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What Is Insulin Therapy For Type 2 Diabetes?

Insulin Therapy For Adult Patients With Type 2 Diabetes Mellitus: A Position Statement Of The Korean Diabetes Association, 2017

Insulin Therapy For Adult Patients With Type 2 Diabetes Mellitus: A Position Statement Of The Korean Diabetes Association, 2017

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea 3Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea 4Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea 6Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea 7Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea 8Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea 9Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea Correspondence to Seung-Hyun Ko, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-8155 Fax: +82-31-253-8898 E-mail: [email protected] This manuscript is simultaneously published in the Diabetes Metabolism Journal and the Korean Journal of Internal Medicine by the Korean Diabetes Association and the Korean Association of Internal Medicine. *These authors contributed equally to this work. Received September 8, 2017 Accepted October 14, 2017 Copyri Continue reading >>

Insulin Therapy For Type 2 Diabetes

Insulin Therapy For Type 2 Diabetes

A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications (1,2). In addition, recent follow-up data from the U.K. Prospective Diabetes Study (UKPDS) suggest that early insulin treatment also lowers macrovascular risk in type 2 diabetes (3). Whereas there is consensus on the need for insulin, controversy exists on how to initiate and intensify insulin therapy. The options for the practical implementation of insulin therapy are many. In this presentation, we will give an overview of the evidence on the various insulin regimens commonly used to treat type 2 diabetes. Secondary analyses of the aforementioned landmark trials endeavored to establish a glycemic threshold value below which no complications would occur. The UKPDS found no evidence for such a threshold for A1C, but instead showed that better glycemic control was associated with reduced risks of complications over the whole glycemic range (“the lower the better”) (4). For the management of type 2 diabetes, this resulted in the recommendation to “maintain glycemic levels as close to the nondiabetic range as possible” (5). However, in contrast to the UKPDS, the Kumamoto study observed a threshold, with no exacerbation of microvascular complications in patients with type 2 diabetes whose A1C was <6.5%, suggesting no additional benefit in lowering A1C below this level (2). Moreover, the intensive glycemia treatment arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, targeting A1C <6.0%, was discontinued because of higher mortality in this group compared with the standard therapy group targeting A1C from 7.0 to 7.9% (6). Therefore, the American Diabetes Association (ADA) recommendation of an A1C target <7.0% seems the most balan Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Insulin In Type 2 Diabetes Mellitus

Insulin In Type 2 Diabetes Mellitus

the United Kingdom Prospective Diabetes Study Group (UKPDS) has pointed out that majority of type 2 diabetes patients will experience progressive pancreatic beta cell dysfunction even when their diabetes control is excellent (1) so type 2 diabetics may eventually require treatment with insulin when oral hypoglycaemic medication is no longer effective a straight swap to insulin treatment is usual if the maximal therapy with non-insulin treatments have been reached according to estimations in UK general practice, only 50% of patients who require insulin due to failure of oral medication will receive it within 5 years o the average time taken from beginning treatment with the last oral agent to beginning insulin therapy is around 8 years (2) in the case of overweight patients taking metformin, then treatment with metformin may be continued - this is because metformin may attenuate weight gain resulting from the introduction of insulin therapy insulin therapy and a sulphonylurea may decrease the amount of insulin actually required and enhance the use of a single night-time dose but overall the clinical advantages of this combination are small (3) the average weight gain resulting from introduction of insulin therapy is 4 kg - however some patients may have a marked increase in weight after onset of insulin therapy in a comprehensive review of combination therapies with insulin in type 2 diabetes Yki-Jarvinen suggests an algorithm for starting insulin in an insulin naive type 2 diabetic patient who is on maximal oral hypoglycaemic therapy. In this algorithm she suggests stopping sulphonylurea treatment and continuation of metformin at a dose of 2g per day in combination with insulin treatment (4). If the patient is not on a dose of 2g per day when conversion to insulin occur Continue reading >>

Is Type 2 Diabetes Reversible?

Is Type 2 Diabetes Reversible?

I just wrote an answer to this question about 5 minutes ago and will answer it again because it is so very important for you and for millions of other people. The answer to your question is yes. From my personal experience Type 2 Diabetes can be reversed. In March of 2017 I was diagnosed with Type II Diabetes. It really scared me. My father was diagnosed with Type 2 diabetes at 60 and I watched him have to inject insulin 2 times a day. His body still deteriorated due to the diabetes. I did not want to end up like that. I was a chocoholic and ate huge portions. I was too heavy for my height and did not get enough exercise. I immediately got on the internet and started researching for cures for Type II Diabetes. I read all the information at the American Diabetes Association website and was thoroughly depressed. I was being told that I had a progressive disease with no cure that would last the rest of my life and finally cause my death. I learned that I would have to take progressively stronger medications to control my diabetes and BG, (Blood glucose levels). I decided that this path was not for me. I knew there had to be a cure for this terrible disease even if all these doctors and pharmaceutical companies were saying that there is no cure. I read everything I could find on T2 Diabetes. Causes, treatments, reversal and cure. I decided that changing my diet drastically to a low carb high fat diet, LCHF, was the way to go. I found a great deal of good information at Diet Doctor - Making low carb simple. So I did it. I absolutely changed my diet completely from that day. It was very difficult. My body was craving carbohydrates, especially sweets. I had physical flu symptoms from the body adjusting to this new diet. I used meditation and mindful eating to get through those 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 >>

Insulin Therapy In Type 2 Diabetes Mellitus: A Practical Approach For Primary Care Physicians And Other Health Care Professionals

Insulin Therapy In Type 2 Diabetes Mellitus: A Practical Approach For Primary Care Physicians And Other Health Care Professionals

The responsibility of diabetes management and insulin therapy has definitively moved to primary care physicians. Within the primary care setting, there is a growing need for clear, evidence-based guidelines related to the management of insulin therapy. Straightforward algorithms regarding insulin initiation, titration, and follow-up management can help physicians effectively treat patients with type 2 diabetes mellitus. Once 2 oral diabetic drugs have failed in a patient whose disease duration is 7 to 10 years, use of insulin therapy with a basal insulin analog should be considered. For patients who receive maximal basal insulin doses without reaching fasting blood glucose and target glycated hemoglobin levels with basal insulin analogs, a mealtime-insulin intensification approach should be considered. The authors discuss how simplified insulin initiation and titration regimens allow primary care physicians and other health care professionals to care for patients with type 2 diabetes mellitus. Diabetes affects 25.8 million people in the United States; most (90-95%) adults with a diagnosis of diabetes have type 2 diabetes mellitus (T2DM).1 Primary care physicians (PCPs) deliver approximately 90% of diabetes care in the United States.2 Type 2 diabetes mellitus is characterized by progressive β-cell failure and increasing difficulty in maintaining glycemic control.3,4 Even with multiple oral antidiabetic drugs, many patients need insulin therapy to achieve and maintain glycated hemoglobin (HbA1c) target levels.4 The intensification of diabetes treatment—that is, the transition from oral antidiabetic drugs to injectable treatments such as insulin—is often delayed in many patients, which substantially increases the risk of diabetes-related complications.5-10 In a popula Continue reading >>

Type 2 Diabetes And Insulin

Type 2 Diabetes And Insulin

People with type 2 diabetes do not always have to take insulin right away; that is more common in people with type 1 diabetes. The longer someone has type 2 diabetes, the more likely they will require insulin. Just as in type 1 diabetes, insulin is a way to control your blood glucose level. With type 2 diabetes, though, dietary changes, increasing physical activity, and some oral medications are usually enough to bring your blood glucose to a normal level. To learn about how the hormone insulin works, we have an article that explains the role of insulin. There are several reasons people with type 2 diabetes may want to use insulin: It can quickly bring your blood glucose level down to a healthier range. If your blood glucose level is excessively high when you are diagnosed with type 2 diabetes, the doctor may have you use insulin to lower your blood glucose level—in a way that’s much faster than diet and exercise. Insulin will give your body a respite; it (and especially the beta cells that produce insulin) has been working overtime to try to bring down your blood glucose level. In this scenario, you’d also watch what you eat and exercise, but having your blood glucose under better control may make it easier to adjust to those lifestyle changes. It has fewer side effects than some of the medications: Insulin is a synthetic version of a hormone our bodies produce. Therefore, it interacts with your body in a more natural way than medications do, leading to fewer side effects. The one side effect is hypoglycemia. It can be cheaper. Diabetes medications can be expensive, although there is an array of options that try to cater to people of all economic levels. However, insulin is generally cheaper than medications (on a monthly basis), especially if the doctor wants yo Continue reading >>

Overcoming Challenges And Barriers To Insulin Therapy In Type 2 Diabetes

Overcoming Challenges And Barriers To Insulin Therapy In Type 2 Diabetes

This activity is supported by an educational grant from sanofi-aventis U.S. Overcoming Challenges and Barriers to Insulin Therapy in Type 2 Diabetes Faculty Jennifer Goldman, PharmD, CDE, BC-ADM, FCCP Professor of Pharmacy Practice School of Pharmacy MCPHS University Boston, Massachusetts Donna Horn, RPh, DPh Adjunct Instructor Department of Pharmacy Practice School of Pharmacy MCPHS University Boston, Massachusetts Educational Objectives: After completing this continuing education program, the participant will be able to: Explain barriers for the appropriate use of basal insulin to promote patient adherence to therapy. Differentiate between the different pharmacokinetic and pharmacodynamics actions of available and emerging insulin agents. Determine the potential role for new and emerging insulin therapies and dosage strengths for treatment of type 2 diabetes mellitus. Illustrate insulin administration errors, and explain how effective patient counseling surrounding treatment regimens can reduce errors. Target audience: Pharmacists Type of activity: Application Release date: May 6, 2015 Expiration date: May 6, 2017 Estimated time to complete activity: 2.0 hours Fee: Free Pharmacy Times Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.0 contact hours (0.2 CEUs) under the ACPE universal activity number 0290-0000-15-040-H01-P. The activity is available for CE credit through May 6, 2017. ◄ 1 Continue reading >>

Type 2 Diabetes Mellitus Treatment & Management

Type 2 Diabetes Mellitus Treatment & Management

Approach Considerations The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers, highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations – 2015. [117] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [2] Management includes the following: Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, glycemia, lipids, blood pressure). Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. In patients with advanced type 2 diabetes who are at high risk for cardiovascular disease, lowering Hb Continue reading >>

Insulin Therapy For Type 2 Diabetes: How Doctors Use It And Adjust For Treatment

Insulin Therapy For Type 2 Diabetes: How Doctors Use It And Adjust For Treatment

Insulin therapy requires frequent dosage adjustments to maintain adequate blood glucose levels. Here’s information patients with type 2 diabetes can use. So your doctor told you that you need insulin therapy for your type 2 diabetes. This is a common problem and is likely to grow in the coming years. MORE FROM MICHIGAN: Subscribe to our weekly newsletter About 29 million people in the United States have type 2 diabetes, and 86 million more have prediabetes. About 1 in 4 people with type 2 diabetes is on insulin therapy; an additional 1 in 4 probably needs to be. What does it mean to be on insulin therapy? Could you have prevented this? Will insulin actually work? These are frequent questions people who need insulin therapy ask. As someone who has treated people with diabetes for years and has been working to improve the treatment’s effectiveness, I will do my best to help you answer these questions. I also have been working to develop a better way to personalize dosing for insulin. Insulin therapy for type 2 diabetes Diabetes is a condition in which your pancreas fails to secrete a sufficient amount of insulin to help you maintain normal blood glucose, or sugar in the blood, which is transported to various parts of the body to supply energy. There are many causes of insulin deficiency, but the most common is type 2 diabetes. The main risk factors for type 2 diabetes are family history, weight and age. In fact, most overweight and obese people in the Western world will never develop diabetes. Weight is an important, yet misunderstood, risk factor for diabetes. The foods you eat are usually less relevant than the weight itself. Most people in the world with type 2 diabetes do not fulfill the medical criteria of obesity; rather, their weight exceeds the capacity of the Continue reading >>

Basal Insulin Therapy In Type 2 Diabetes

Basal Insulin Therapy In Type 2 Diabetes

Abstract Patients with type 2 diabetes mellitus are usually treated initially with oral antidiabetic agents, but as the disease progresses, most patients eventually require insulin to maintain glucose control. Optimal insulin therapy should mimic the normal physiologic secretion of insulin and minimize the risk of hypoglycemia. This article discusses the role of insulin therapy in patients with type 2 diabetes, emphasizing long-acting insulin agents designed to approximate physiologic basal insulin secretion and provide control over fasting plasma glucose. Clinical trials of recently developed long-acting insulins are reviewed herein, with emphasis on studies that combined basal insulin with oral agents or with short-acting insulins in a basal-bolus approach. The normal physiologic pattern of insulin secretion by pancreatic β cells consists of a sustained basal insulin level throughout the day, superimposed after meals by relatively large bursts of insulin that slowly decay over 2 to 3 hours (bolus insulin). Basal support with long-acting insulin is a key component of basal-bolus therapy for patients with diabetes who require insulin with or without the addition of oral agents. Newer long-acting agents such as insulin glargine provide a steadier and more reliable level of basal insulin coverage and may have significant advantages over traditional long-acting insulins as part of a basal-bolus treatment strategy. Continue reading >>

The Facts About Insulin For Diabetes

The Facts About Insulin For Diabetes

Insulin is a hormone that your pancreas makes to allow cells to use glucose. When your body isn't making or using insulin correctly, you can take man-made insulin to help control your blood sugar. Many types can be used to treat diabetes. They're usually described by how they affect your body. Rapid-acting insulin starts to work within a few minutes and lasts for a couple of hours. Regular- or short-acting insulin takes about 30 minutes to work fully and lasts for 3 to 6 hours. Intermediate-acting insulin takes 2 to 4 hours to work fully. Its effects can last for up to 18 hours. Long-acting insulin can work for an entire day. Your doctor may prescribe more than one type. You might need to take insulin more than once daily, to space your doses throughout the day, and possibly to also take other medicines. How Do I Take It? Many people get insulin into their blood using a needle and syringe, a cartridge system, or pre-filled pen systems. The place on the body where you give yourself the shot may matter. You'll absorb insulin the most consistently when you inject it into your belly. The next best places to inject it are your arms, thighs, and buttocks. Make it a habit to inject insulin at the same general area of your body, but change up the exact injection spot. This helps lessen scarring under the skin. Inhaled insulin, insulin pumps, and a quick-acting insulin device are also available. When Do I Take It? It will depend on the type of insulin you use. You want to time your shot so that the glucose from your food gets into your system at about the same time that the insulin starts to work. This will help your body use the glucose and avoid low blood sugar reactions. For example, if you use a rapid-acting insulin, you'd likely take it 10 minutes before or even with your m Continue reading >>

Early Insulin Therapy In Patients With Type 2 Diabetes Mellitus

Early Insulin Therapy In Patients With Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. ‘Clinical inertia’ in T2DM, defined as lack of initiation or intensification of therapy when clinically indicated, is common among clinicians. Patients are exposed to hyperglycaemia for a long time resulting in glucotoxicity to beta cells, leading to further beta cell deterioration. The traditional approach to the management of T2DM is lifestyle change, diet, exercise, weight loss, oral agents and, lastly, insulin. This traditional approach is usually carried out step-by-step and at a slow pace, with insulin offered as a last option. By the time insulin therapy is initiated, complications have already developed. It is, therefore, important for clinicians to be aware of the importance of initiating insulin therapy early to prevent poor glycaemic control and the development of diabetes-related complications. Continue reading >>

What Is The Molecular Mechanism For Insulin To Treat Insulin Resistance Even At A Severe State?

What Is The Molecular Mechanism For Insulin To Treat Insulin Resistance Even At A Severe State?

I can't give you a molecular answer, because I am not a biologist nor an endocrinologist. But I am the next-best thing: A type 1 diabetic. Like most type 1 diabetics you'll encounter, I have been forced into the position of becoming more knowlegeable about the endocrine system than the average person. You'll forgive me if some of what I am about to write isn't perfect. It's what I currently understand as of today. Injecting insulin does not improve insulin resistance at all. What it does is it makes up the insulin "shortfall" caused by the insulin resistance. It helps the type 2 diabetic avoid some of the terrible complications associated with persistent high blood sugar. So, insulin therapy is not a cure for type 2 diabetes at all, it is simply a way to avoid complications. But, there is some evidence to suggest that injecting insulin can help a type 2 diabetic preserve beta cell functionality. (Beta cells are the pancreatic cells responsible for insulin production.) If one's beta cells are constantly under the strain of excessive insulin production, eventually they will fail and then even the type 2 diabetic will have something like type 1 diabetes. That's not good. So please, take your insulin. It is possible for a type 2 diabetic to work hard enough that s/he can go off of insulin therapy. In order to accomplish this, the type 2 diabetic must radically change his or her diet, lose weight, and increase insulin sensitivity. The truth is, this should be the goal of every type 2 diabetic. It is possible to completely cure yourself - no more insulin, no more metformin, no more Januvia, no more nothing. But this will require you to work out diligently, manage your diet like a mad scientist, and above all, preserve the functionality of your beta cells. You can see how impo Continue reading >>

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