Most people adjust their own insulin doses, although you will need help from time to time. Meetings with a member of your diabetes care team will usually be scheduled every three to four months; you will review your blood sugar levels and insulin doses at these visits, helping to fine-tune your diabetes control.

See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics ". Types — There are several types of insulin. These types are classified according to how quickly the insulin begins to work and how long it remains active:.

Most insulins are supplied in a concentration of units per milliliter. There are also more concentrated forms of insulin that can be used to control high blood sugar hyperglycemia.

The more concentrated forms allow for delivery of the same number of units but in a smaller volume. Insulin types are used in various combinations to achieve around-the-clock blood sugar control in type 1 diabetes. INSULIN REGIMENS. Intensive insulin treatment plans are designed to imitate how the nondiabetic pancreas works.

Intensive insulin therapy is recommended for most people with type 1 diabetes, although simpler insulin treatments may still be recommended for some people. Intensive insulin treatment — Intensive insulin treatment is best for keeping blood sugar in near-normal or "tight" control.

You will need to take three or more insulin shots per day or use an insulin pump, and you will need to check your blood sugar frequently. Your personal blood sugar goals will be determined by your treatment team to make sure that you are achieving blood sugar levels that are as close to the nondiabetic range as safely possible, while minimizing hypoglycemia low blood sugar events.

Your insulin treatment regimen will need to be realistic, taking into account your work or school schedules, eating times and preferences, exercise schedule, and cost concerns.

Intensive insulin therapy is recommended for most people with type 1 diabetes, starting as soon as possible after diagnosis. However, this regimen will be successful only if you are fully committed to it and you have a good understanding of the regimen.

The different intensive treatment regimens all provide some insulin as a base or "basal" supply, which is meant to provide insulin supply at low levels throughout the day and night.

This insulin is supposed to keep your blood sugars as close to normal as possible when you are not eating. The rest of the insulin is given before meals, as so-called "bolus" or prandial insulin, which keeps your blood sugar levels in control after eating.

Benefits — Intensive insulin treatment is aimed at improved blood sugar control, which has been shown to improve how you feel on a daily basis and reduce your risk of health complications later in life. Challenges — There are a few challenges to intensive insulin treatment:. See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ".

Staying motivated — Intensive treatment can be demanding, and some people lose motivation over time. Your diabetes health care team can provide tips and encouragement to help you stay on track. INJECTING INSULIN. Insulin is given as a shot under the skin this is called a subcutaneous injection using an insulin "pen" injector or a needle and syringe.

Alternatively, insulin can be delivered with an insulin pump that uses a small tube, called a catheter, to give the insulin under the skin see 'Insulin pump' below. The following figure demonstrates the sites where you can inject insulin figure 2.

You and your parents or partner should learn to draw up and give insulin shots. Infants and very young children will need a parent or caregiver to give insulin, but most older children can give themselves injections.

Insulin pen injectors — Insulin pen injectors may be more convenient to carry and use, particularly when you are away from home. Most are approximately the size of a large writing pen and contain a cartridge that contains the insulin, a dial to set the dose, and a button to deliver the injection figure 3.

A new needle must be attached to the pen prior to each injection. The needles are sold separately from the pens. Insulin pen cartridges should never be shared, even if the needle is changed. The injection technique is similar to using a needle and syringe. See 'Injection technique' below.

Pens are especially useful for accurately injecting very small doses of insulin and may be easier to use if you have vision problems. Pens are generally more expensive than traditional syringes and needles. A number of different insulin pens are available; if your health care provider prescribes a pen for you, it will come with specific instructions for use.

Needle and syringe — You will use a needle and syringe to draw up insulin from a bottle vial and inject the insulin under the skin. The needle must be injected at the correct angle; injecting too deeply could deliver insulin to the muscle, where it may be absorbed too quickly. Injecting too shallowly deposits insulin in the skin, which is painful and reduces complete absorption.

The best angle for insulin injection depends upon your body type, where you are injecting, and the length of your needle. A doctor or nurse can show you the right angle of injection. Drawing up insulin — There are many different types of syringes and needles, so it is best to get specific instructions on drawing up insulin from your doctor or nurse.

Basic information is provided in the table table 1. If you use an insulin pen, you should follow the instructions for dosing and giving insulin provided by the pen manufacturer and your doctor.

See 'Insulin pen injectors' above. Before drawing up insulin, it is important to know the dose and type of insulin needed. If more than one type of insulin is combined in one syringe, the person drawing up the insulin should calculate the total dose before drawing up the insulin.

Some people, including young children and those with difficulty seeing or other disabilities, may need assistance. Devices to magnify the syringe markings and simplify the drawing up process are available.

One type of insulin, called U insulin, requires a special U syringe; this syringe makes it easier to measure the right dose.

If you use this type of insulin, your doctor or pharmacist can show you how to use the U syringe. It is very important to use this specially marked syringe only for U insulin.

Using a U syringe with other insulins or using a U syringe with U can potentially result in dangerous errors in insulin dose. Injection technique — The following is a description of subcutaneous insulin injection:. It is not necessary to clean the skin with alcohol unless the skin is dirty.

Keep the skin pinched to avoid injecting insulin into the muscle. Depending upon your body type, you may not need to pinch up a fold of skin. Hold the syringe and needle in place for 5 to 10 seconds.

If blood or clear fluid insulin is seen at the injection site, apply pressure to the area for five to eight seconds. The area should not be rubbed, because this can cause the insulin to be absorbed too quickly. Needles and syringes should only be used once and then thrown away.

Needles and syringes should never be shared. Used needles and syringes should not be included with regular household trash but should instead be placed in a puncture-proof container also known as a sharps container , available from most pharmacies or hospital supply stores.

Alternatively, a puncture-proof container such as an old liquid laundry detergent bottle, which can be closed with a screw cap, can be used.

Check your local rules concerning disposal of these containers. Injecting through clothing — Some people wonder about the safety of injecting insulin through their clothing.

While it may be possible to do this, it's best to seek guidance from your health care provider if you are interested in using this technique. Inhaled insulin — One formulation of inhaled insulin brand name: Afrezza is available for clinical use in the United States. Once inhaled, it begins to work quickly, similar to rapid-acting insulin, and is therefore considered a prandial mealtime insulin.

Inhaled insulin has not been shown to lower glycated hemoglobin A1C levels to the usual target level of less than 7 percent in most studies. In addition, lung function testing is required before starting it and periodically during therapy.

Insulin pump. General principles — Insulin can be continuously administered by an insulin pump, rather than through multiple daily injections with a pen injector or needle and syringe.

An insulin pump may be recommended based on your preference and willingness and ability to use it. The pump stores rapid-acting insulin in a cartridge. Pumps are programmed to give a small dose of rapid-acting insulin every few minutes through the day and night basal insulin.

Before a meal, the pump needs to deliver a larger dose bolus of insulin, to prevent your blood sugar level from going too high after eating. Most pumps deliver insulin through a long spaghetti-like catheter, the end of which you insert under the skin.

The catheter is taken out and re-inserted approximately every two to three days. You will be taught how to do this relatively painless and quick procedure. Other pumps are entirely self-contained, with a small catheter built right into the small, disposable pump unit that needs to be replaced every few days.

For these "patch" pumps, insulin delivery is controlled by another device or compatible smartphone that you need to carry with you. The pump can be taken off for up to one hour without impacting blood sugar control; if it is taken off for longer periods of time, insulin injections may be needed to control the blood sugar.

If available and affordable, people using multiple daily insulin injections or an insulin pump generally use a continuous glucose monitoring CGM device, which provides more information about blood sugar levels than traditional fingersticks and a glucose meter.

These devices allow you to make better informed decisions about insulin dosing based on your blood sugar trends. If you do not use CGM, you may need to check your blood sugar levels four to seven times daily before meals, bedtime, sometimes two to three hours after meals, and occasionally in the middle of the night while your doses are being adjusted.

In addition, testing is recommended when low blood sugar is suspected; before, during, and after exercise; and before driving or engaging in a dangerous activity. After doses are programmed initially in the pump, testing at least four times per day, including before meals, is required as you must direct the pump to give pre-meal insulin based upon your blood sugar level and amount and type of food you plan to eat.

If insulin injection therapy is used, the pre-meal blood sugar and anticipated food intake are also used to help calculate the mealtime insulin dose injected. Some insulin pumps communicate with CGMs, receiving glucose readings every five minutes.

They can automatically adjust the basal rate of insulin delivery and deliver extra insulin to help correct for high blood sugars depending on the CGM results called a partial "artificial pancreas," "automated insulin delivery" [AID], or "hybrid closed-loop" system figure 5.

These devices can improve or maintain glucose control with less risk of hypoglycemia low blood sugar. The following devices, combining an insulin pump with CGM, are available or will become available in the future:. The insulin pump can be programmed to stop insulin delivery for up to two hours at a preset glucose value "low glucose suspend" feature or to reduce or stop insulin infusion if the system "predicts" that your blood sugar will soon go too low "predictive low glucose suspend" feature.

These features reduce the frequency and duration of hypoglycemia that may occur while you are sleeping. Some systems will also deliver extra insulin to help correct for hyperglycemia high blood sugar when there is insufficient insulin on board. You need to manually direct delivery of insulin doses prior to meals.

Use of these systems has been associated with less hypoglycemia low blood sugar and more blood sugar readings in the target range. An investigational bihormonal system uses two commercially available pumps, with one delivering insulin and the other glucagon. These systems are also fully automated, in that the delivery of the insulin and glucagon is determined completely automatically by an algorithm that is, in turn, dependent on CGM results.

These devices have not yet been approved and are not commercially available. The insulin pump has advantages and disadvantages; it may be helpful to talk with a person who uses a pump before deciding to try it. Most pump manufacturers have a list of people willing to speak with prospective pump users.

It may also be possible to use a trial pump for a few days before committing to it. Advantages — Insulin pumps have the advantage of increasing flexibility in the timing of meals and other day-to-day events. This can be of great benefit for children or adults whose schedule varies from one day to the next.

People who use an insulin pump do not require multiple daily injections; most people who use the pump change their injection insulin infusion site every 48 to 72 hours. Another major advantage of an insulin pump is that there is less variation in the amount of insulin absorbed compared with when insulin is given with a needle and syringe or pen.

This can help reduce day-to-day variations in blood sugar levels. Insulin pumps can deliver smaller amounts of insulin at a time than injection therapy. The greatest advantage is for people with type 1 diabetes having blood glucose readings that are too low hypoglycemia and too high hyperglycemia.

The use of an insulin pump with CGM in an automated system can help reduce hypoglycemia and increase time in the target range. Disadvantages — The cost of an insulin pump and supplies is greater than the cost of insulin syringes and needles or pens, although most insurance carriers cover some portion of the expenses.

Some people develop pump-associated problems, including skin irritation or infection at the infusion site or pump malfunction. You must take care to monitor your blood sugar levels carefully; stopping insulin, even for a short time, can lead to a significant increase in blood sugar. Some people find the pump awkward, unpleasant, or embarrassing although others find that they are able to adjust to it fairly easily.

However, you can disconnect the pump for brief periods, if desired. FACTORS AFFECTING INSULIN ACTION. Dose of insulin injected — The dose of insulin injected affects the rate at which your body absorbs it. For example, larger doses of insulin may be absorbed more slowly than a small dose.

With larger doses of insulin, the insulin may peak later or last longer than with small doses. This could mean that your blood sugar level is higher than expected within a few hours after eating but then becomes low.

Injection technique — In general, we recommend the use of short insulin needles 4 or 5 mm to minimize tissue damage and reduce the likelihood of inadvertently injecting into muscle. These conditions include:.

Insulin therapy keeps your blood sugar within your target range. It helps prevent serious complications. If you have type 1 diabetes, you need insulin therapy to stay healthy.

It replaces the insulin your body doesn't make. If you have type 2 diabetes, insulin therapy might be part of your treatment. It's needed when healthy-lifestyle changes and other diabetes treatments don't control your blood sugar well enough.

Insulin therapy also is sometimes needed to treat a type of diabetes that happens during pregnancy. This is called gestational diabetes. If you have gestational diabetes, you might need insulin therapy if healthy habits and other diabetes treatments don't help enough.

Any types of insulin help treat diabetes. Each type varies in how quickly and how long it controls blood sugar. You may need to take more than one kind of insulin. Factors that help determine which types of insulin you need and how much you need include:. Long-acting, ultralong-acting or intermediate-acting insulins.

When you're not eating, your liver releases glucose so your body has energy. Long-, ultralong- or intermediate-acting insulin prevents blood sugar levels from rising without eating.

Examples of these insulins are glargine Lantus, Basaglar, others , detemir Levemir , degludec Tresiba and NPH Humulin N, Novolin N, others.

Intermediate-acting insulin lasts about 12 to 18 hours. Long-acting insulin works for about 24 hours. And ultralong-acting insulin lasts about 36 hours or longer. Rapid-acting or short-acting insulins. These insulins are ideal for use before meals. If taken with a meal, they can help bring blood sugar back down to the baseline.

They also blunt the sugar spikes after you eat. They start to work much faster than long-acting or intermediate-acting insulins do. Sometimes, rapid-acting insulins begin working in as few as 5 to 15 minutes.

But they work for a much shorter time. Rapid-acting insulin lasts about 2 to 3 hours. Short-acting insulin lasts about 3 to 6 hours. Examples of these insulins include ultrafast-acting aspart Fiasp and lispro Lyumjev ; rapid-acting aspart NovoLog , glulisine Apidra and lispro Humalog, Admelog ; and short-acting, regular Humulin R, Novolin R.

Sometimes, insulin-makers combine two types of insulin. This is called pre-mixed insulin. It can be helpful for people who have trouble using more than one type of insulin. Pre-mixed insulin often starts to work in 5 to 60 minutes.

It can keep working for 10 to 16 hours. Be aware that different preparations of insulin vary in terms of when they start working and how long they last. Be sure to read the instructions that come with your insulin.

And follow any directions from your health care team. Insulin doesn't come in pill form. The digestive system would break the pill down before it had a chance to work. But there are other ways to take insulin.

Your health care team can help you decide which method fits best for you. Sometimes, using insulin therapy can be a challenge. But it's an effective way to lower blood sugar.

Talk to a member of your health care team if you have any trouble with your insulin routine. Ask for help right away if at-home glucose tests show that you have very low or very high blood sugar. Your insulin or other diabetes medicines may need to be adjusted. With time, you can find an insulin routine that fits your needs and lifestyle.

And that can help you lead an active, healthy life. If you take many doses of insulin a day, ask your health care provider if there's a way to make the routine simpler. Adding noninsulin medicines to your treatment plan might lower the number of insulin shots you need each day.

And if you take fewer insulin shots, you'll need to check your blood sugar less often. Certain noninsulin medicines have other health benefits too. Some can help control weight and lower the chances of heart attack or stroke, heart failure, and kidney failure.

Some people with type 2 diabetes can stop taking insulin completely after they start taking noninsulin medicines. But it's important to keep taking your insulin as prescribed until your health care provider tells you it's OK to stop.

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Diabetes treatment: Using insulin to manage blood sugar Learning how insulin affects your blood sugar can help you better manage your condition. By Mayo Clinic Staff.

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