If your have type 1 diabetes, your pancreas no longer makes enough insulin, so the conventional approach then is to introduce insulin into your body. However, because insulin is a protein, it can not be ingested as a pill or taken orally. If it were taken orally, your body would break it down and digest it before it could get into your blood system to lower your blood glucose. So most type 1 diabetics take insulin as a subcutaneous shot . . . injected just under the skin with a small, short needle. Most type 1 diabetics need at least two insulin shots a day for good blood glucose control. Some take three or four shots a day to have a more flexible diabetes plan.

There are six main types of insulin. They each work at different speeds. Many type 1 diabetics take two types of insulin. if you take regular insulin alone or with a longer-acting insulin, it should be injected 30 minutes before a meal. If you take a rapid-acting insulin, you should take your shot just before you eat.

An insulin pump is a portable, battery-operated device (about the size of a deck of cards) worn outside the body, usually attached to a belt or waistband or kept in a pocket. Insulin pumps deliver rapid- or short-acting insulin 24 hours a day. The insulin is pumped from a reservoir through a system of plastic tubing (infusion set) that ends with a catheter needle inserted just under the skin of the abdominal wall.

Insulin doses are separated into 3 kinds:

1. Basal doses
• Delivered continuously over 24 hours
• Keeps your blood glucose levels in range between meals and overnight
• Different amounts of insulin are often programmed for different times of the day and night.
2. Bolus doses
• When you eat, you use buttons on the pump to give additional insulin called a bolus
• You take a bolus to cover the carbohydrate in each meal or snack.
3. Correction or supplemental doses
• If you eat more than you planned, you can simply program a larger bolus of insulin to cover it
• You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your target range

In recent years there have been many technological advances with insulin pumps. Now a days, type 1 diabetics of all ages use insulin pumps and people with type 2 diabetes have started to use them as well.

Using an insulin pump has the following advantages over insulin injections:

• totally eliminates individual insulin injections
• delivers insulin more accurately than injections
• improved A1C
• fewer large swings in your blood glucose levels
• reduces severe low blood glucose episodes
• eliminates unpredictable effects of intermediate- or long-acting insulin
• more flexibility about when and what you eat
• allows you to exercise without having to eat large amounts of carbohydrate

Using an insulin pump has the following disadvantages over insulin injections

• Can cause weight gain
• Can be expensive
• Can be bothersome since you are attached to the pump most of the time
• Can require a hospital stay or maybe a full day in the outpatient center to be trained

Regardless of whether you inject insulin or pump it . . . there are serious risks and complications associated with taking insulin:

• Insulin causes weight gain.
• Insulin is THE most fattening hormone.
• Its purpose is to take energy out of the bloodstream and store it as fat . . .
  the very thing that conventional treatment is aimed at stopping.
• Diabetics who have to inject insulin find it almost impossible to lose weight.
• Insulin increases risk of heart disease
• Insulin increases risk of thrombosis
• Insulin increases plaque formation
• Insulin prevents plaque regression
• Insulin stimulates connective tissue synthesis
• Insulin stimulates IGF-1

• Insulin elevates blood pressure:
• Insulin causes kidney Na+ retention
• Insulin enhances flow of Na+ and Ca++ to vascular smooth muscle cell
• Fasting and postprandial insulin levels have significant positive associations with systolic and diastolic BP
• Hyperinsulinaemia (HIGH blood insulin level) can cause:
  
  • hypoglycemia (LOW blood glucose levels) which can lead to coma and death

• Hyperinsulinaemia is also known to be involved in:
• Polycystic ovarian syndrome (PCOS)
• Prostate cancer
• Endometrial cancer
• Breast cancer

• Insulin is suspected in:
• Gestational hypertension
• Preeclampsia
• Osteoporosis

As discussed above, type 1 diabetics can't use oral medications. These medications are only prescribed for type 2 diabetes and work best in those who have only had high blood sugar for ten years or less and who have normal weight. It's not uncommon for oral medication to control blood sugar well for years and then stop working. Some people who begin treatment with oral medications eventually need to take insulin. Many of the diabetic medications have significant side-effects and/or liver toxicity issues.

Oral Diabetes Drugs can be broken down into 5 classes:

1. Sulfonylureas (chlorpropamide [Diabinese], tolazamide [Tolinase], glipizide [Glucotrol] and others): Until 1994, sulfonylureas were the only oral medications for diabetes available in the US. These medications act to force your pancreas to make more insulin, which then lowers your blood sugar. For this medication to work, your pancreas has to make some insulin. If your pancreas makes no insulin at all, you aren't a good candidate for this class of drugs. Also, if you have an allergy to sulfa drugs you should probably avoid sulfonylureas.
• Side Effects:
• weight gain
• low blood sugar (hypoglycemia)
• an upset stomach
• skin rash or itching
2. Nonsulfonurea Meglitinides (repaglinide [Prandin], nateglitinide [Starlix]):
   Similar in action to sulfonureas, but used in people with sufa sensitivity. The mechanism of action is to stimulate insulin production. This activity is both dose dependent and dependent on the presence of glucose, so that these drugs have reduced effectiveness in the presence of low blood glucose levels. Nonsulfonurea Meglitinides work fast and your body uses them quickly. This fast action means you can vary the times you eat and the number of meals you eat more easily than you can with other diabetes medications. These work like short acting sulfonylureas.The meglitinides may be used alone, or in combination with metformin, but never in combination with other drugs that enhance insulin secretion.
• Side Effects:
• weight gain
• low blood sugar
3. Alpha Glucosidase Inhibitors (acarbose [Precose], miglitol [Glyset]):
   These medications block the enzymes that digest the starches you eat. This action causes a slower and lower rise of blood sugar through the day, but mainly right after meals. These drugs do not prevent conversion, but only delay it, reducing the peak blood glucose levels. Alpha-glucosidase inhibitors may be used alone or in combination with sulfonylureas or other hypoglycemic agents.
• Side Effects:
• stomach problems such as:
• gas
• bloating
• diarrhea
4. Biguanides (metformin [Glucophage]):
   Helps lower blood sugar by making sure your liver doesn't make too much sugar. It also decreases intestinal absorption of glucose and increases peripheral glucose uptake and use. Metformin also lowers the amount of insulin in your body. You may lose a few pounds when you start to take metformin. This weight loss can help you control your blood glucose. Metformin can also improve blood fat and cholesterol levels, which are often high if you have Type 2 diabetes. Biguanides may be used alone or in combination with a sulfonylurea.
• Side Effects:
• weakness
• tired or dizzy
• trouble breathing.
• nausea
• vomiting
• diarrhea
• taste of metal in your mouth
• sick when drinking alcoholic beverages
• potential worsening of existing kidney problems
5. Thiazolidinediones (Rosiglitazone [Avandia], pioglitazone [Actos], Troglitazone [Rezulin, Resulin, Romozin]): These drugs act by both reducing glucose production in the liver, and increasing insulin dependent glucose uptake in muscle cells. They do not increase insulin production. Thiazolidinediones are only used in combination with other medications. Troglitazone was introduced in the late 1990s but turned out to be associated with an idiosyncratic reaction leading to drug-induced hepatitis. Furthermore, it can cause a rare but life-threatening condition called primary pulmonary hypertension. This condition is caused when blood vessels narrow, causing the heart to pump harder and in turn increase blood pressure. The heart must pump harder to supply the lungs with blood, and eventually this will weaken the heart muscle itself and result in total heart failure. Troglitazone was withdrawn from the USA market on 21 March 2000, and from other markets soon afterwards.
• Side Effects:
• weight gain
• low blood sugar
• anemia
• decreased effectiveness of birth control pills
• swelling in the legs or ankles

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