treatment for type 2 diabetes

- [voiceover] since typeone diabetes is caused by autoimmune destruction of the pancreas, that results in an absolutedeficiency of insulin, it makes sense that thetreatment of type one diabetes is to give insulin.

treatment for type 2 diabetes, now, this is true, but unfortunately it's not quite that simple. so let's talk abouttreating type one diabetes. and before we get into thespecifics of the treatment,

let's first briefly reviewsome of the metabolic states in the human body. and there are two general states. you have the absorptive state in which the body takesenergy and stores it and you have the post-absorptive state, in which the body takes this stored energy from the absorptive state and utilizes it. now this absorptive state here

is driven by the hormone insulin. whereas the post-absorptivestate is driven by the hormone glucagon. now throughout the day, the human body will typically fluctuateback and forth between this absorptive state and thispost-absorptive state. so to get a betterunderstanding of how this looks, let's draw what i'll calla physiologic timeline. and let's just bring in a graph here

to help describe this timeline. now down here on this x-axiswe'll have the time of the day. and right here in themiddle we'll have noon, six in the morning, six at night, midnight, and then maybe we'll put three am, nine am, three pm, and nine pm. now as i mentioned before, the body will fluctuateback and forth between this

absorptive state andpost-absorptive state. so let's see that here. and if you look closely, this fluxuation back and forth makes sense here, and around six am when you go from this post-absorptive statewhile 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 in breakfast and then as your morning goes you go back into this post-absorptive stateand 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'sput in these hormone levels. so in purple here we'll put in insulin, and then in green we'll do glucagon.

and what you can see from this is that it's really insulin herethat's driving these changes between the post-absorptive state and the absorptive state. and glucagon also plays a role, but its level doesn't vary nearly as much as insulin's level throughout the day. now since in type one diabetes the body doesn't produce enough of this insulin,

it makes sense that the goal of treatment when we're treating type one diabetes, is to give insulin that will try and mimic the body's normal production of insulin. however, when we'retreating type one diabetes, just giving insulin maybeonce or twice a day, as is done with most medication, doesn't really work because the levels are changing so frequently.

so then how exactly do wemanage type one diabetes? to get a better understanding of this, let's erase some of our work. now fortunately, physiciansand pharmacologists have created a veryelegant method for treating type one diabetes. and this method is known asthe basal-bolus strategy. and in order to understand thisconcept 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'tbe taken in a pill form, because the stomach and digestive system would break down thepeptides or the protein of insulin into its component parts before it could be absorbed. and therefor insulin mustbe given as an injection. and there are manydifferent types of insulin

that are available for usein the treatment of diabetes and they are classified based on how quickly they take effect, which is know 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 create anothergraph similar to this one that we'll call thepharmacologic timeline.

and on the x-axis here we'llput that duration of action. and this will be an hour,so we'll have maybe three, six, nine, 12, 15, 18 hours here. so one of the threemain groups of insulins that can be given whentreating type one diabetes are known as the rapid-acting insulins. and their pharmacologic timelooks something like this. and these rapid-actinginsulins usually take somewhere

about 15 minutes to 30 minutesbefore the start working and their duration of actionwill last, you can see here, somewhere around four to six hours. now the next major groupof 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 betweenmaybe eight 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 take even longer to take action, somewhere in the order of

maybe one to four hours, and their peek actionis not quite as intense as this rapid orintermediate-acting insulins, and their duration ofaction is much longer. depending on the typeof long-acting insulin, it can be somewherebetween 12 and 24 hours. so now that we have a little bit better understanding of thedifferent types of insulin and why it needs to be injected

instead of taken as a pill, let's go back to thisphysiologic timeline here. and let's specificallylook 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 intermediatelythere are these peaks, which we'll call boluses.

and these boluses occur after we eat and they're what drivethe transition from that post-absorptive stateto the absorptive state, about three times a day,depending on how often you eat. now hopefully what youcan see by this is that if we transpose a couple of these graphs from the pharmacologic timeline onto the physiologic timeline, wecan use injectable insulin to mimic this physiologic timeline

in order to treat type one diabetes. so for these boluses,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 levelhere, this constant level, 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 geta little crowded here so i'll highlight it, is that by using this basal-bolus strategy someone with type one diabetes can kind of mimic thenatural levels of insulin that the pancreas should be producing. and this is why this basal-bolus strategy of treating type onediabetes 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 typeof long-acting insulin, say in the morning andthen again at night, someone with type one diabetes will take a dose of insulin, ofthis long acting insulin that will serve as this basal rate. and then at meal time they'lltake an additional dose

of the rapid-acting insulinto cover these boluses to help the body transition from the post-absorptive hereto the absorptive state, to absorb the energy inthe meal they just ate. now it's important to know that this graph demonstrates the principleof the basal-bolus strategy, but it is somewhat ofan oversimplification and that proper insulin management requires one to be verydiligent with their

insulin dosing and administration. this is especially important in regards to the bolus doses here. and this is because the amount of insulin that someone's gonna needto take with each bolus dose will vary depending onwhat their blood sugar is at that time as well ason how many carbohydrates they're planning on eating. so in order to properlymanage their insulin regiment,

individuals with type onediabetes must regularly check their blood sugar levels and adjust their insulin dosing accordingly. now type one diabetescan be a very serious and potentially even lethal disease. however, with diligent adherenceto the basal-bolus strategy and regular appointmentswith one's physician in order to adjust the insulin dosing as well as monitor for complications,

someone diagnosed with type one diabetes can still live a veryhealthy and long life.