3 Dec 2014

Why insulin is given in diabetes?

Diabetes is a state of insulin deficiency. In adult diabetes is treated with either oral anti diabetic tablets or with insulin. 

Insulin has got the following advantages
1. To stop the severe catabolic state & regain lean body mass.
2. Decreases frequent infections.
3. Reduce  fetal & maternal complications  in pregnancy.
4. Prevent & delay complications of diabetes.
5. Eliminate symptoms of hypoglycemia.
6. Prevent DKA(diabetic ketoacidosis).
Principles of insulin therapy
1. To supply  sufficient insulin throughout 24 h to cover the  basal requirements
2. To provide higher boluses of insulin to match the high glucose levels  following meals .

Treatment strategies
Appropriate insulin regimen is planned based on
1. Patient’s lifestyle.
2. Age.
3. Motivation.
4. General health.
5. Self management skills.
6. Goals of treatment.
Before initiating insulin patient should be given appropriate education & support about the care & use of insulin, detection & management of  hypoglycemia.

Treatment strategies in type 1
1. Multiple Daily Injections.
2. Twice daily injections are not recommended in Type 1 DM.
3. Complementary education & support.
4. Most newly diagnosed patients with type 1 diabetes may be started on a total daily dose of 0.2 to .0.4 u/ kg / day, most will ultimately require 0.6 to 0.7 u/ kg / day.
6. During puberty > 1 IU/kg per day insulin is given

Type 2 DM (Diabetes mellitus) 
1. Initial management does not include insulin.
2. Given for patients unable to achieve good blood sugar  control with a combination of diet, exercise and OHA.
3. Goals of insulin treatment is  similar to Type1 DM

Achronym's used
DM - Diabetes mellitus.
IU/kg - Units of Drug per Kilogram of body weight.
OHA - oral hypoglycemic agents.
DKA - diabetic ketoacidosis.

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