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When To Start Insulin Therapy

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Nice Guidance - Insulin Therapy In Type 2 Diabetes

initiation of insulin therapy in type 2 diabetes: insulin therapy may be indicated when other measures no longer achieve adequate blood glucose control (to HbA1c < 7.5% or other higher level agreed with the individual) when starting insulin therapy, use a structured programme employing active insulin dose titration that encompasses: structured education continuing telephone support frequent self-monitoring dose titration to target dietary understanding management of hypoglycaemia management of acute changes in plasma glucose control support from an appropriately trained and experienced healthcare professional when starting insulin therapy in adults with type 2 diabetes, continue to offer metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies NICE suggest that insulin therapy should be initiated from a choice of a number of insulin types and regimens. preferably begin with human NPH insulin, taken at bed-time or twice daily according to need which insulin to choose? initiate insulin therapy from a choice of a number of insulin types and regimens begin with human NPH insulin injected at bed-time or twice dai Continue reading >>

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Popular Questions

  1. sloan

    type 1 AND insulin resistant????

    I have had type 1 diabetes for 15 years. I was diagnosed when I was 9 years old. All seemed to go well for the longest time; about 13 1/2 years. I cannot really even remember ever worrying about having diabetes. I counted carbs religiously and had my ratios down pat. I remember when I switched to Humolog from R and the doc told me to make sure that I ate within 10 minutes after giving myself humolog lest I become hypoglycemic. I followed orders and so long as I did the correct amount of humolog I would not get hyperglycemia (i.e. my blood sugar would maybe get up to 150 an hour or so after eating and then come down to the correct range within 2 hours after eating).
    About a year ago I found myself getting up into the 200's after eating even if I would give myself the correct amount of insulin. I know my ratios were correct (despite getting up into the 200's) because my blood sugars would eventually come down within range within a 3-4 hours after eating. For a while I would "stack" (or over correct my 200's blood sugar only to get hypoglycemia an hour or two later). I began to think that the insulin was just not working or something, so I tried switching to a "faster insulin" thinking that may fix the problem; first I switched to novolog but when the problem continued I even tried Apidra, which is supposedly the fastest. But the problem persists.
    I have learned to quasi-remedy the problem by exercising after eating (thus increasing my blood flow to speed insulin absorption), eating a lot of fiber (slowing down digestion), and I even sometimes do my apidra doses up to an hour before I eating. By the time I get around to eating the insulin has begun absorbing so the insulin starts doing its job right when I start eating. All of these strategies work to a degree, but it has become unduly burdensome managing by blood sugars after eating because it JUST DOESN'T FEEL LIKE MY INSULIN IS WORKING like it used to.
    I have therefore begun thinking that I may be insulin resistant like a type 2 diabetic. The way I understand "insulin resistance" is that one's cell's more or less build a callas. Consequently, one's insulin cannot successfully unlock the cell to transfer the glucose (that it is carrying into the cell) in order to use it for energy. As a remedy, type 2's many times take pills to get rid of the calluses around their cells. I feel like the symptoms I have been experiencing (i.e. high blood sugars after eating despite doing the correct amount of insulin) is the result of inefficient transferring of glucose (by the insulin I inject) into my cell's, which perhaps have developed some type of callas; a.k.a insulin resistance. ???????????
    I have been recommended by a doc to take chromium which supposedly aids insulin function not by helping insulin production or by increasing the quality of the insulin created (which in a type 1's case would be pointless to take then), but rather in order to help my insulin better unlock my cells to dump the glucose in. If this is the case then would this be another way of saying that I may be insulin resistant? If so, then could it be conceivably better to take a more powerful "cell unlocker" that type 2's take?
    Thank you for taking the time to read this. Any comments are much appreciated.

  2. Shanny

    Hello, Sloan . . . I'm just going to offer greetings and then make room for Richard, who has much more knowledge & wisdom about type 1.
    Just know that we're all here to help & support each other & are glad to have you join our forum. Welcome aboard!

  3. sloan

    thanks shanny

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