Management of Type 1 Diabetes: Guidelines and Best Practices

Core Insulin Therapy Recommendations

The American Diabetes Association recommends that most individuals with type 1 diabetes should be treated with continuous subcutaneous insulin infusion or multiple daily doses of prandial and basal insulin, with insulin analogs preferred over human insulins to minimize hypoglycemia risk 1
Multiple daily injections of prandial and basal insulin or continuous subcutaneous insulin infusion via insulin pump are the standard of care for type 1 diabetes management, as recommended by the American Diabetes Association 1, 2
Rapid-acting insulin analogs should be used over regular human insulin to reduce hypoglycemia risk, according to the American Diabetes Association 1, 3
Automated insulin delivery systems should be considered for all adults with type 1 diabetes to improve glycemic control, as recommended by the American Diabetes Association 1

Total daily insulin requirements typically range from 0.4 to 1.0 units/kg/day, with approximately 30-50% as basal insulin and the remainder as prandial insulin, as reported by the American Diabetes Association 4
Prandial insulin should be administered before meals, with timing based on the specific insulin formulation's pharmacokinetics, premeal blood glucose, and carbohydrate content, according to the American Diabetes Association 4

Patients should receive comprehensive education on matching mealtime insulin doses to carbohydrate intake, fat and protein content of meals, premeal blood glucose levels, and anticipated physical activity, as recommended by the American Diabetes Association 1, 2, 3, 4
Education should include correction dose calculation based on concurrent glycemia, glycemic trends, and sick-day management, according to the American Diabetes Association 1
All patients should be prescribed glucagon, with family members and caregivers educated on its administration for hypoglycemia management, as recommended by the American Diabetes Association 1

Insulin treatment plans should be reevaluated at regular intervals (every 3-6 months) and adjusted as needed, according to the American Diabetes Association 1
Continuous glucose monitoring should be considered for all patients, particularly those with hypoglycemia unawareness or frequent hypoglycemic episodes, as recommended by the American Diabetes Association 1, 4

Automated insulin delivery systems that combine continuous glucose monitoring with insulin pumps provide superior glycemic control with reduced hypoglycemia risk, as reported by the American Diabetes Association 4
Continuous subcutaneous insulin infusion offers advantages including reduced hypoglycemia risk, according to the American Diabetes Association 3

Insulin analogs are associated with lower risk of hypoglycemia compared to human insulins, as reported by the American Diabetes Association 1, 3
Glucagon should be prescribed for all individuals taking insulin, with proper education for family and caregivers on administration techniques, according to the American Diabetes Association 1
Glucagon preparations that do not require reconstitution are preferred for ease of use in emergency situations, as recommended by the American Diabetes Association 1

Insulin requirements may increase during puberty, menses, and medical illness, as reported by the American Diabetes Association 4