Type 1 diabetes mellitus
Autoimmune destruction of pancreatic beta cells with absolute insulin deficiency. Requires lifelong insulin therapy. Modern standard is basal-bolus or continuous subcutaneous insulin infusion (pump). Sensor-augmented pumps and closed-loop systems are recommended in children and adolescents.
ICD-10 E108 drugs
Also known as: T1D, Type 1 DM
Drugs used for this condition
- AInsulinFirst line · Insulins and analogues (general card; individual products require separate cards)Insulin therapy is the only life-sustaining treatment for type 1 diabetes. Recommended by ADA 2024, ISPAD 2022, ESPE, and the Russian Ministry of Health. Modern standard is basal-bolus (long-acting analogue as basal plus ultra-short before meals) or pump therapy; in children and adolescents, sensor-augmented and closed-loop systems. Target HbA1c < 7% in most adults; individual targets in children, adolescents, older adults, and pregnancy.
- AInsulin aspartFirst line · Rapid-acting insulin analogueAspart covers the post-meal glucose rise in a basal-bolus regimen and runs in insulin pumps. The AEMPS NovoRapid label places the injection immediately before the meal, or right after it when needed, and approves the product from 1 year of age. The dose is calculated against the carbohydrate of that particular meal rather than fixed for every day. A short action demands discipline: if the meal does not happen after the injection, hypoglycaemia arrives within an hour or two. The niacinamide formulation starts earlier and is given closer to the first bite. In a pump, aspart provides both basal and bolus delivery, and a catheter occlusion there turns into ketosis within hours.
- AInsulin degludecFirst line · Ultra-long-acting insulin analogueDegludec covers the basal requirement in type 1 diabetes with a single injection, and its duration forgives a shifted injection time – the AEMPS Tresiba label allows the interval to move as long as at least 8 hours separate doses. That matters for teenagers and for people on shift work, where a fixed injection hour does not hold. The product is approved from 1 year of age. The dose reaches steady state in 2–3 days, so titration steps belong no more often than every 3–4 days; otherwise titration outruns accumulation and ends in hypoglycaemia. Degludec does not replace prandial insulin: post-meal rises are covered by a rapid analogue.
- AInsulin detemirFirst line · Long-acting insulin analogueDetemir serves as the basal insulin in a basal-bolus regimen for type 1 diabetes and is approved from 1 year of age in the AEMPS Levemir label. Its feature is dose-dependent duration: at a small daily dose the action does not cover 24 hours, and then two injections are used, morning and evening. A twice-daily schedule covers dawn hyperglycaemia more precisely than a single injection. Weight gain on detemir is usually smaller than on NPH or glargine, which is an argument when weight matters to the patient. Fasting glucose stays the titration reference, and meals are still covered by a rapid insulin.
- AInsulin glargineFirst line · Long-acting insulin analogueInsulin glargine is the basal component of a type 1 diabetes regimen: it holds the background between meals and overnight, while a rapid insulin covers food. The AEMPS Lantus label allows the product from 2 years of age. Against NPH, glargine produces fewer nocturnal hypoglycaemic episodes at comparable HbA1c, and that is its main practical difference. One injection a day at the same time, rotating sites within one anatomical area. The dose is titrated to fasting glucose rather than to a single reading: basal insulin answers for the background, not for post-meal rises. Switching from NPH to glargine, and switching between the 100 and 300 units/ml strengths, calls for dose recalculation and tighter self-monitoring in the first weeks.
- AInsulin glulisineFirst line · Rapid-acting insulin analogueGlulisine covers meals in a basal-bolus regimen and works in a pump. The AEMPS Apidra label allows injection 0–15 minutes before a meal or shortly after it and permits use from 6 years of age. The product suits situations where the amount eaten is not known in advance: the dose is given after the meal based on what was actually eaten, which helps in children and with poor appetite. Glulisine is not mixed in one syringe with insulin glargine – the label prohibits that mixture and allows only NPH, with glulisine drawn up first.
- AInsulin human isophane (NPH)Second line · Intermediate-acting human insulinNPH covers the basal requirement in type 1 diabetes where long-acting analogues are unavailable or unaffordable. The regimen needs two injections a day, and the pronounced 4–8 hour peak produces more nocturnal hypoglycaemia than glargine or degludec. Hence the practice of moving the evening dose closer to bedtime so the peak does not fall in the middle of the night. The AEMPS Humulina NPH label requires resuspending the suspension before every injection. For someone counting carbohydrates on an irregular schedule a basal analogue is more convenient, but on HbA1c control NPH does not fall behind.
- AInsulin lisproFirst line · Rapid-acting insulin analogueLispro is the prandial insulin of a basal-bolus regimen and one of the commonest pump fills. The AEMPS Humalog label places the injection within 15 minutes before a meal or immediately after it, and sets no age limit. Flexible timing is the practical difference from human regular insulin, which needs half an hour. The dose is calculated against the carbohydrate of the meal and corrected for current glucose. Before exercise that follows a meal the dose is reduced in advance: muscle work amplifies prandial insulin, and hypoglycaemia arrives during the session itself.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit