What’s Better and Why—Taking Long-Acting Insulin or Going on the Pump?

Ask Dr. Einhorn

| Jan 1, 2005

The insulin pump remains the gold standard for optimal control of type 1 diabetes and for anyone who needs intensive insulin therapy.

The pump offers maximum flexibility. For example, only the pump has the ability to vary the basal rate, something that may be very important for the many individuals who need a low basal rate early in their sleep (for example, 11 p.m. to 3 a.m.) and a higher basal rate during the early hours before awakening (3 a.m. to 7 a.m.).

In addition, only the pump allows the user to immediately suspend insulin delivery, thereby avoiding hypoglycemia if a meal is delayed or in other unforeseen circumstances. And today’s pumps are much easier to use and more reliable, and the infusion sets and skin interface are much better than before.

However, insulin pumps are not for everyone, since they involve significant effort and expense as well as the need to wear a device.

Fortunately, the current generation of long- and rapid-acting insulins is so good that intensive insulin therapy without a pump has become much better. In the past, the unpredictable peaks and troughs of Regular, NPH, Lente and Ultralente insulins made tight control very difficult without a high risk of hypoglycemia.

Current long-acting insulin analogs such as Lantus (glargine) and the soon-to-be-released insulin detemir have been shown to produce fewer instances of hypoglycemia and can be given morning or evening to people with type 2 diabetes. However, people with type 1 may need to divide their long-acting insulin into two doses to get the best basal insulin coverage over 24 hours.

The same predictability and fewer instances of hypoglycemia are also the case with the rapid-acting insulins Humalog (lispro), NovoLog (aspart) and Apidra (glulisine). They can be given before, during or even right after a meal so there is less guesswork about when and what is eaten.

As with most everything in the management of diabetes, the choice of therapy is individualized and based on many personal and medical factors. Certainly either strategy should result in achieving glycemic targets much more easily and safely than was possible just a few years ago. Our choices in the area of insulin delivery have never been so good.

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Categories: Diabetes, Diabetes, Insulin, Insulin Pumps, Lantus, Low Blood Sugar, Professional Issues, Type 1 Issues, Type 2 Issues

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