Therapy for diabetes

Intensive conventional insulin therapy (ICT)

The fundamental idea behind intensive therapy, which is also described in the section on pump therapy, is the extensive separation of background and peak (before meals) insulin intake. Background long-acting insulin, which is usually injected in the mornings and evenings, covers the basic insulin needs of the body. Before each meal, additional short-acting normal or analogue insulin is injected to cover peak demand. Short-acting insulin regulates the blood glucose levels that result from the carbohydrates eaten during a meal.

The combination of background and peak insulin intake is an attempt to mimic the insulin secretion of a healthy person. If this does not work, it can lead to problems:

Many diabetics have experienced the problem of a night-time hypo between midnight and 3:00 a.m., when the level of the long-acting insulin is too high but the body has a low requirement. Later in the early morning hours, when the insulin requirement increases (“dawn phenomenon”) and the effect of the insulin simultaneously tails off, this can be followed by marked hyperglycaemia.
Despite injecting insulin punctually, “gaps” in the effect of the insulin can occur as an interaction between the background and peak insulin takes place. The result is variations in the blood sugar level (too low or too high), particularly when there are changes to the daily routine of meals or physical activity.

Summary:
Although diabetics who use intensive therapy have to inject themselves five to six times (or even more frequently) per day, and have to put up with limitations in their daily life, their insulin supply is not optimal. Insulin pump therapy can change this.

Insulin ‘release’ in intensified conventional therapy (ICT)

Insulin ‘release’ in intensive conventional therapy compared with insulin release in non-diabetics: too little insulin in the early hours of the morning and in the late afternoon, too much insulin in the middle of the day and particularly at night.
: Normal insulin : Long-acting insulin

Print version | Top of page