▪ Treatment differs based on the type of diabetes and glycemic control:

• Type 1 DM: insulin replacement.
• Type 2 DM: oral agents (metformin is first line), non-insulin injectables, insulin replacement; weight loss particularly helpful in lowering blood glucose.
• Gestational DM: insulin replacement if nutrition therapy and exercise alone fail. Regular (short-acting) insulin: preferred for DKA (because it can be used intravenously), hyperkalemia (with glucose to prevent hypoglycemia), stress hyperglycemia.

Insulin preparations.

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Diabetic patients often require two types of insulin: a basal long-acting insulin and a postprandial short-acting insulin.

A. Short-acting insulin (Regular):

This type of insulin starts working 30 minutes after subcutaneous injection, with peak effects occurring between 2-4 hours. Unfortunately, the peak effect of regular insulin often happens after the postprandial peak in blood glucose concentration. This mismatch between insulin and glucose peaks generally leads to inadequate control of glucose following meals.

B. Rapid-acting insulin (Lispro, Aspart, Glulisine):

Rapid-acting insulins, such as lispro, aspart, and glulisine, have significantly improved postprandial insulin therapy. Their onset of action is under 15 minutes, peaking between 45-75 minutes. This pattern closely mimics the endogenous postprandial insulin response of normal individuals.

C. Intermediate-acting insulin (NPH):

NPH is effective for about 18 hours, (shots given twice a day).