Skip to main content
SpringerLink
Log in

Therapy with Insulin

  • Chapter
  • First Online:
Book cover Endocrinology and Diabetes

  • 3003 Accesses

Abstract

The aim of the present chapter is to describe insulin treatment in diabetic patients. Since the Diabetes Control and Complications Trial and the United Kingdom Prospective Survey Study, it has been recommended intensive treatment of type 1 and type 2 diabetes patients to achieve good control and avoid chronic complications secondary to poor metabolic control.

The recommended therapy of type 1 diabetes patients consists of intensive insulin treatment (basal–bolus), using multiple daily insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion therapy. To type 2 diabetes patients is recommended initially to begin changes in lifestyle (diet, cholesterol control, weight reduction, blood pressure control, physical activity and tobacco avoidance) associated to metformin and, if good control is not achieved another therapy must be implemented (insulin, sulfonylurea, thiazolidinedione (pioglitazone), or DPP-4 inhibitors). In this chapter we review different ways of insulin treatment in type 1 and type 2 diabetes patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329(14):977–86.

    Google Scholar 

  2. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.

    Google Scholar 

  3. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287(19):2563–9.

    Google Scholar 

  4. Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort. Diabetes Care. 1999;22(1):99–111.

    Google Scholar 

  5. Effect of intensive therapy on residual beta-cell function in patients with type 1 diabetes in the diabetes control and complications trial. A randomized, controlled trial. The Diabetes Control and Complications Trial Research Group. Ann Intern Med. 1998;128(7): 517–23.

    Google Scholar 

  6. Nathan DM, Zinman B, Cleary PA, Backlund JY, Genuth S, Miller R, et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983–2005). Arch Intern Med. 2009;169(14):1307–16.

    Article  PubMed  Google Scholar 

  7. Calvert M, Shankar A, McManus RJ, Lester H, Freemantle N. Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study. BMJ. 2009;338:b1870.

    Article  PubMed  Google Scholar 

  8. Consensus statement on the worldwide standardization of the hemoglobin A1C measurement: the American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation. Diabetes Care. 2007;30(9):2399–400.

    Google Scholar 

  9. Rodbard HW, Blonde L, Braithwaite SS, Brett EM, Cobin RH, Handelsman Y, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13 Suppl 1:1–68.

    Article  PubMed  Google Scholar 

  10. Liebl A. Insulin intensification—the rationale and the target. Int J Clin Pract Suppl. 2009 Oct;164:1–5.

    Article  PubMed  Google Scholar 

  11. Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes. 2009;10 Suppl 12:71–81.

    Article  PubMed  Google Scholar 

  12. Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes. 2007 Dec;8(6):408–18.

    Article  PubMed  Google Scholar 

  13. Ludvigsson J, Bolli GB. Intensive insulin treatment in diabetic children. Diabetes Nutr Metab. 2001 Oct;14(5):292–304.

    PubMed  CAS  Google Scholar 

  14. White NH, Cleary PA, Dahms W, Goldstein D, Malone J, Tamborlane WV. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001 Dec;139(6):804–12.

    Article  PubMed  CAS  Google Scholar 

  15. Pesic M, Zivic S, Radenkovic S, Velojic M, Dimic D, Antic S. Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy. Vojnosanit Pregl. 2007;64(4):247–52.

    Article  PubMed  Google Scholar 

  16. Gerich JE. Novel insulins: expanding options in diabetes management. Am J Med. 2002;113(4): 308–16.

    Article  PubMed  CAS  Google Scholar 

  17. Dunn CJ, Plosker GL, Keating GM, McKeage K, Scott LJ. Insulin glargine: an updated review of its use in the management of diabetes mellitus. Drugs. 2003;63(16):1743–78.

    Article  PubMed  CAS  Google Scholar 

  18. Skyler JS. Intensive insulin therapy: a personal and historical perspective. Diabetes Educ. 1989;15(1):33–9.

    Article  PubMed  CAS  Google Scholar 

  19. Hirsch IB, Farkas-Hirsch R, Skyler JS. Intensive insulin therapy for treatment of type I diabetes. Diabetes Care. 1990;13(12):1265–83.

    Article  PubMed  CAS  Google Scholar 

  20. Bolli GB. Insulin treatment in type 1 diabetes. Endocr Pract. 2006;12 Suppl 1:105–9.

    Article  PubMed  Google Scholar 

  21. Bangstad HJ, Danne T, Deeb L, Jarosz-Chobot P, Urakami T, Hanas R. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2009;10 Suppl 12:82–99.

    Article  PubMed  Google Scholar 

  22. Bruno G, Cerutti F, Merletti F, Cavallo-Perin P, Gandolfo E, Rivetti M, et al. Residual beta-cell function and male/female ratio are higher in incident young adults than in children: the registry of type 1 diabetes of the province of Turin, Italy, 1984–2000. Diabetes Care. 2005 Feb;28(2):312–7.

    Article  PubMed  Google Scholar 

  23. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22;353(25): 2643–53.

    Article  PubMed  Google Scholar 

  24. White NH, Sun W, Cleary PA, Danis RP, Davis MD, Hainsworth DP, et al. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. Arch Ophthalmol. 2008;126(12):1707–15.

    Article  PubMed  Google Scholar 

  25. Raskin P, Holcombe JH, Tamborlane WV, Malone JI, Strowig S, Ahern JA, et al. A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump. J Diabetes Complications. 2001;15(6):295–300.

    Article  PubMed  CAS  Google Scholar 

  26. Skyler JS, Cefalu WT, Kourides IA, Landschulz WH, Balagtas CC, Cheng SL, et al. Efficacy of inhaled human insulin in type 1 diabetes mellitus: a randomised proof-of-concept study. Lancet. 2001;357(9253):331–5.

    Article  PubMed  CAS  Google Scholar 

  27. Skyler JS, Jovanovic L, Klioze S, Reis J, Duggan W. Two-year safety and efficacy of inhaled human insulin (Exubera) in adult patients with type 1 diabetes. Diabetes Care. 2007;30(3):579–85.

    Article  PubMed  CAS  Google Scholar 

  28. Brunner GA, Hirschberger S, Sendlhofer G, Wutte A, Ellmerer M, Balent B, et al. Post-prandial administration of the insulin analog insulin aspart in patients with Type 1 diabetes mellitus. Diabet Med. 2000;17(5):371–5.

    Article  PubMed  CAS  Google Scholar 

  29. Schernthaner G, Wein W, Sandholzer K, Equiluz-Bruck S, Bates PC, Birkett MA. Postprandial insulin lispro. A new therapeutic option for type 1 diabetic patients. Diabetes Care. 1998;21(4):570–3.

    Article  PubMed  CAS  Google Scholar 

  30. Danne T, Aman J, Schober E, Deiss D, Jacobsen JL, Friberg HH, et al. A comparison of postprandial and preprandial administration of insulin aspart in children and adolescents with type 1 diabetes. Diabetes Care. 2003;26(8):2359–64.

    Article  PubMed  CAS  Google Scholar 

  31. Campbell RK, White JR, Levien T, Baker D. Insulin glargine. Clin Ther. 2001;23(12):1938–57. discussion 23.

    Article  PubMed  CAS  Google Scholar 

  32. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis. Diabetes Obes Metab. 2009;11(4):372–8.

    Article  PubMed  CAS  Google Scholar 

  33. Robertson KJ, Schoenle E, Gucev Z, Mordhorst L, Gall MA, Ludvigsson J. Insulin detemir compared with NPH insulin in children and adolescents with Type 1 diabetes. Diabet Med. 2007;24(1):27–34.

    Article  PubMed  CAS  Google Scholar 

  34. Rovet JF, Ehrlich RM, Hoppe M. Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children. Diabetes Care. 1987;10(4): 510–5.

    Article  PubMed  CAS  Google Scholar 

  35. Naguib JM, Kulinskaya E, Lomax CL, Garralda ME. Neuro-cognitive performance in children with type 1 diabetes—a meta-analysis. J Pediatr Psychol. 2009; 34(3):271–82.

    Article  PubMed  Google Scholar 

  36. Rovet JF, Ehrlich RM, Hoppe M. Specific intellectual deficits in children with early onset diabetes mellitus. Child Dev. 1988;59(1):226–34.

    Article  PubMed  CAS  Google Scholar 

  37. Instituto da Criança com Diabetes. http://www.icdrs.org.br/conduta.php.

  38. Lalli C, Ciofetta M, Del Sindaco P, Torlone E, Pampanelli S, Compagnucci P, et al. Long-term intensive treatment of type 1 diabetes with the short-acting insulin analog lispro in variable combination with NPH insulin at mealtime. Diabetes Care. 1999;22(3): 468–77.

    Article  PubMed  CAS  Google Scholar 

  39. Rossetti P, Pampanelli S, Fanelli C, Porcellati F, Costa E, Torlone E, et al. Intensive replacement of basal insulin in patients with type 1 diabetes given rapid-acting insulin analog at mealtime: a 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime. Diabetes Care. 2003;26(5):1490–6.

    Article  PubMed  CAS  Google Scholar 

  40. Bolli GB, Di Marchi RD, Park GD, Pramming S, Koivisto VA. Insulin analogues and their potential in the management of diabetes mellitus. Diabetologia. 1999;42(10):1151–67.

    Article  PubMed  CAS  Google Scholar 

  41. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(Suppl 1):S11–63.

    Google Scholar 

  42. Hirsch IB. Insulin analogues. N Engl J Med. 2005;352(2):174–83.

    Article  PubMed  CAS  Google Scholar 

  43. Macknight JM, Mistry DJ, Pastors JG, Holmes V, Rynders CA. The daily management of athletes with diabetes. Clin Sports Med. 2009;28(3):479–95.

    Article  PubMed  Google Scholar 

  44. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31(3):596–615.

    Google Scholar 

  45. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317(7160):703–13.

    Google Scholar 

  46. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–93.

    Article  PubMed  Google Scholar 

  47. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999;354(9179):617–21.

    Google Scholar 

  48. Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    Article  PubMed  CAS  Google Scholar 

  49. Standards of medical care in diabetes—2006. Diabetes Care. 2006;29 Suppl 1:S4–42.

    Google Scholar 

  50. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33 Suppl 1:S11–61.

    Google Scholar 

  51. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Endocr Pract. 2006;12(4):458–68.

    Google Scholar 

  52. A desktop guide to Type 2 diabetes mellitus. European Diabetes Policy Group 1999. Diabet Med. 1999;16(9):716–30.

    Google Scholar 

  53. Garber AJ. The metabolic syndrome. Med Clin North Am. 2004;88(4):837–46, ix.

    Google Scholar 

  54. Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2006 Aug;29(8):1963–72.

    Article  PubMed  Google Scholar 

  55. DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA. 2003;289(17):2254–64.

    Article  PubMed  CAS  Google Scholar 

  56. Fritsche A, Schweitzer MA, Haring HU. Glimepiride combined with morning insulin glargine, bedtime neutral protamine hagedorn insulin, or bedtime insulin glargine in patients with type 2 diabetes. A randomized, controlled trial. Ann Intern Med. 2003;138(12):952–9.

    Article  PubMed  CAS  Google Scholar 

  57. Riddle MC, Rosenstock J, Gerich J. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care. 2003;26(11):3080–6.

    Article  PubMed  CAS  Google Scholar 

  58. Yki-Jarvinen H, Kauppinen-Makelin R, Tiikkainen M, Vahatalo M, Virtamo H, Nikkila K, et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia. 2006;49(3):442–51.

    Article  PubMed  CAS  Google Scholar 

  59. Kennedy L, Herman WH, Strange P, Harris A. Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. Diabetes Care. 2006;29(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  60. Lankisch MR, Ferlinz KC, Leahy JL, Scherbaum WA. Introducing a simplified approach to insulin therapy in type 2 diabetes: a comparison of two single-dose regimens of insulin glulisine plus insulin glargine and oral antidiabetic drugs. Diabetes Obes Metab. 2008;10(12):1178–85.

    PubMed  CAS  Google Scholar 

  61. Murase Y, Yagi K, Sugihara M, Chujo D, Otsuji M, Muramoto H, et al. Lispro is superior to regular insulin in transient intensive insulin therapy in type 2 diabetes. Intern Med. 2004;43(9):779–86.

    Article  PubMed  CAS  Google Scholar 

  62. Plank J, Wutte A, Brunner G, Siebenhofer A, Semlitsch B, Sommer R, et al. A direct comparison of insulin aspart and insulin lispro in patients with type 1 diabetes. Diabetes Care. 2002;25(11):2053–7.

    Article  PubMed  Google Scholar 

  63. Rosenfalck AM, Thorsby P, Kjems L, Birkeland K, Dejgaard A, Hanssen KF, et al. Improved postprandial glycaemic control with insulin Aspart in type 2 diabetic patients treated with insulin. Acta Diabetol. 2000;37(1):41–6.

    Article  PubMed  CAS  Google Scholar 

  64. Haak T, Tiengo A, Draeger E, Suntum M, Waldhausl W. Lower within-subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes. Diabetes Obes Metab. 2005;7(1):56–64.

    Article  PubMed  CAS  Google Scholar 

  65. Rosenstock J, Park G, Zimmerman J. Basal insulin glargine (HOE 901) versus NPH insulin in patients with type 1 diabetes on multiple daily insulin regimens. U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Diabetes Care. 2000;23(8):1137–42.

    Article  PubMed  CAS  Google Scholar 

  66. Koivisto VA, Tuominen JA, Ebeling P. Lispro Mix25 insulin as premeal therapy in type 2 diabetic patients. Diabetes Care. 1999;22(3):459–62.

    Article  PubMed  CAS  Google Scholar 

  67. Kilo C, Mezitis N, Jain R, Mersey J, McGill J, Raskin P. Starting patients with type 2 diabetes on insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin. J Diabetes Complications. 2003;17(6):307–13.

    Article  PubMed  Google Scholar 

  68. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jan;97(1):16–38.

    Article  PubMed  CAS  Google Scholar 

  69. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15(4):353–69.

    Article  PubMed  Google Scholar 

  70. SBD. Controle da hiperglicemia intra-hospitalr em pacientes críticos e não críticos Posicionamento Oficial SBD 2011;11.

    Google Scholar 

  71. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  PubMed  Google Scholar 

  72. Smiley D, Rhee M, Peng L, Roediger L, Mulligan P, Satterwhite L, et al. Safety and efficacy of continuous insulin infusion in noncritical care settings. J Hosp Med. 2012 Apr;5(4):212–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Alvares Cabral, 529, Porto Alegre, RS, 91350-250, Brazil

    Balduino Tschiedel M.D., M.Sc.

  2. Instituto da Criança com Diabetes and Hospital da Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil

    Marcia Puñales M.D., Ph.D.

Authors
  1. Balduino Tschiedel M.D., M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcia Puñales M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Balduino Tschiedel M.D., M.Sc. .

Editor information

Editors and Affiliations

  1. Professor Associado e Livre-Docente, Disciplina de Endocrinologia da Faculdade de Ciências Medicas da Universidade de Pernambuco, Chefe da Divisão de Endocrinologia e Diabetes do Hospital Agamenon, Magalhães-MS/UPE, Recife, Brazil

    Francisco Bandeira

  2. American Thyroid Association Past President, American Association of Clinical Endocrinologists, Professor of Medicine, Mayo Clinic College of Medicine President-Elect, Rochester, Minnesota, USA

    Hossein Gharib

  3. Federal Foundation and School of Medical Sciences, Porto Alegre, Brazil

    Airton Golbert

  4. Department of Medicine, University of Pernambuco School of Medicine, Recife, Brazil

    Luiz Griz

  5. Department of Medicine, University of Maranhao School of Medicine, Sao Luis, Brazil

    Manuel Faria

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tschiedel, B., Puñales, M. (2014). Therapy with Insulin. In: Bandeira, F., Gharib, H., Golbert, A., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8684-8_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8684-8_31

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8683-1

  • Online ISBN: 978-1-4614-8684-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation