From the Guidelines
MDI, or Multiple Daily Injections, typically requires four injections daily with fixed doses of N and RAA, although more flexible plans can mimic normal insulin secretion with flexible doses of URAA or RAA at meals. According to the most recent evidence from 1, MDI plans with less flexibility require four injections daily with fixed doses of N and RAA.
Key Characteristics of MDI
- Four injections daily with fixed doses of N and RAA for less flexible plans
- Flexible doses of URAA or RAA at meals for more flexible plans
- Can mimic normal insulin secretion
- Offers flexibility with meal timing and carbohydrate amounts compared to fixed insulin regimens
Evidence-Based Recommendations
The 2025 standards of care in diabetes recommend MDI plans with flexible doses of URAA or RAA at meals for patients who require intensive insulin therapy 1. However, for patients who require less flexibility, four injections daily with fixed doses of N and RAA may be necessary 1. It's essential to individualize dosing based on the patient's weight, insulin sensitivity, carbohydrate intake, and blood glucose targets.
Comparison with Other Regimens
Compared to insulin pump therapy, MDI may be less expensive but requires more frequent injections 1. MDI regimens with less flexibility may be feasible for patients who are unable to carbohydrate count, but they may have a greater risk of nocturnal hypoglycemia with N 1. Overall, MDI is an effective strategy for many people with type 1 diabetes and some with type 2 diabetes who require intensive insulin therapy, as it provides continuous background insulin and addresses glucose rises that occur with eating 1.
From the Research
Definition of MDI
- MDI stands for Multiple Daily Injections, which is a treatment regimen for diabetes that involves injecting insulin multiple times a day 2, 3, 4, 5.
Components of MDI
- MDI typically consists of a combination of basal insulin (e.g. insulin glargine) and mealtime insulin (e.g. insulin lispro) 2, 4.
- The basal insulin provides a steady background level of insulin throughout the day, while the mealtime insulin is taken before meals to control blood sugar spikes 2, 4.
Comparison with Other Treatments
- MDI has been compared to continuous subcutaneous insulin infusion (CSII) in several studies, with some showing similar glycemic control and others showing improved outcomes with CSII 2, 3, 4.
- MDI has also been compared to basal-bolus therapy, with some studies showing non-inferior glycemic improvements with less weight gain, less hypoglycemia, and fewer daily injections 6.
Practical Considerations
- Switching between MDI and CSII may be necessary for some patients, and strategies for doing so have been outlined in the literature 4, 5.
- MDI may be preferred by some patients due to its flexibility and portability, while others may prefer CSII for its ability to provide a steady background level of insulin 5.