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type 1 diabetes treatments and therapies: from insulin to glucose monitoring

managing blood sugar is only part of a bigger picture.

by karen hawthorne
published nov 06, 2023
last updated dec 15, 2023
read time 8 minute read
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read time 8 minute read
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type 1 diabetes treatments and therapies: from insulin to glucose monitoring
a continuous glucose monitor (cgm) is a wearable sensor and transmitter that tracks blood sugar every few minutes throughout the day and night. getty images
the discovery of insulin at the university of toronto in 1921 has saved the lives of tens of millions of people worldwide, changing the course of what was formerly a fatal disease into a chronic one that can be managed with treatment and discipline. the young, newly-certified canadian physician frederick banting, physiology student charles best, and professors john macleod and james collip tested the pancreatic extract on dogs and then on a 13-year-old boy with type 1 diabetes in january 1922.
the therapy’s success led to a 1923 nobel prize in medicine, along with the rapid development of the technology for insulin production around the globe.
why is insulin so important? type 1 diabetes is an autoimmune disease caused by antibodies that mistakenly damage the cells in the pancreas that make insulin. without insulin, blood sugar can’t get into cells that you need to function and builds up in the bloodstream.
the resulting high blood sugar is damaging to the body, causing thirst and kidney problems to get rid of that extra sugar, along with long-term effects on inflamed blood vessels, including vision loss, nerve problems, and heart attack and stroke.
managing blood sugar is only part of a bigger picture.

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insulin is still the cornerstone type 1 diabetes treatment used today, but it continues to be refined to help better mimic how a healthy body operates. research has also led to supportive technology for monitoring blood sugar and delivering insulin, and we’re seeing transplants of pancreatic islet cells that can produce insulin when needed and free patients from frequent insulin injections.
other promising therapies in development include stem cell transplants that will convert to insulin-producing cells, smart insulin that can sense the blood glucose level and deliver the amount of insulin required autonomously, and teplizumab, the first fda-approved drug for delaying type 1 diabetes in at-risk patients, helping to reduce the potential for severe complications (not yet approved in canada).
“there are lots of things that people can do now with type 1 diabetes that we could never do in the past with so many better ways of managing it,” says dr. akshay jain, a clinical and research endocrinologist who treats patients in surrey, b.c. he is also a clinical instructor at the university of british columbia and renowned speaker on the subject at medical conferences in canada and abroad.
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jain recommends discussing newer developments with your healthcare team. “if people have been living with type 1 diabetes for a long time, sometimes they don’t really follow up with their doctors and may not be aware of the latest advances. insulin management has come a long way.”
here are a list of therapies for people living with type 1 diabetes:

rapid or short-acting insulin (bolus insulin)

multiple daily injections of bolus insulin by pen, syringe or insulin pump (a wearable device) are used to control the glycemic rise at meals. it’s also used to correct hyperglycemia, which happens when your blood sugar is too high and you have symptoms like extreme thirst, dry mouth, hunger, drowsiness or even blurred vision. when you eat, the carbohydrates in food and drink – that are ranked on a reference scale called the glycemic index – naturally raise your blood sugar. the insulin your body is lacking to transport the blood sugar is injected into your body to do the job.
bolus insulin is usually taken a short time before a meal. three common types include:
  • aspart (marketed as novolog, fiasp (or faster aspart), novolog flexpen, fiasp flextouch)
  • lispro (marketed as humalog, admelog, humalog kwikpen, admelog solostar)
  • glulisine (marketed as apidra and the apidra solostar pen)
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as diabetes canada notes, dosing for these medications is different for each individual, with a regimen carefully developed by your healthcare team, that takes into account age, general health, treatment goals, lifestyle, diet, ability for self-management and hypoglycemia awareness status. hypoglycemia happens when your blood sugar is too low for your body to function, and you can experience shaking, sweating, fast heartbeat, confusion and dizziness.
common insulin side effects include hypoglycemia, weight gain, headaches, and injection site reactions with swelling, redness and itchiness. rare side effects of insulin are lipodystrophy (abnormal fat distribution) and swelling in the arms and legs. typically, side effects resolve as your body gets used to the medication, but if they worsen, talk to your healthcare provider. dosage or type of insulin can be adjusted.
“living with type 1 diabetes is so difficult because there are so many variables that can affect sugars,” jain says. “you’re constantly trying to achieve this delicate balance between too little and too much sugar. so you need to understand how your body reacts to carbohydrates, so different foods that have a different glycemic index, how it’s affected during activity levels, and how alcohol affects this. so for all of these, education is paramount.”
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long or intermediate-acting insulin (basal insulin)

basal insulin is the other key part of current insulin therapy for type 1 diabetes. it provides control of blood glucose in between meals and when you’re fasting or asleep, and it’s taken once or twice a day. basal has the same unique dosing requirements and side effects as bolus insulin.
as johns hopkins’ patient guide outlines, the common types of intermediate-acting basal insulin include:
  • nph (marketed as humulin n and the humulin n pen, as well as novolin n and the novolin n flexpen)
nph is usually injected twice a day and begins working one to three hours after injection. it is most effective between four to 10 hours of injection and keeps working for 10 to 16 hours.
the common types of long-acting basal insulin include:
  • glargine (marketed as lantus, basaglar, and the solo star pen)
  • detemir (marketed as  levemir and the flexpen)
  • degludec (marketed as tresiba and the flextouch pen)
glargine is injected once a day, and starts working a few hours after later, remaining highly effective until it wears off in 20 to 24 hours.
detemir can be used once or twice a day. it begins working a few hours after injection and keeps working for 20 to 24 hours.
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degludec is taken once a day and begins to work a few hours after injection. it can remain effective longer than 24 hours.
“when we first discovered insulin, it was the shorter-acting insulin,” says jain. “but what happens is that it’ll have a peak and then it’ll clear out from the body. so that necessitated having multiple injections. but that’s not how the pancreas works in the body. our brain requires sugar on an ongoing basis and when we are not eating, obviously the brain still requires sugar.”
he explains that the liver is the warehouse for storage of sugar, breaking down sugar stores and releasing them into the blood supply. “but with diabetes, unfortunately the liver is leaking far more glucose, so you need some insulin in the background to prevent the liver from leaking too much glucose into the bloodstream. so this is where having a long-acting insulin makes a big difference, because the long-acting insulin is what will counteract the excess leakage of sugar from the liver.”

continuous glucose monitoring

instead of the need for frequent finger pricks to determine blood sugar levels, a continuous glucose monitor (cgm) is a wearable sensor and transmitter that tracks blood sugar throughout the day and night. the readings are relayed in real-time to a device and app for the patient, caregiver or healthcare provider, and can be a lifesaver for people who experience low glucose during the night. some cgm, brands like dexcom g7 and medtronic guardian connect system, can also be paired with an insulin pump.
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“with continuous glucose monitoring devices, people living with type 1 diabetes now get access to understanding how their sugar readings are at any given time. these devices will also alert the person about low or high sugars. in fact, some of these devices can alert about a low sugar 20 minutes before it happens,” says jain.

insulin pumps vs. hybrid closed loop pumps

an insulin pump is a wearable device which is programmed to administer micro doses of insulin on an ongoing basis. the pump sends insulin through a narrow plastic tube, or catheter, that ends in a tiny needle that goes into the skin. with most pumps, the needle pulls out after inserting the tubing, leaving the flexible tube under the skin. this gives people more freedom to eat, sleep and exercise when they want, so they don’t have to be planning their schedules around giving insulin shots. another benefit is the pump can help with blood sugar control and fewer swings in blood sugar levels, so there’s less chance of dangerous lows. the main devices available in canada are the omnipod dash, and systems from medtronic, tandem and ypsomed. 
hybrid closed loop pumps are also available that combine an insulin pump and software that allows the pump to communicate with a continuous glucose monitoring (cgm) device. they work together to automatically adjust insulin delivery based on real-time readings. these systems don’t require the patient or caregiver to count carbohydrates or input instructions for insulin delivery. but they are designed to be adjusted and calibrated by the patients over time, so they can’t be set on autopilot and expected to work perfectly. systems in canada are marketed under medtronic, tandem and ypsomed.
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nasal glucagon spray

glucagon is like the epipen for diabetes. if someone becomes unconscious because of low sugar, then someone will need to administer a medication called glucagon to revive them. it is in an injection form, but complicated to prepare and administer. now there is a nasal spray version available, says jain. “anyone can put the spray in the nostril, and it revives the person instantaneously. it’s a game changer.” baqsimi in a single-dose compact tube is in pharmacies across the country.
as jain says, type 1 diabetes management takes discipline and adherence to the prescribed therapies – and a commitment to lifestyle habits of healthy eating, regular physical activity and not smoking, to live full and unlimited lives.
“if people are educated about diabetes management, and you put them in the driver’s seat, they can be their own advocates.”
karen hawthorne
karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

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