Who Is Eligible

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Every person with type I diabetes should be a candidate for intensive insulin therapy unless there is a contraindication. Exclusions can be medical (history of severe hypoglycemia, too old or too young, illnesses in which hypoglycemia could be life-threatening such as severe coronary, cerebrovascular, or hepatic disease) or nonmedical (unwillingness or inability to follow the program, drug or alcohol abuse, etc.). However, it must be emphasized these factors do not de facto exclude a candidate. There are many elderly patients who do spectacularly well on multishot insulin programs, and many persons with debilitating hypogly-

Table 1 Pharmacokinetics of Subcutaneous Insulin

Insulin

Onset

Peak action

Duration

Short-acting

Lispro/aspart

5-15 min

1-2 hr

3-4 hr

Regular

30-60 min

2-4 hr

6-8 hr

Intermediate-acting

NPH

1-3 hr

5-7 hr

13-16 hr

Lente

1-3 hr

4-8 hr

13-20 hr

Long-acting

Ultra lente

2-4 hr

8-14 hr

<20 hr

Glargine

1-2 hr

Peakless

cemia on a standard insulin regimen who see a major improvement when switched to a physiologically correct program. Thus, most patients with type 1 diabetes should be receiving intensive insulin therapy.

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