By Tim Holt, Sudhesh Kumar
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Additional resources for ABC of Diabetes, Sixth Edition
Diabetic Med 2006(s3);23: 22–4. CHAPTER 8 Insulin Therapy Tim Holt1 and Sudhesh Kumar2 1 Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK Clinical Sciences Research Institute, Warwick Medical School, University of Warwick; and WISDEM, University Hospital, Coventry, UK 2 OVERVIEW • Patients presenting with type 1 diabetes require insulin without delay to avoid ketoacidosis • An increasing proportion of type 2 patients will require insulin to achieve modern glycaemic control targets • The majority of type 2 patients requiring insulin can have this treatment initiated in primary care • A wide range of insulin types is available, but most patients can be managed using a limited selection of regimens and devices • Familiarity with these devices and regimens overcomes the inertia that may delay the initiation of insulin in type 2 diabetes 2 3 Introduction Insulin replacement therapy is essential for a patient with type 1 diabetes and is needed to achieve good glycaemic control in many patients with type 2 diabetes once other agents are no longer able to achieve this effectively.
1 Life expectancy is reduced in diabetes, particularly for the young type 1 patients diagnosed in childhood. This Figure is based on a mortality study reported in the 1970s (Goodkin G. Journal of Occupational Medicine 1975;17(11):716–21). Modern proactive prevention programmes with tight risk factor control and early intervention for emerging complications are changing this pattern. 19 20 ABC of Diabetes drugs are safe for the majority. Controlling blood pressure using two or more different agents is more likely to be successful than using higher doses of single drugs, and less likely to give the side effects that are often associated with the higher rather than middle range doses.
This plant had been used for centuries to treat the symptoms of diabetes. Metformin is less lipophilic and safer than phenformin, rarely causing lactic acidosis, but is contraindicated in renal failure (see Chapter 12) for this reason. Metformin has a number of beneﬁcial actions in diabetes. It reduces hepatic gluconeogenesis, increases insulin sensitivity and reduces carbohydrate absorption from the gastrointestinal tract. It also improves circulating free fatty acids and very low density lipoprotein (VLDL) levels.