What are my options for insulin delivery systems?
To replace insulin as close to normal levels as possible, you can use either Multiple Dose Insulin (MDI) therapy or insulin infusion (pump) therapy.
Multiple dose insulin (MDI)
Meal and basal insulin are given with an insulin pen or syringe. There are several factors to consider when choosing a type of insulin – some of these are described below but a discussion with your diabetes care provider is required to really know what is best for you!
Rapid acting analogues are preferred for meal insulin. They cause less lows and provide better control. They are more expensive than the older Regular or Toronto insulin.
There are several delivery devices (pens) to choose from depending on which brand of insulin you use. Discuss your choices with your educator.
Either intermediate or long acting insulin may be used as basal insulin, given once or twice a day. The factors to consider in choosing a basal insulin are outlined in Table 2 below.
| Factors to consider | N/NPH | Glargine | Detem1r |
| Action | Peak (~
5-8h) & duration (13-18h) |
Relatively
Peak less lasts ~ 22h |
Relatively
Peak less lasts ~20h |
| Predictable? | No | Yes | Yes |
| Hypoglycemia risk | Yes | Less | Still less |
| Storage | Room temp x 28d | Better in
fridge - discard after open for 28d |
Room temp x 42d |
| Cost /Format | $ / pen or vial | $$ / pen or vial | $$ / pen |
| Weight effect | Usual gain | Usual gain | Maintain or lose |
The most common MDI plan used in Canada today, shown in the following diagram, uses either intermediate (N or NPH) twice per day OR glargine or detemir once or twice per day. A rapid acting analogue is taken before each meal or snack. Self-monitoring of blood glucose (blood testing) is vital to success with all insulin therapy plans.
Multiple Dose Insulin (MDI): Four/Five (4 or 5) injections/day – Rapid analogue insulin
at mealtime and intermediate or long acting insulin (1 or 2 times per day)
Insulin Pumps
The insulin pump option (or continuous subcutaneous insulin infusion) is becoming more popular and available today.
