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Does Type 2 Diabetes Use Insulin

The Use Of Insulin In Type 2 Diabetes

The Use Of Insulin In Type 2 Diabetes

This item is 8 years and 9 months old; some content may no longer be current. There is evidence that early use of insulin in people with type 2 diabetes is beneficial. At present insulin is under used in this group, but it should be part of the normal progression of disease management. When insulin is initiated it requires a team approach and close follow-up. The simplest starting regimen is the addition of intermediate acting insulin to existing oral medication. View / Download pdf version of this article Key reviewer: Dr Rick Cutfield, Diabetologist, Waitemata DHB Key points: Insulin is under used in people with type 2 diabetes There is evidence that early initiation of insulin is beneficial Initiation of insulin requires a team approach and close follow up Start with low doses of insulin and then slowly but steadily titrate until target HbA1c is reached Combined therapy with insulin and oral metformin can result in improved glycaemic control, less weight gain and fewer hypoglycaemic episodes Insulin is often required for best management of type 2 diabetes The challenge of achieving optimal blood glucose control in people with type 2 diabetes is something faced on a daily basis by many GPs. The progressive effects of diabetes on beta cell function and insulin resistance mean that oral anti-diabetic medications become less effective with time.1 Best management of type 2 diabetes therefore inevitably results in consideration of the use of insulin. The task of initiation of insulin therapy has traditionally been undertaken in a secondary care setting. Factors such as the increasing prevalence of diabetes, an aging population, financial constraints, the push for tighter control and the earlier need for insulin to achieve this mean that this role will increasingly fall to Continue reading >>

What Are The Side Effects Of Insulin Shots?

What Are The Side Effects Of Insulin Shots?

Insulin is at the center of the diabetes problem. In people with type 2 diabetes, the body does not use insulin effectively. The pancreas compensates by overproducing insulin, and in time, it simply cannot keep up with the demands of the body to keep glucose levels down. To provide enough insulin to the body to manage blood glucose levels, many diabetics are advised to take insulin shots. The insulin in these injections is a chemical that is produced artificially to resemble the insulin made in our pancreas. This insulin works just like natural insulin by escorting sugar from our blood into our cells. Type 2 diabetics deal with a condition known as insulin resistance. It is a phenomenon where cells aren’t sensitive to the action of insulin (escorting blood glucose into cells) and hence, do not respond to it. This leads to the accumulation of glucose in the blood and is called hyperglycemia. Supplemental insulin given to Type 2 diabetics helps the body ‘muscle’ sugar out of the bloodstream and into cells. Insulin injections are used to regulate blood sugar differently for the different diabetes-types: For people who have type 1 diabetes – Their bodies cannot make insulin and therefore they aren’t able to regulate the amount of glucose in their bloodstream. For people who have type 2 diabetes – Their bodies aren’t able to produce enough insulin, or use it effectively. The insulin shots are used because the blood sugar cannot be regulated with oral medications alone. They also stop the liver from producing more sugar. Every type of insulin available in a drug store works in this way. They, mainly, differ in two ways – How quickly they begin to work For how long they can regulate blood sugar levels Mechanism of Action Regulating the process in which glucose Continue reading >>

The Introduction Of Insulin In Type 2 Diabetes Mellitus

The Introduction Of Insulin In Type 2 Diabetes Mellitus

Eddy Tabet Background Conservatively, over 1 million people have been diagnosed with diabetes mellitus in Australia, the majority with type 2 diabetes mellitus (T2DM). Until the progressive decline in pancreatic beta cell function, which characterises T2DM, can be meaningfully halted, most of these patients will require insulin therapy to maintain optimal glycaemic control over time. Objective/s The aim of this article is to provide a pragmatic overview of when and how to initiate insulin therapy for T2DM in a primary care setting. Discussion Current Australian guidelines recommend initiating insulin therapy as once daily basal therapy or as premixed insulin. Com-mencement and titration of either insulin in T2DM can be conducted safely in an ambulatory care setting and it is ideal that gen-eral practitioners become familiar with this, particularly in the context of the number of people affected. For the majority with type 2 diabetes mellitus (T2DM), insulin therapy will be required to maintain optimal glycaemic control over time.1 The general practitioner (GP) plays a vital part in the care of patients with T2DM using insulin. This article provides a pragmatic overview of introducing insulin therapy in T2DM. The pathophysiology of T2DM The core pathophysiological defects leading to the development of T2DM are insulin resistance in muscle and liver cells, resulting in decreased glucose uptake and increased hepatic glucose output, coupled with failure of pancreatic beta cells to produce sufficient insulin to maintain normoglycaemia and to prevent adipose fatty acid release. This ‘glucolipotoxicity’ leads to further impairment of the beta cells, and a progressive cycle of beta cell dysfunction and metabolic decline. Although these processes are not necessarily the only Continue reading >>

Insulin Usually Better Than Oral Drugs For Type 2 Diabetes

Insulin Usually Better Than Oral Drugs For Type 2 Diabetes

According to a study published in , the combination of insulin and metformin may not benefit individuals with type 2 diabetes. Although the combination results in less weight gain, improved blood glucose control and less need for insulin, the researchers state that further research is required in order to provide solid evidence regarding the benefits and harms, as well as the risks of premature death. The study was conducted by researchers from the Copenhagen Trial Unit, Steno Hospital and the Copenhagen University Hospital. At present, guidelines recommend metformin, an oral blood glucose reducing medication, for type 2 diabetics starting insulin treatment. The researchers examined 2,217 individuals aged 18+ with type 2 diabetes. Among the trials examined, the team found insufficient reports of important patient outcomes, such as total mortality and death from heart disease. According to 20 trials, levels of HbA1c (a measure of average blood glucose levels over time) were reduced when insulin and metformin was taken together. Furthermore, the researchers found that the combination of drugs considerably reduced weight gain and body mass index (BMI) by an average of 1.6 kg. The researchers state that additional studies are required in order to research the long term benefits and harms of the combination, as it increases the risk of severe hypoglycaemic attack. In this week's BMJ podcast, Trish Groves, the deputy editor of BMJ, talks to lead author Bianca Hemmingsen about how this study was able to draw on more data than prior studies, and how the researchers examined major complications and mortality instead of surrogate outcomes, such as blood sugar levels and weight. In addition, Dr. Hemmingsen highlights the insufficient evidence for determining if the combination or Continue reading >>

12 Myths About Insulin And Type 2 Diabetes

12 Myths About Insulin And Type 2 Diabetes

Insulin facts vs. fiction When you hear the word “insulin,” do you picture giant needles (ouch!) or pop culture portrayals of insulin users with low blood sugar (like Julia Roberts losing it in Steel Magnolias)? Either way, most people think of insulin as a difficult, painful, or potentially scary medical treatment. The problem is that if you have type 2 diabetes, you need to know the real deal before you can make an informed choice about whether or not this potentially lifesaving therapy is right for you. Here, we take a look at the facts and fiction about insulin when it comes to treating type 2 diabetes. Diabetics always need insulin Not necessarily. People with type 1 diabetes (about 5% to 10% of diabetics) do need insulin. If you have type 2, which includes 90% to 95% of all people with diabetes, you may not need insulin. Of adults with diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC. The point is to get blood sugar—which can be a highly toxic poison in the body—into the safe zone by any means necessary. Taking insulin means you’ve ‘failed’ “This is a big myth,” says Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. “Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin.” The fact is that type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to make sure your blood sugar is in a healthy range. Eating right and exercise will always be important, but medication needs can vary. “A large percentage of people with ty Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes is a disease that affects how your body processes blood sugar (glucose). If you have type 2 diabetes, this means your body doesn’t make enough insulin, or it can’t use the insulin it has. Our bodies use glucose—or sugar—for energy. Insulin allows the cells in our body to process glucose. If your body doesn’t have enough insulin, glucose can collect in your blood. This causes high blood sugar. There’s no cure for type 2 diabetes. People with this disease will need to manage it with medication, diet, and exercise for the rest of their life. The reason doctors call diabetes a “chronic” disease is because it is a long-term health problem that can’t be cured or prevented with medication. Type 2 diabetes is also called adult onset diabetes. It’s also the most common kind of diabetes. Doctors and researchers don’t know exactly causes type 2 diabetes. Some families have higher rates of the disease. But lifestyle factors like poor diet, obesity, and not exercising enough increase your chances of developing the disease. Some medications also may increase your chances of getting it. Risk Factors For Type 2 Diabetes A risk factor is anything that increases your chances of getting a certain kind of disease. There are many risk factors for type 2 diabetes. This means that if you have or do any of these things, you have a higher chance of getting type 2 diabetes. Risk factors for type 2 diabetes include the following: Having a history of diabetes in your family Being overweight Age. People who are older than 45 have a higher chance of developing diabetes. Not getting enough exercise Being pregnant Race and ethnicity. Hispanic Americans, African Americans, Asian Americans, and American Indians have higher chances of developing type 2 diabetes than Continue reading >>

7 Scary Things That Can Happen When You Don't Treat Your Diabetes

7 Scary Things That Can Happen When You Don't Treat Your Diabetes

Swallowing pills, checking your blood sugar all the time, or sticking yourself with needles full of insulin probably doesn't sound like your idea of a good time. But taking steps to keep your diabetes under control is your best shot at preventing a slew of frightening complications. If you don't take care of yourself, "diabetes complications typically start within 5 years; within 10 to 15 years, the majority of patients will progress to have multiple health issues," says Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic. Fortunately, eating a nutritious diet, exercising, and taking your medication may not only stop complications from progressing, but can also reverse them, she says. Need motivation to stick to your treatment plan? Here's what can happen when you slack off. With type 1 diabetes, your body stops producing insulin, a hormone that regulates blood sugar; with type 2 diabetes, your body can't properly use the insulin you do produce. In turn, your HDL (or "good") cholesterol lowers, and your levels of harmful blood fats called triglycerides rise. Insulin resistance also contributes to hardened, narrow arteries, which in turn increases your blood pressure. As a result, about 70% of people with either type of diabetes also have hypertension—a risk factor for stroke, heart disease, and trouble with thinking and memory. (Add these 13 power foods to your diet to help lower blood pressure naturally.) Failing to control high blood pressure and high cholesterol, either with diet and exercise alone or by adding medications, accelerates the rate at which all your other complications progress, says Robert Gabbay, MD, PhD, chief medical officer at Joslin Diabetes Center in Boston. More than 4 million people with diabetes have some degree of retinopathy, or dam Continue reading >>

What Is Type 2 Diabetes?

What Is Type 2 Diabetes?

When your body can’t make enough insulin or can’t use insulin, it is called type 2 diabetes. Insulin helps the cells in the body absorb glucose, or sugar, for energy. Without insulin, glucose builds up in the blood resulting in high blood sugar. Type 2 diabetes is a chronic disease that has no known cure. It is the most common type of diabetes. What causes type 2 diabetes? The exact cause of type 2 diabetes is unknown. It seems to run in families. But, it often takes other factors to bring on the disease such as obesity, physical inactivity, or taking certain medicines. What are the risk factors for type 2 diabetes? Risk factors for type 2 diabetes include: Age, people age 45 or older are at higher risk for diabetes Family history of diabetes Being overweight Not exercising regularly Race and ethnicity (African-Americans, Hispanic Americans, Asian Americans, and American Indians are more prone to develop type 2 diabetes than white Americans) Pregnancy History of gestational diabetes (pregnancy induced diabetes) Giving birth to a baby who weighed more than 9 pounds A low HDL (high-density lipoprotein, or the "good cholesterol") A high triglyceride level Being a smoker What are the symptoms of type 2 diabetes? Symptoms of type 2 diabetes may include: Frequent bladder and skin infections that don't heal easily Unusual thirst Frequent passing urine Weight loss despite an increase in appetite Blurred vision Nausea and vomiting Extreme weakness and fatigue Irritability and mood changes Dry, itchy skin Tingling or loss of feeling in the hands or feet Some people who have type 2 diabetes don’t have symptoms. Symptoms may be mild and almost unnoticeable. Half of all Americans who have diabetes do not know it. The symptoms of type 2 diabetes may look like other conditions o Continue reading >>

What Is Type 2 Diabetes?

What Is Type 2 Diabetes?

Type 2 diabetes… the basics Diabetes includes a group of diseases of which there are three main types: type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes. Diabetes is a disorder of metabolism, a word that means how our body uses the food we digest for growth and energy. In other words, with diabetes something goes wrong with the way our body processes the food we take in, interfering with our ability to use that food for energy and to maintain our health. Of the three main forms of diabetes, type 2 diabetes mellitus is by far the most common. It accounts for over 90% of cases of diabetes. All forms of diabetes are characterized by high levels of sugar in the blood (this is described as “high blood sugar” or “high blood glucose”).1 Type 2 diabetes and high blood glucose We need some basic information about food and nutrition to understand why the high blood sugar that occurs with diabetes is a problem. Our bodies require energy to function properly and we get that energy from the foods we eat. Our diet (everything we eat and drink) includes three main sources of energy (also known as calories): protein, fat, and carbohydrates (sugars, starches, and fibers).When the body digests most sources of carbohydrates, they are transformed through digestion into a very important source of instant energy, a form of sugar called glucose.1-3 Our bodies depend on the action of a number of different natural body chemicals called hormones, working together in conjunction, to control how we use glucose. These include insulin, a hormone produced in the beta cells of the pancreas (an organ located behind the stomach) that serves as sort of a “gate keeper,” allowing glucose to enter cells where it can be transformed into energy and used to support vita Continue reading >>

Starting On Insulin In Type 2 Diabetes

Starting On Insulin In Type 2 Diabetes

Tweet If type 2 diabetes develops, your body’s ability to produce sufficient insulin may decrease and it may be appropriate to take insulin injections to control your diabetes. Some people may be apprehensive about switching onto insulin injections. Benefits of insulin injections Insulin is a stronger medication for lowering blood glucose levels and can help with the following aspects: Decrease the effects of symptoms of high blood sugar, such as fatigue and frequent need to urinate Reduce the risk of developing diabetic complications Decrease pressure on the pancreas to produce insulin Disadvantages of being on insulin injections Raises the risk of hypoglycemia Can promote weight gain Some people may be uncomfortable about injecting Could affect employment if you drive for a living The needles used for insulin injections are very slim and many people who start injections are surprised by how painless the needles are. How many injections will I need to take each day? A number of different injection regimes are available, ranging from one injection a day to multiple injections a day. Your health team will be able to help you to choose an injection regime that best fits in with your lifestyle. Learning to inject Your health team should instruct you on injection technique to ensure insulin is delivered correctly. Watch a video on how to inject insulin Blood glucose testing People starting insulin therapy may need to regularly test their blood sugar levels to monitor the effect that insulin is having and to help prevent low glucose levels (hypoglycemia) from happening. Watch our video on how to perform a blood glucose test Insulin therapy and hypoglycemia Insulin is a powerful medication for lowering blood glucose levels and can cause blood glucose levels to go too low if Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Whether you have type 2 diabetes, are a caregiver or loved one of a person with type 2 diabetes, or just want to learn more, the following page provides an overview of type 2 diabetes. New to type 2 diabetes? Check out “Starting Point: Type 2 Diabetes Basics” below, which answers some of the basic questions about type 2 diabetes: what is type 2 diabetes, what are its symptoms, how is it treated, and many more! Want to learn a bit more? See our “Helpful Links” page below, which provides links to diaTribe articles focused on type 2 diabetes. These pages provide helpful tips for living with type 2 diabetes, drug and device overviews, information about diabetes complications, nutrition and food resources, and some extra pages we hope you’ll find useful! Starting Point: Type 2 Diabetes Basics Who is at risk of developing type 2 diabetes? What is the risk of developing type 2 diabetes if it runs in the family? What is type 2 diabetes and prediabetes? Behind type 2 diabetes is a disease where the body’s cells have trouble responding to insulin – this is called insulin resistance. Insulin is a hormone needed to store the energy found in food into the body’s cells. In prediabetes, insulin resistance starts growing and the beta cells in the pancreas that release insulin will try to make even more insulin to make up for the body’s insensitivity. This can go on for a long time without any symptoms. Over time, though, the beta cells in the pancreas will fatigue and will no longer be able to produce enough insulin – this is called “beta burnout.” Once there is not enough insulin, blood sugars will start to rise above normal. Prediabetes causes people to have higher-than-normal blood sugars (and an increased risk for heart disease and stroke). Left unnoticed or Continue reading >>

Insulin For Type 2 Diabetes: Who, When, And Why?

Insulin For Type 2 Diabetes: Who, When, And Why?

Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later. As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time. In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated. Insulin Resistance and Deficiency in Type 2 Diabetes Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell “burnout.” Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease. When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this proc Continue reading >>

Starting Insulin Treatment In Type 2 Diabetes

Starting Insulin Treatment In Type 2 Diabetes

Introduction The emerging epidemic of type 2 diabetes, coupled with finite health resources, requires the treatment of hyperglycaemia to be simple and efficiently managed. Type 2 diabetes is a progressive disease and eventually almost all patients will require insulin to maintain good glycaemic control. Knowing when and how to start insulin in general practice is central to the optimal management of type 2 diabetes. The need to start insulin therapy in a newly diagnosed patient with type 2 diabetes is relatively uncommon. It should be considered when there is considerable weight loss, severe symptoms of hyperglycaemia or the presence of significant ketonuria. Many of these patients can be converted back to oral drugs once glycaemic control has been established and there is some recovery of pancreatic β cell function. A more common problem is when and how to commence insulin in patients with type 2 diabetes who are in 'secondary failure'. The term secondary failure refers to the 'failure' of oral hypoglycaemic drugs to maintain glycaemic control. The United Kingdom Prospective Diabetes Study (UKPDS)1 clearly showed that most people with type 2 diabetes will experience progressive pancreatic β cell dysfunction, despite excellent control. The secondary failure rate in this study was 44% after six years of diabetes. Since the time of the UKPDS, targets for glycaemic control have become increasingly stringent so secondary failure of oral hypoglycaemic drugs now occurs much sooner and is almost invariable. The younger, the sooner, the better The key to when to start insulin is to identify the appropriate glycated haemoglobin (HbA1c) target for an individual patient. Despite the promulgation of various 'guidelines', there is no single HbA1c concentration which suits everyone Continue reading >>

Why Do Some People With Type 2 Diabetes Who Are Using Insulin Have Poor Glycaemic Control? A Qualitative Study

Why Do Some People With Type 2 Diabetes Who Are Using Insulin Have Poor Glycaemic Control? A Qualitative Study

Strengths and limitations of this study The major strength lies in the fact that reasons for poor glycaemic control were uncovered from the perspectives of people with type 2 diabetes with sustained hyperglycaemia for more than 1 year despite insulin use, through in-depth interviews. Issues such as difficulty of adhering to regular meal and medication times, fear of hypoglycaemia, needles and pain, and lack of knowledge about and self-efficacy in diabetes care were found to be barriers to glycaemic control in people with type 2 diabetes using insulin. Issues such as social stigma, ethnicity, socioeconomic factors, family, friends, healthcare system and healthcare providers did not emerge as reasons for poor glycaemic control despite insulin use. The recruitment of participants was conducted in a single hospital, and therefore the involvement of healthcare systems in poor glycaemic control cannot be further explored. The fact that the interviews were conducted in the hospital environment may have influenced the participants to give a socially desirable response. However, they were informed that their responses would not affect their medical care and would be kept confidential. Insulin has been identified as the most effective glucose-lowering agent; however, it has been shown that many people with diabetes who are using insulin still fail to achieve glycaemic control.1 ,2 The challenges of achieving glycaemic control in people with diabetes using insulin are: the progression of the disease; the impact of hypoglycaemia and weight gain; the burden of polypharmacy; lack of resources in provision of diabetes self-care education and support of patients; and the inherent limitations of subcutaneous exogenous insulin administration.3 Other predictors of poor glycaemic control i Continue reading >>

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