolus regimen. The results of these studies showed that Insulin Glargine had similar effects on HbA1c and severe symptomatic hypoglycemia compared to NPH insulin 2. Additionally, a study with Insulin Glulisine also evaluated its efficacy in Type 1 Diabetes in adults, showing similar glycemic control compared to Insulin Lispro 3.
From the Research
Type 1 Diabetes Management
- Type 1 diabetes is characterized by insulin deficiency and requires near-physiological insulin replacement 4
- Basal bolus therapy, consisting of a long-acting basal insulin and short-acting insulin with main meals, is commonly used to manage type 1 diabetes 4, 5
Insulin Therapies
- Long-acting insulin analogs, such as insulin glargine and insulin detemir, have been developed to optimize basal insulin therapy 4
- Insulin glargine U300 and insulin degludec provide non-inferior efficacy and reduce hypoglycemia risk compared to insulin glargine U100 4, 6
- Rapid-acting insulin analogs, such as aspart, glulisine, and lispro, are preferred for prandial glycemic control 5, 7
Treatment Strategies
- Continuous subcutaneous insulin infusion (CSII) is a treatment option for patients with type 1 diabetes who do not meet individual glycemic targets or experience frequent or severe hypoglycemia 5
- Continuous glucose monitoring (CGM) can improve glycemic control irrespective of treatment regimen 5
- A glycemic target of glycated hemoglobin <7% (53 mmol/mol) is appropriate for most nonpregnant adults with type 1 diabetes 5
Insulin Regimens
- Basal insulin analogs with a reduced peak profile and extended duration of action are preferred over neutral protamine Hagedorn (NPH) insulin 5, 7
- Premixed insulin preparations do not provide the flexibility to address individual needs of patients with type 1 diabetes 7
- Insulin degludec can be used as an alternative to insulin glargine or detemir, with a potential for lower doses and similar glycemic control 6, 8