1, 2 This multiple daily injection (MDI) regimen involves a total of five or six injections a day. It involves giving quick-acting insulin just before eating and administering longer-acting background insulin, preferably twice daily, to maintain blood glucose levels in between meals. The need for intensification of therapy and its integration into flexible lifestyles is promoted in DAFNE (Dose Adjustment for Normal Eating) and other structured education courses. Traditionally, insulin was given twice a day, often as premixed insulin, but such an approach imposes a rigid lifestyle and makes it difficult to maintain a glucose level close to normal. Insulin is generally administered by intermittent subcutaneous injection, with the dose adjusted according to eating and other activities, such as exercise. In the long term, the aim of insulin therapy is to keep blood glucose close to normal and so prevent the development of microvascular complications, such as retinopathy, neuropathy and diabetic kidney disease. ![]() ![]() Insulin is essential in the short term to prevent the onset of ketoacidosis, a potentially fatal condition. People with type 1 diabetes mellitus (T1DM), around 250,000 individuals in the UK, have lost the ability to make insulin because of autoimmune destruction of the insulin-secreting β cells within the islets of the pancreas. ![]() Chapter 1 Introduction Background Type 1 diabetes mellitus and its treatment
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