snacks. Adjust the dose based on self-monitoring of glucose levels, HbA1C, weight, lifestyle and other concurrent conditions.

Insulin Therapy for Type 1 diabetes :

Successful insulin therapy for type 1 diabetes requires the co-ordination of the following factors:

Properly titrated insulin dose

Diet

Physical activity

Blood glucose monitoring

Patient education

Readily accessible medical support

There are 2 main insulin regimens

Twice-daily injections of mixed intermediate (cloudy isophane) or long-acting insulin with a short acting (clear soluble) insulin.

The basal bolus regimen: This is particularly suitable for patients with irregular meal times or hectic lifestyles. This consists of intermediate acting insulin at bedtime (to provide the basal insulin requirement) with short acting insulin before each meal.

Multiple Dose Insulin (MDI) regimen: Here a combination of short and long acting insulin (Mixtard 30:70 0r 50:50) is given prior to breakfast and dinner, while a short acting insulin is given at lunch. This regime can be modified in numerous ways to suit the patient’s needs, e.g. long acting insulin may be added at bedtime.

Nowadays an entirely new dimension has been added with the availability of ultra short acting Lispro/Aspart insulin and the very long acting Glargine (Lantus) insulins. Glargine insulin is given at bedtime, with the ultra short insulins being administered prior to each major meal.

Self-monitoring of blood glucose (SMBG) with or with a glucometer is recommended at least once daily. Testing time should be changed frequently with the majority of the readings being pre-meal or at bedtime.

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