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Prandial insulin, also called mealtime or bolus insulin, is designed as a bolus dose of insulin prior to a meal to regulate the spike in blood glucose that occurs following a meal. The dose of prandial insulin may be static, or may be calculated by the patient using either their current blood sugar, planned carbohydrate intake, or both.
Several drug classes are indicated for use in type 2 diabetes and are often used in combination. Therapeutic combinations may include several insulin isoforms or varying classes of oral antihyperglycemic agents. As of 2020, 23 unique antihyperglycemic drug combinations were approved by the FDA. [1]
Insulin can be injected by several methods, including a hypodermic needle, jet injector, or insulin pump. There is also inhaled insulin that can be used in adults with diabetes. [33] There are several types of insulin that are commonly used in medical practice, with varying times of onset and duration of action. [32]
Regular insulin, also known as neutral insulin and soluble insulin, is a type of short-acting medical insulin. [2] It is used to treat type 1 diabetes , type 2 diabetes , gestational diabetes , and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states . [ 5 ]
Conventional insulin therapy is characterized by: Insulin injections of a mixture of regular (or rapid) and intermediate acting insulin are performed two times a day, or to improve overnight glucose, mixed in the morning to cover breakfast and lunch, but with regular (or rapid) acting insulin alone for dinner and intermediate acting insulin at bedtime (instead of being mixed in at dinner).
A non-insulin medication approved by the U.S. Food and Drug Administration for treating type 1 diabetes is the amylin analog pramlintide, which replaces the beta-cell hormone amylin. Addition of pramlintide to mealtime insulin injections reduces the boost in blood sugar after a meal, improving blood sugar control. [57]