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 >>
Why Insulin Can Become Necessary For A Person With Type 2 Diabetes
People with type 2 diabetes may require insulin when their meal plan, weight loss, exercise and antidiabetic drugs do not achieve targeted blood glucose (sugar) levels. Diabetes is a progressive disease and the body may require insulin injections to compensate for declining insulin production by the pancreas. That is why starting insulin treatment should never be seen as a failure. Starting insulin treatment should never be seen as a failure. Treatment with insulin may be added to an antidiabetic medication or completely replace it. Regardless of the treatment, lifestyle habits (diet, exercise, stress management) are essential to managing diabetes. Many people are reluctant to inject insulin for various reasons: Fear of pain or needles Guilt Impression that this is the “last resort” Fear of hypoglycemic attacks Fear of weight gain Memories of loved one who had to take insulin If this is the case, do not hesitate to discuss your concerns with a health care professional. Some of your fears may be due to false beliefs. Learning more about today’s insulin treatment will probably allay your fears. For many people, insulin is an effective way to achieve good blood-sugar control, which can prevent or delay certain diabetes complications over the long term. Every person with diabetes being treated with insulin should be trained by a health care professional. This training should include the different injection steps, as well as the treatment and prevention of hypoglycemia, which can occur in anyone on insulin. Research and text: Cynthia Chaput, Dietitian Scientific review: Louise Tremblay, Nurse. M. Ed. June 2014 - Revised May 2016 Continue reading >>
Patient Education: Diabetes Mellitus Type 2: Insulin Treatment (beyond The Basics)
TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body's tissues become resistant to normal or even high levels of insulin. This causes high blood glucose (sugar) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medications, which can minimize the risk of diabetes-related and cardiovascular complications (eg, heart attacks and strokes). Learning to manage diabetes is a process that continues over a lifetime. The diagnosis of diabetes can be overwhelming at the beginning; however, most people are able to lead normal lives, and many patients become experts in their own care. This topic review discusses the role of insulin in blood sugar control for patients with type 2 diabetes. Separate topic reviews about other aspects of type 2 diabetes are also available. (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)" and "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)" and "Patient education: Hypoglycemia (low blood sugar) in diabetes mellitus (Beyond the Basics)" and "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)" and "Patient education: Preventing complications in diabetes mellitus (Beyond the Basics)".) IMPORTANCE OF BLOOD SUGAR CONTROL IN TYPE 2 DIABETES Keeping blood sugar levels in control is one way to decrease the risk of complications related to type 2 diabetes. The most common complication of type 2 diabetes is heart d Continue reading >>
Tweet Injecting insulin is an essential part of the daily regime for many diabetics. Although insulin that can be inhaled is now available and approved, the reality is that most type 1 diabetics (and type 2 diabetics who require insulin) will have to continue injecting insulin until it is more common. Does injecting insulin hurt? Needle technology for insulin injection has become much better in recent years, meaning that the injection process, although not pain-free, does not hurt as much as it used to. Many patients still find injecting insulin to manage their diabetes an unpleasant process, however. Is injecting insulin and having diabetes going to change my life? Unfortunately, having diabetes does lead to lifestyle complications. For insulin therapy to be effective, it is necessary to make certain lifestyle changes. These should include: eating healthily exercising regularly testing blood glucose regularly and following a strict insulin regimen Although adhering to all these changes does influence your daily routine, the benefits for diabetics are enormous. Into what part of my body should I inject insulin to best help my diabetes? The abdomen is the most common site for injecting insulin. For some people, this site is not suitable, and other sites must be used. These include the upper arms, the upper buttocks and the outside of the thigh. All of these sites are most effective because they have a layer of fat to absorb the insulin better. This process directly injects insulin into the subcutaneous tissue. These areas also have fewer nerve endings, meaning that they are the least painful areas in which to inject. Should I switch the site where I inject insulin? Your healthcare team should be able to help you to decided the best places to inject insulin, when you shou Continue reading >>
Diabetes Mellitus - Insulin Treatment In Dogs
By Ernest Ward, DVM & Robin Downing, DVM, DAAPM, DACVSMR, CVPP Emergency Situations, Medical Conditions This handout provides detailed information on insulin administration. For more information about diabetes mellitus, see the fact sheets "Diabetes Mellitus - General Information", and "Diabetes Mellitus - Principles of Treatment". What is diabetes mellitus? In dogs, diabetes mellitus is caused by the failure of the pancreas to produce enough insulin to regulate blood sugar. This is Insulin Dependent Diabetes Mellitus (also called Type 1 Diabetes). This type of diabetes usually results from destruction of most or all of the beta-cells that produce insulin in the pancreas. As the name implies, dogs with this type of diabetes require insulin injections to stabilize blood sugar levels. What do I need to know about insulin treatment for diabetes mellitus? In diabetic dogs, the main treatment for regulating blood glucose is giving insulin by injection. Dogs with diabetes mellitus typically require two daily insulin injections as well as a dietary change. Although the dog can go a day or so without insulin and not have a crisis, this should not be a regular occurrence; treatment should be looked upon as part of the dog's daily routine. This means that you, as the dog's owner, must make both a financial commitment and a personal commitment to treat your dog. If are out of town or go on vacation, your dog must receive proper treatment in your absence. Initially, your dog may be hospitalized for a few days to deal with any immediate crisis and to begin the insulin regulation process. For instance, if your dog is so sick that he has quit eating and drinking for several days, he may be experiencing “diabetic ketoacidosis,” which may require a several days of intensive care. On Continue reading >>
Regulating & Monitoring A Diabetic Cat Using Insulin
Not all cats with diabetes will need to be treated with insulin (some cats with mild diabetes may respond to and dietary change), but a majority of them will. The goal of treatment is to resolve the signs of the disease, maintain proper body weight, eliminate or reduce the likelihood of any complications, and provide the cat with a good quality of life. This can be accomplished by maintaining the blood glucose at an acceptable level (100-290 mg/dL; normal is 55-160 mg/dL). In addition to treating the diabetes, any other concurrent diseases such as pancreatic exocrine insufficiency, hyperthyroidism, Cushing's disease, and infections need to be treated as well. What should an owner know before trying to 'regulate' a cat with diabetes? Before treatment is started, it is important that the owner be well-informed and have the time necessary to make the correct decision since regulating a diabetic cat requires commitment. Owners should know: The cat will need to be hospitalized for a number of days and one or more blood glucose profiles (described below) will need to be performed. The initial regulation of a cat on insulin generally takes 2-8 weeks. The process of getting a cat regulated can be costly. Insulin must usually be given twice a day, every day at specific times, probably for the life of the cat. Insulin must be handled properly (refrigerated, not shaken, etc). There is a proper technique for administering insulin to a cat that must be followed. The type of insulin and insulin syringe that are used should not be changed unless under guidance by the veterinarian. The type and amount of food and when it is fed must be consistent. In most cases, foods high in protein and low in carbohydrates are recommended. These are usually canned foods. The cat will need to be caref Continue reading >>
What Is Insulin And Why Do Some Diabetics Need To Take It?
Question: What is insulin and why do some diabetics need to take it? Answer: Insulin is a hormone. It's made by certain cells in the pancreas, which are called the beta cells of the pancreas, and the beta cells from the pancreas are part of these little islets called the Islets of Langerhans. That's where insulin normally comes from, and in type 2 diabetes there is always some insulin coming out from those beta cells; in type 1 diabetes, you tend to lose the beta cells and make no insulin. Since 1921 or so, though, insulin has been available as a pharmacologic approach, so you can take insulin by injection, and you can replace what's not being made in the pancreas. Who needs insulin? Well, it really is two situations. First of all, in type 1 diabetes, insulin is always necessary because the beta cells in the pancreas are not making any insulin. So, people with type 1 or juvenile onset diabetes always need insulin injections. In type 2 diabetes, you may also need insulin if your pancreas has sort of worn out to the point that it's not making anywhere near enough insulin, and you do need insulin injections. Type 2 diabetes often can be treated by different pills that might improve the insulin release by the pancreas or improve the response of the body to insulin, but eventually even type 2 diabetes may simply not be making, the pancreas may not be making enough insulin, and the person may need insulin by injection. Next: What Causes Diabetes? Previous: What Is Gestational Diabetes And Can It Hurt My Baby? Continue reading >>
Type 1 Diabetes Mellitus Treatment & Management
Approach Considerations Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Long-term management requires a multidisciplinary approach that includes physicians, nurses, dietitians, and selected specialists. In some patients, the onset of type 1 DM is marked by an episode of diabetic ketoacidosis (DKA) but is followed by a symptom-free “honeymoon period” in which the symptoms remit and the patient requires little or no insulin. This remission is caused by a partial return of endogenous insulin secretion, and it may last for several weeks or months (sometimes for as long as 1-2 years). Ultimately, however, the disease recurs, and patients require insulin therapy. Often, the patient with new-onset type 1 DM who presents with mild manifestations and who is judged to be compliant can begin insulin therapy as an outpatient. However, this approach requires close follow-up and the ability to provide immediate and thorough education about the use of insulin; the signs, symptoms, and treatment of hypoglycemia; and the need to self-monitor blood glucose levels. The American Diabetes Association (ADA) recommends using patient age as one consideration in the establishment of glycemic goals, with targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels.  In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. The statement includes a new pediatric glycemic control target of HbA1c of less than 7.5% across all pediatric age groups, replacing earlier guidelines that specified different glycemic control targets by age. The adult HbA1c target of les Continue reading >>
Everything You Need To Know About Insulin
Insulin is a hormone made in your pancreas, a gland located behind your stomach. It allows your body to use glucose for energy. Glucose is a type of sugar found in many carbohydrates. After a meal or snack, the digestive tract breaks down carbohydrates and changes them into glucose. Glucose is then absorbed into your bloodstream through the lining in your small intestine. Once glucose is in your bloodstream, insulin causes cells throughout your body to absorb the sugar and use it for energy. Insulin also helps balance your blood glucose levels. When there’s too much glucose in your bloodstream, insulin signals your body to store the excess in your liver. The stored glucose isn’t released until your blood glucose levels decrease, such as between meals or when your body is stressed or needs an extra boost of energy. Diabetes occurs when your body doesn't use insulin properly or doesn't make enough insulin. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is a type of autoimmune disease. These are diseases in which the body attacks itself. If you have type 1 diabetes, your body can’t make insulin. This is because your immune system has destroyed all of the insulin-producing cells in your pancreas. This disease is more commonly diagnosed in young people, although it can develop in adulthood. In type 2 diabetes, your body has become resistant to the effects of insulin. This means your body needs more insulin to get the same effects. Therefore, your body overproduces insulin to keep blood glucose levels normal. However, after many years of overproduction, the insulin-producing cells in your pancreas burn out. Type 2 diabetes also affects people of any age, but typically develops later in life. Injections of insulin as a replacement or supplement Continue reading >>
Insulin: The Holy Grail Of Diabetes Treatment
Insulin is a hormone made by beta cells in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. In people with type 1 diabetes, the body produces little or no insulin as the cells that produce insulin have been destroyed by an autoimmune reaction in the body. Insulin replacement by daily injections is required. In people with type 2 diabetes the body produces insulin but the insulin does not work as well as it should. This is often referred to as insulin resistance. To compensate the body makes more but eventually cannot make enough to keep the balance right. Lifestyle changes can delay the need for tablets and/or insulin to stabilise blood glucose levels. When insulin is required, it is important to understand that this is just the natural progression of the condition. RMIT University have produced a short overview of insulin, a drug that keeps in excess of one million Australians alive. Watch the video to understand why insulin is important and why so many Australians rely on it to stay alive. Copyright © 2015 RMIT University, Prepared by the School of Applied Sciences (Discipline of Chemistry). At this stage, insulin can only be injected. Insulin cannot be given in tablet form as it would be destroyed in the stomach, meaning it would not be available to convert glucose into energy. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. You do not inject it into muscle or directly into the blood. Absorption of insulin varies depending on the part of the body into which you inject. The tummy (abdomen) absorbs insulin the fastest and is the site used by most people. The buttocks and thighs are also used by some people. While i Continue reading >>
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 >>
Should I Use Diabetes Pills Or Insulin?
Diabetes affects the way your body breaks down food. Treatment depends on which type of diabetes you have. In type 1 diabetes, your pancreas stops producing insulin. Insulin is a hormone that helps regulate glucose, or sugar, in your blood. Type 2 diabetes starts with insulin resistance. Your pancreas no longer produces enough insulin or doesn’t use it efficiently. Every cell in your body uses glucose for energy. If insulin isn’t doing its job, glucose builds up in your blood. This causes a condition called hyperglycemia. Low blood glucose is called hypoglycemia. Both can lead to serious complications. A variety of pills are available to treat diabetes, but they can’t help everyone. They only work if your pancreas still produces some insulin. They can’t treat type 1 diabetes. They aren’t effective in people with type 2 diabetes when the pancreas has stopped making insulin. Some people with type 2 diabetes can benefit from using both pills and insulin. Some pills to treat diabetes include: Biguanides Metformin (Glucophage, Fortamet, Riomet, Glumetza) is a biguanide. It lowers the amount of glucose in your liver and boosts insulin sensitivity. It may also improve cholesterol levels and might help you lose a little weight. People normally take it twice per day with meals. You can take the extended-release version once per day. Potential side effects include: upset stomach nausea bloating gas diarrhea a temporary loss of appetite It may also cause lactic acidosis in people with kidney failure, but this is rare. Sulfonylureas Sulfonylureas are fast-acting medications that help the pancreas release insulin after meals. They include: People usually take these medications once per day with a meal. Potential side effects include: irritability low blood glucose upset st Continue reading >>
Type 2 Diabetes And Insulin
Getting Started When most people find out they have Type 2 diabetes, they are first instructed to make changes in their diet and lifestyle. These changes, which are likely to include routine exercise, more nutritious food choices, and often a lower calorie intake, are crucial to managing diabetes and may successfully lower blood glucose levels to an acceptable level. If they do not, a drug such as glyburide, glipizide, or metformin is often prescribed. But lifestyle changes and oral drugs for Type 2 diabetes are unlikely to be permanent solutions. This is because over time, the pancreas tends to produce less and less insulin until eventually it cannot meet the body’s needs. Ultimately, insulin (injected or infused) is the most effective treatment for Type 2 diabetes. There are many barriers to starting insulin therapy: Often they are psychological; sometimes they are physical or financial. But if insulin is begun early enough and is used appropriately, people who use it have a marked decrease in complications related to diabetes such as retinopathy (a diabetic eye disease), nephropathy (diabetic kidney disease), and neuropathy (nerve damage). The need for insulin should not be viewed as a personal failure, but rather as a largely inevitable part of the treatment of Type 2 diabetes. This article offers some practical guidance on starting insulin for people with Type 2 diabetes. When to start insulin Insulin is usually started when oral medicines (usually no more than two) and lifestyle changes (which should be maintained for life even if oral pills or insulin are later prescribed) have failed to lower a person’s HbA1c level to less than 7%. (HbA1c stands for glycosylated hemoglobin and is a measure of blood glucose control.) However, a recent consensus statement from Continue reading >>
What Type Of Diabetes Requires Insulin Injections?
People with Type 1 diabetes always require insulin injections in order to control blood sugar readings because they make little or no insulin. Insulin is also prescribed for Type 2 diabetes when oral medications or other injectable meds are not controlling blood sugar levels adequately. Anyone taking insulin of any kind is at risk for hypoglycemia (low blood sugar). Taking insulin does not mean you have a “bad type” of diabetes. The purpose of using insulin is to get the best management of blood sugar readings as close to normal blood sugar readings as possible to help avoid complications from diabetes. Type 1 diabetes is an autoimmune disease that results in destruction of the insulin producing cells. People with this type of diabetes must take insulin. Type 2 diabetes is a multimolecular disorder that causes 2 things (at least). First insulin secretion is inadequate. It may be the amount or the way it is secreted. Second most people with this type of diabetes also have a resistance to the insulin they do put out. So it's a double whammy. There are three factors that come into play that might determine the need for insulin: physical activity, dietary intake and age. A lot of exercise, a proper diet to control weight may minimize the amount of medication you need for many years but this is a progressive disorder and as you get older so does your ability to produce insulin. Sooner or later, even under the best of circumstances you will need insulin. Now, it may be of advantage to start insulin way before that time to keep your blood glucose normal which leads to a better quality of life and reduce risk for complications. Actually, all types of diabetes (type 1, type 2 and gestational) can require insulin injections. With type 1 diabetes, a person's beta cells stop pr Continue reading >>
What Is The Best Way To Treat Or Control Diabetes?
MANAGING DIABETES People with diabetes can live long and healthy lives if their diabetes is detected and well-managed. Good management using a standardized protocol can potentially prevent complications and premature death from diabetes using: a small set of generic medicines; interventions to promote healthy lifestyles; patient education to facilitate self-care; regular screening for early detection and treatment of complications through a multidisciplinary team. The longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be Blood glucose control is important in preventing and slowing the progression of complications CONTROLLING DIABETES 1. Life style changes are used to controlling diabetes and have several principles of good diabetes care: Monitor your diabetes regularly Prevent long term diabetes problems Get checked for long term problems and treat them 2. Exercise is important in helping to prevent diabetes and is having vital role of our treatment. Helps in losing weight Reduces blood glucose levels Exercise can reduce cholesterol and blood pressure Exercise helps reduce stress Exercise makes the tissues in your body more sensitive to the effects of insulin. 3. Diet places an emphasis on foods that are higher in fiber and low in fat. A high fiber, low fat diet can make body more sensitive to insulin. Diet may involve weight loss which can increase diabetic patient’s body sensitivity to the effects of insulin. There is a good website on healthcare, with some informative blogs on diabetes, you can check it here: Latest Health Care and News | DiscussMed Continue reading >>