INSULIN THERAPY

WHILST THE USE OF INSULIN IS MANDATORY IN TYPE -I PATIENTS, A JUDICIOUS USE OF INSULIN THERAPY MAY BE NECESSARY FOR OPTIMAL MANAGEMENT IN MANY NON INSULIN DEPENDENT DIABETICS !

Non dependence does NOT imply that Type -II's may never require insulin in order to obtain optimal control.

At the same time, there is increasing apprehension that raised levels of insulin in the blood may itself contribute to hypertension, lipid abnormalities and atherosclerosis.

In view of this, THE DECISION TO USE INSULIN IN NIDDM SHOULD BE TAKEN AFTER CAREFUL, JUDICIOUS CONSIDERATION

 

• Patients who should receive Insulin
• Types of insulin
• Patients who should preferably use Human insulins
• Time Activity characteristics of the commonly available insulins
• ALGORITHM for insulin therapy
• Practical aspects of insulin therapy
• Combination therapy
• Commonly used Multiple Dose Regimens (MDRs)
• Side effects of insulin therapy
• Insulin analogues

The Economics of insulin use: Should U-100 human insulins be the only insulins used?

The X-Files: What is syndrome X?

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• All patients with Type I diabetes ( insulin dependent diabetes)
• Patients manifesting OHA failure.
• Insulin should be considered in diabetics with significant complications like ischemic heart disease, CVA, peripheral artery disease, significant retinopathy, nephropathy and neuropathy, hepatic complications such as viral hepatitis.
• Any diabetic with an acute problem like several infection, injury, etc., should preferably receive insulin.
• Diabetics with tuberculosis often do better with insulin.
• Any Type II patient who manifests ketosis for whatever reason.
• Diabetics undergoing most surgical procedures, especially those requiring general anesthesia, and where the patient will be on intravenous fluids for any significant period of time should be stabilised on insulin.
• Pregnant diabetics, if not "tightly" controlled with diet alone, must be managed with insulin.
• Any patient, even if optimally controlled with OHA's who shows evidence that may contraindicate the use of these oral agents, must be shifted to insulin.
• Many underweight patients and those with significant symptoms would do better with insulin therapy, possibly in combination with small doses of OHAs;