If you're seeing this message, it means we're having trouble loading external resources on our website.

If you're behind a web filter, please make sure that the domains *.kastatic.org and *.kasandbox.org are unblocked.

Main content
Current time:0:00Total duration:8:49

Video transcript

since type 1 diabetes is caused by autoimmune destruction of the pancreas that results in an absolute deficiency of insulin it makes sense that the treatment of type 1 diabetes is to give insulin now this is true but unfortunately it's not quite that simple so let's talk about treating type 1 diabetes and before we get into the specifics of the treatment let's first briefly review some of the metabolic states in the human body and there are two general states you have the absorptive state in which the body takes energy and stores it and you have the post-absorptive state in which the body takes this stored energy during from the absorptive state and utilizes it now this absorptive state here is driven by the hormone insulin whereas the post-absorptive state is driven by the hormone glucagon now throughout the day that the human body will typically fluctuate back and forth between this absorptive state and this post-absorptive States so to get a better understanding of how this looks let's draw what we'll call the physio of physiologic timeline and let's just bring in a graph here to help describe this timeline now down here on the x-axis we'll have the time of the day and right here in the middle we'll have noon 6:00 in the morning 6:00 at night midnight and then maybe we'll put 3 a.m. 9 a.m. 3 p.m. and 9 p.m. now as I mentioned before the body will fluctuate back and forth between this pub zorp to state and post absorptive state so let's see that here and if you look closely this fluctuation back and forth makes sense here around 6:00 a.m. when you go from this post absorptive state oil you're sleeping and then you eat breakfast and then you'll go into an absorptive state because you need to absorb the nutrients from the food and breakfast and then as your morning goes on you go back into this post absorptive state and so on and so forth now these changes back and forth between these metabolic states are driven by these hormones insulin and glucagon so on the y-axis here let's put in these hormone so in purple here we'll put in insulin and then in green will do glucagon and what you can see from this is that it's really insulin here that's driving these changes between the post absorptive state and the absorptive state and glucagon also plays a role but it's level doesn't very nearly as much as insulins level throughout the day now since in type 1 diabetes the body doesn't produce enough of this insulin it makes sense that the goal of treatment when we're treating type 1 diabetes is to give insulin that will try and mimic the body's normal production of insulin however when we're treating type 1 diabetes just giving insulin maybe once or twice a day as is done with most medications doesn't really work because the levels are changing so frequently so then how exactly do we manage type 1 diabetes to get a better understanding of this let's erase some of our work now fortunately physicians and pharmacologists have created a very elegant method for treating type 1 diabetes and this method is known as the basal bolus strategy and in order to understand this concept a little bit better let's first talk briefly about insulin now insulin is a peptide hormone and as such that means when we give it as a medication it can't be taken within a pill form because the stomach and digestive system would break down the peptides or the protein of insulin into its component parts before it could be absorbed and therefore insulin must be given as an injection and there are many different types of insulin that are available for use in the treatment of diabetes and they are classified based on how quickly they take effect which is known as the onset of action and how long they work for which is known as the duration of action so to get a better understanding of this let's put let's create another graph similar to this one that will call the pharmacologic timeline and on the x-axis here we'll put this that duration of action and this will be an hour so we'll have maybe 3 6 9 12 15 18 hours here so one of the three main groups of insulins that can be given when treating type 1 diabetes are known as the rapid acting insulins and their pharmacologic timeline looks something like this and these rapid acting insulins usually take somewhere about 15 minutes to 30 minutes and before they start working and their duration of action will last you can see you're somewhere around 4 to 6 hours now the next major group of insulins are known as intermediate acting insulins and these intermediate acting insulins you can see by the graph take a little bit longer before they have an onset of action about 30 minutes to an hour and then they last a little bit longer than the rapid acting insulins for somewhere between maybe 8 to 12 hours as you can see on the graph here now the last major category of insulin are known as the long-acting insulins and as you can see on this graph the long-acting insulins will take even longer to take action somewhere in the order of maybe 1 to 4 hours and their peak action is not quite as intense as this rapid or intermediate acting insulins and their duration of action is much longer depending on the type of long-acting insulin it can be somewhere between 12 and 24 hours so now that we have a little bit better understanding of the different types of insulin and why it needs to be injected instead of being taken as a pill let's go back to this time this physiologic time line here and let's specifically look at this insulin level now you notice that the insulin level never goes all the way down to zero there's always this baseline level here and we'll call this the basal level and then intermediately there are these Peaks which we'll call bolus and these bolus occur after we eat and there would drive the transition from that post-absorptive state to the absorptive state three times about three times a day depending on how often you eat now hopefully what you can see by this is that if we transpose a couple of these graphs from the formal collage ik timeline on to the physiologic timeline we can use injectable insulin to mimic this physiologic timeline in order to treat type 1 diabetes so for these bolus a--'s these kind of rapid Peaks you'll notice that they look somewhat like the rapid acting insulin here so let's put that on there and then this basal level here this constant level you could prop you can create with a long-acting insulin so we'll put that on the graph now hopefully what you can see by this and it's starting to get a little crowded here so I'll highlight it is that by using this basal bolus strategy someone with type 1 diabetes can kind of mimic the natural levels of insulin that the pancreas should be producing and this is why this basal bolus strategy of treating type 1 diabetes is very efficient because it mimics what the body would do if the pancreas was working properly so an overview of the basal bolus strategy is that usually once or twice a day depending on the type of long-acting insulin say in the morning and then again at night someone with type 1 diabetes will take a dose of insulin of this long-acting insulin that's will serve as this basal rate and then at mealtime they'll take an additional dose of the rapid-acting insulin to cover these bolus --is to help the body transition from the post absorptive state here to the absorptive state to absorb the energy in the meal data state now it's important to note that this graph demonstrates the principle of the basal bolus strategy but it is somewhat of an oversimplification and that proper insulin management requires one to be very diligent with their insulin dosing and in its and administration this is especially important in regards to the bolus doses here and this is because the amount of insulin that someone is going to need to take with each bolus dose will vary depending on what their blood sugar is at that time as well as on how many carbohydrates they're planning on eating so in order to properly manage their insulin regimen individuals with type 1 diabetes must regularly check their blood sugar levels and adjust their insulin dosing accordingly now type 1 diabetes can be a very serious and potentially even lethal disease however with diligent and hiren so the Basel Bowles strategy and regular appointments with one's physician in order to adjust the insulin dosing as well as monitor for complications someone diagnosed with type 1 diabetes can still live a very healthy and long life