According to the Center for Disease Control (CDC) 11.3% or 37.1 million people in the United States have diabetes mellitus. Major complications of diabetes are neuropathy, heart disease, and hypertension. Diabetes management should be aimed at preventing short and long-term complications.
Different Types of Diabetes
Type I diabetes, also known as juvenile diabetes, because the onset commonly occurs during childhood or adolescence and is abrupt. Type I diabetes occurs when pancreatic beta cells are damaged or destroyed. Pancreatic beta cells produce insulin and when they are damaged or destroyed by autoimmune disease, genetic or environmental factors or viral infections insulin production becomes insufficient. Type II diabetes commonly occurs in middle age and progresses gradually. In Type II diabetes a combination of increased tissue resistance to insulin and impaired pancreatic insulin secretion lead to hyperglycemia. A third type of diabetes is gestational diabetes which occurs during pregnancy and subsides rapidly following delivery. Gestational diabetes causes high birth weights, and hyperinsulinemia in infants (Rosenthal & Burchum, 2021).
The mainstay of treatment for Type I diabetes is insulin. Insulin dosing is weight-based and recommended ranges are 0.4 to 1.0 units per kilogram per day (u/kg/day) of total insulin. Higher ends of the dosing range are needed during puberty and if the patient presents with ketoacidosis. American Diabetes Association (ADA) recommendations for initiation of therapy in a patient who is metabolically stable is 0.5 (u/kg/day) (American Diabetes Association [ADA], 2018).
Insulin should be administered with a meal and based on blood glucose levels, carbohydrate consumption, and activity level. While administration of rapid onset insulin should be at meal- time, timing and administration should be individualized (ADA, 2018).
Insulin comes in many forms and prandial dosing insulin should be fast acting to reduce the risk of hypoglycemic episodes. Humalog (insulin lispro) is a fast-acting insulin that can be administered IV, by subcutaneous injection or by a continuous subcutaneous infusion pump. Most short acting insulin is available in a pen that is easy for patients to use correctly and conveniently by dialing the dose into the pen and then attaching a small needle and pressing it into subcutaneous tissue on the stomach, back of the arm, or fatty portion of the thigh. Humalog has a more rapid onset and a shorter duration of action than regular human insulin so when taken with a meal the risk of hypoglycemia is reduced. Onset is within 5 minutes and peak is usually 30 – 60 minutes after administration (Food and Drug Administration [FDA] & Eli Lilly and Company, 2012).
Individuals who are diagnosed with Type I diabetes face short-term risks of ketoacidosis if glucose levels are not controlled, and hypoglycemic episodes related to insulin therapy (Rosenthal & Burchum, 2021, Chapter 68). They face long-term risks of renal failure, peripheral neuropathy, hypertension, and heart disease. Treatment with ACE inhibitors, angiotensin II receptor blockers, and statin drugs should be considered for long-term disease prevention in adult patients (Gray & Threlkeld, 2019). Treatment with prandial insulin dosing, and balancing carbohydrate intake with activity are key to maintaining safe blood glucose levels.
Type I diabetes is caused by decreased or lack of insulin production and requires close management that includes insulin dosing to prevent long-term disease complications. Humalog is a form of insulin that can be used as part of a comprehensive treatment plan to successfully treat Type I diabetes.
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