The MDI regimen is a treatment option for insulin-dependent diabetics that uses long-acting and fast-acting insulin to manage blood glucose levels. It allows for more freedom in eating but requires multiple injections and can cause hypoglycemia. The decision to use this method or an insulin pump should be made with the guidance of a doctor.
Insulin-dependent diabetics have a range of insulin treatments to choose from. Some are able to take one or two injections of long-acting insulin each day, some use an insulin pump, and some diabetics use the MDI regimen or multiple daily injections.
The MDI regimen works based on how the body uses insulin. The pancreas tends to produce a constant flow of insulin throughout the day to maintain function. However, when a person eats something, the pancreas gets a message to make more insulin to handle the carbohydrates the person is eating. This is why a low-carb diet is often prescribed to help manage diabetes. In an insulin-dependent diabetic, however, the pancreas produces little or no insulin. If the diabetic is a type 2, their insulin resistance may be severe enough that they require extra insulin to overcome the resistance.
An MDI regimen generally uses two types of insulin: long-acting and fast-acting. Long-acting insulin is called basal insulin. Longer-acting insulin usually supplies the body’s basic insulin needs for 12 to 24 hours. Short-acting, or bolus, insulin covers the body’s need for insulin for a meal. Basal and bolus insulin levels are determined by frequent blood glucose testing. Baseline rates on an MDI regimen are often determined by measuring blood glucose overnight and the morning fasting reading. Once the baseline readings have been worked out, the diabetic usually starts working on the bolus numbers.
The MDI regimen allows a type 1 diabetic to eat more freely than a type 2 diabetic, although the MDI regimen may also allow a type 2 diabetic more freedom than those not taking insulin. This is because the diabetic ‘coats’ the carbohydrates in their meals with extra fast-acting insulin which enters the bloodstream quickly and, when administered correctly, prevents the diabetic from having a blood glucose ‘surge’ after a meal. For a correct bolus, a diabetic will need to calculate the approximate number of carbohydrates in the meal and know its insulin-to-carb ratio. For example, a standard digit is 1:15. That is, the diabetic takes one unit of bolus insulin for every 15 grams of carbohydrate consumed. This figure is often determined by trial and error, and for type 2 diabetics with severe insulin resistance, the numbers will be much higher.
While an MDI regimen can be effective in managing diabetics, it has the obvious disadvantage of multiple injections. Many diabetics find it difficult to find “fresh” injection sites that also provide good insulin absorption. It can also be expensive, when you factor in the cost of insulin, syringes and needles or insulin pens. The MDI regimen can also cause cases of hypoglycemia, or hypo (very low blood glucose levels), when too much insulin has been given. Most diabetics are advised to keep glucose tablets or some other form of quickly absorbed sugar nearby, in case of a hypo. A hypo is usually manifested by shaking, sweating, blurred vision, dizziness. A hypo is easily treated with sugar, but a diabetic should also keep a blood glucose meter on the person at all times, to test the blood in case of a suspected hypo.
While the MDI regimen is manageable for many diabetics, others decide to use the insulin pump, which delivers a steady stream of fast-acting insulin. The decision to switch from one method to the other should never be taken lightly and the diabetic should always research both regimens extensively. The diabetic’s doctor should also be consulted and should work with the patient, regardless of the regimen he chooses.
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