From the Guidelines
Type 1 diabetes management should prioritize continuous subcutaneous insulin infusion or multiple daily doses of prandial and basal insulin, with a focus on minimizing hypoglycemia risk and improving glycemic outcomes, as recommended by the 2025 standards of care in diabetes 1.
Key Considerations
- Insulin analogs are preferred over injectable human insulins to minimize hypoglycemia risk in adults with type 1 diabetes 1.
- Early use of continuous glucose monitoring is recommended to improve glycemic outcomes and quality of life, and to minimize hypoglycemia 1.
- Automated insulin delivery systems should be offered to all adults with type 1 diabetes to improve glycemic control and reduce hypoglycemia risk 1.
Insulin Regimens
- The standard insulin regimen includes basal insulin and bolus insulin, with individualized doses based on carbohydrate intake, glucose levels, and physical activity 1.
- Most adults start with a total daily insulin dose of 0.5-0.8 units per kilogram of body weight, with approximately 50% as basal insulin and 50% divided among meals 1.
Monitoring and Adjustments
- Regular blood glucose monitoring (4-6 times daily) or continuous glucose monitoring is essential to adjust insulin doses appropriately 1.
- Patients should learn carbohydrate counting to calculate mealtime insulin doses, using an insulin-to-carbohydrate ratio, and adjust for high readings using a correction factor 1.
Medical Follow-up
- Regular medical follow-up every 3-6 months is essential to assess HbA1c levels and adjust insulin regimens 1.
From the FDA Drug Label
The safety and effectiveness of subcutaneous Insulin Aspart were compared to regular human insulin in 596 type 1 diabetes adult, 187 pediatric type 1 diabetes, and 91 adult type 2 diabetes patients using NPH as basal insulin. The reduction in glycated hemoglobin (HbA 1c) was similar to regular human insulin Two 24-week, open‑label, active-controlled studies were conducted to compare the safety and efficacy of Insulin Aspart to regular human insulin injection in adult patients with type 1 diabetes The efficacy of Insulin Aspart to improve glycemic control in pediatric patients with type 1 diabetes mellitus is based on an adequate and well-controlled trial of regular human insulin in pediatric patients with type 1 diabetes mellitus Similar effects on HbA 1c were observed in both treatment groups
The insulin aspart is effective for type 1 diabetes patients, with similar HbA 1c reduction compared to regular human insulin.
- Adult type 1 diabetes patients: Insulin Aspart showed similar efficacy to regular human insulin in reducing HbA 1c levels 2.
- Pediatric type 1 diabetes patients: Insulin Aspart also showed similar efficacy to regular human insulin in reducing HbA 1c levels 2. Key points:
- Insulin Aspart can be used in type 1 diabetes patients.
- The HbA 1c reduction is similar to regular human insulin.
- It is effective in both adult and pediatric type 1 diabetes patients.
From the Research
Insulin Therapy for Type 1 Diabetes
- Insulin treatment is crucial for managing type 1 diabetes, with the goal of achieving near-physiological insulin replacement 3, 4.
- Basal-bolus therapy, consisting of a long-acting basal insulin and short-acting insulin with meals, is a common approach for managing type 1 diabetes 4, 5.
- Long-acting insulin analogs, such as insulin glargine and insulin detemir, have been developed to optimize basal insulin therapy and provide improved glycemic control with reduced risk of hypoglycemia 4, 6, 7.
Types of Insulin
- Rapid-acting insulin analogs, such as insulin aspart, glulisine, and lispro, provide better postprandial glucose coverage than human regular insulin 3, 5.
- Premixed insulin preparations may not provide adequate flexibility for individualized postprandial glucose control 3.
- NPH insulin is not suitable for patients with type 1 diabetes due to its peak, short duration, and high variability 3, 6, 7.
- Long-acting insulin analogs, such as insulin glargine U300 and insulin degludec, offer non-inferior efficacy and reduced hypoglycemia risk compared to NPH insulin 4, 6, 7.
Glycemic Control and Hypoglycemia
- The use of long-acting insulin analogs can improve glycemic control, reduce glucose excursions, and decrease hypoglycemia, particularly during the night 3, 4, 6, 5.
- Continuous subcutaneous insulin infusion (CSII) is a physiologic approach for treating type 1 diabetes and can be an alternative to multiple daily injections 3, 5.
- Glycemic targets, such as glycated hemoglobin <7% (53 mmol/mol), are important for managing type 1 diabetes, and basal insulin analogs can help achieve these targets 5.