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Why Insulin For Type 2 Diabetes

Review Use Of Insulin In Type 2 Diabetes: What We Learned From Recent Clinical Trials On The Benefits Of Early Insulin Initiation

Review Use Of Insulin In Type 2 Diabetes: What We Learned From Recent Clinical Trials On The Benefits Of Early Insulin Initiation

1. Introduction Since the development of insulin therapy in the early 20th century, insulin has been a key component of diabetes management, with the majority of people with type 2 diabetes mellitus (T2DM) requiring insulin therapy to maintain HbA1c levels < 7% within nine years of diagnosis [1,2]. This glycaemic target (HbA1c < 7%) is recommended by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) in their consensus statement on the management of hyperglycaemia, which also emphasizes the need for a patient-centred approach to diabetes management [3]. The management strategy outlined by these guidelines reduces the incidence of microvascular disease, but does not reduce the risk of macrovascular disease to the same extent [4,5]. Therefore, at present a key unmet need for patients with T2DM is the prevention of cardiovascular (CV) disease, the major cause of mortality in those with T2DM, with the risk of heart disease-related death being two to four times higher in people with diabetes [6]. Indeed, T2DM is a CV risk factor comparable to previous myocardial infarction (MI) in people without diabetes aged 30 years or older [7]. T2DM develops over a number of years, with changes in glucose levels, insulin sensitivity and insulin secretion happening 3–6 years before diagnosis and a deficit in β-cell capacity up to 12 years before diagnosis [8–10]. Initial insulin resistance is accompanied by a deficit in early-phase insulin secretion as a result of loss of β-cell mass [11–14]. This results in mild hyperglycaemia, which is termed ‘impaired glucose tolerance’ (IGT) [15], and defined as fasting plasma glucose (FPG) < 7.0 mmol/L and postprandial plasma glucose (PPG) 7.8–11.1 mmol/L following a 75-g oral glucose chall Continue reading >>

So Which Is It, With Type 2 Diabetes? Do You Make Too Much Insulin Or Not Enough?

So Which Is It, With Type 2 Diabetes? Do You Make Too Much Insulin Or Not Enough?

When you have Type 2 diabetes and you have been told that you have it because your pancreas either fails to make enough insulin or that the insulin that it makes is not able to be used properly (that’s a mouthful), have you ever thought to yourself, “Huh?” Has this information been filed away in the part of your brain labeled, “Information I don’t understand and sounds too confusing to learn,” just waiting to be purged when possible? Whenever I hear a patient being told this I often wonder if they’re going to ask, “Well, which is it, do I make too much insulin or not enough, and why does this happen?” I think if I had diabetes I would want to know. Let me see if I can explain it here. I will start off by reminding you that it takes approximately 10 years to go from completely normal to actually having diabetes. I am sure this varies somewhat from person to person, however on average it takes 10 years. After you eat a meal that has sugar in it, the sugar will enter the blood stream. In response to sugar entering the blood the beta cells, located throughout the pancreas, start making insulin. Typically, the greater the amount of sugar that enters the blood, the greater the amount of insulin produced by the beta cells in the pancreas. At least, this is the way it is supposed to work. The insulin produced in the beta cells then enters the blood stream and looks for some sugar. Once it finds a sugar molecule it swims over and grabs a hold of it. (A little-known fact is that insulin only has one arm, so it can only grab ahold of one sugar.) The insulin then takes the sugar out of the blood vessel and over to a muscle, fat or liver cell. Once close to the cell the insulin starts heading over to one of the cell’s many doors. The insulin then opens the door t 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 >>

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 For Type 2 Diabetes

Insulin For Type 2 Diabetes

Considering insulin? What you should know. By the dLife Editors Many people with type 2 diabetes will eventually require insulin to keep their diabetes in control. In fact, most experts believe we wait too long in the progression of type 2 diabetes before starting people on insulin. Progressing to insulin does not mean you are failing, but just that your body needs a little more help to keep your blood sugar in range. How much insulin you need, and when you take it, depends on several factors: the type of insulin your doctor has prescribed, your nutrition and exercise habits, and other co-existing medical conditions, and medications you may be taking. Types of Insulin Insulin can be divided into three main categories. The first is long-acting, also known as basal or background insulin. It is usually given once (or sometimes twice) daily, and is intended to help control blood sugar over a twenty-four-hour period. The second category is shorter-acting insulins. These are used to help control blood sugar spikes after eating, and also to “correct” an unusually high blood sugar reading. Depending on the type, they start to work within fifteen to thirty minutes, and last for three to six hours. Many people with type 2 diabetes do well with just a long-acting insulin combined with oral medicines, while others will need to add a mealtime dose of shorter-acting insulin to control after-meal blood sugar spikes. The third category is made up of combinations of long- and shorter-acting insulin. These insulin mixtures are usually given twice daily. The long-acting insulins now approved for use in the United States are Lantus, Levemir, Toujeo, Tresiba, and Basaglar. Novolin N and Humulin N are older forms of insulin that are not as long-acting as the newer ones, and their activit Continue reading >>

Insulin For Type 1 And Type 2 Diabetes

Insulin For Type 1 And Type 2 Diabetes

Examples The different types of insulin are categorized according to how fast they start to work (onset) and how long they continue to work (duration). The types now available include rapid-, short-, intermediate-, and long-acting insulin. Rapid-acting Generic Name Brand Name insulin aspart NovoLog insulin glulisine Apidra insulin human (inhalation powder) Afrezza insulin lispro Humalog Short-acting Intermediate-acting Long-acting Generic Name Brand Name insulin detemir Levemir insulin glargine Lantus Mixtures Generic Name Brand Name 70% NPH and 30% regular Humulin 70/30, Novolin 70/30 50% lispro protamine and 50% lispro Humalog Mix 50/50 75% lispro protamine and 25% lispro Humalog Mix 75/25 70% aspart protamine and 30% aspart NovoLog Mix 70/30 50% NPH and 50% regular Humulin 50/50 Packaging Injectable insulin is packaged in small glass vials (bottles) and cartridges that hold more than one dose and are sealed with rubber lids. The cartridges are used in pen-shaped devices called insulin pens. Inhaled insulin is a powder that is packaged in a cartridge. Cartridges hold certain dosages of insulin, and more than one cartridge might be needed to take enough insulin. How insulin is taken Insulin usually is given as an injection into the tissues under the skin (subcutaneous). It can also be given through an insulin pump, an insulin pen, or jet injector, a device that sprays the medicine into the skin. Some insulins can be given through a vein (only in a hospital). Powdered insulin is packaged in a cartridge, which fits into an inhaler. Using the inhaler, a person breathes in to take the insulin. How It Works Insulin lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, the blood sugar level rises above what is safe for the body. If the Continue reading >>

“do I Need Insulin For My Type 2 Diabetes?”

“do I Need Insulin For My Type 2 Diabetes?”

After a type 2 diabetes diagnosis, there are four treatment options that you can discuss with your doctor: Diet & Exercise: Learning how to reduce the carbohydrates and overall calories in your diet along with regular exercise for weight loss. Losing weight helps improve insulin sensitivity (gaining weight promotes insulin resistance). For some people with type 2 diabetes, these changes can be enough to achieve healthier blood sugar levels. Oral Medications: There are a variety of oral medications (pills) for improving blood sugars in people with type 2 diabetes. They each are classified by their make-up and the impact on the body. While some pills increase natural insulin production, other pills are designed to decrease the amount of glycogen (which is eventually converted to glucose) secreted by your liver. The 6 primary classifications of pills are, Sulfonylureas, Meglitinides, Biguanides, Thiazolidinediones, Alpha-glucosidase inhibitors, and DPP-4 inhibitors. You may know some of the brand names, like Metformin, Avandia, or Januvia. Your diabetes healthcare team will help you determine the best fit for you. Injectable Medications: Known well as “Byetta” or “Symlin,” these medications are injected, but are very different than insulin. Symlin is known for helping with reducing blood sugars but also for promoting weight loss. Byetta works by increasing your own natural insulin production. Insulin: Lastly, there is insulin, which is administered with a syringe, pen, or pump. While most doctors will take you through the options above before prescribing insulin, this option might be exactly what you need. Insulin is the most powerful hormone in the body for regulating blood sugars, and as a person with type 2 diabetes, you either don’t produce enough to meet you Continue reading >>

Why Insulin Can Become Necessary For A Person With Type 2 Diabetes

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 >>

Do You Worry About Getting Insulin Shots For Type 2 Diabetes?

Do You Worry About Getting Insulin Shots For Type 2 Diabetes?

When your doctor says you have type 2 diabetes, you may worry about getting shots of insulin to control the disease. But that’s seldom the first step, and some people don’t need insulin for years — or ever. When you have type 2 diabetes, your body doesn’t make enough insulin, as the body is unable to use it properly. Without insulin, blood glucose (sugar) levels rise. High blood glucose levels can damage your organs, including blood vessels, nerves, kidneys and eyes. But with lifestyle changes and medications, many people are staying healthier longer with type 2 diabetes. Endocrinologist Richard Shewbridge, MD, says there is lot you can do to live well with diabetes. What’s behind type 2 diabetes? Type 2 diabetes develops because the body becomes resistant to insulin. Insulin is a hormone made by the pancreas to turn blood sugar into energy. “Type 2 diabetes means the process to turn food into energy isn’t working as well,” says Dr. Shewbridge. Poor choices in diet and lack of exercise work to worsen insulin resistance, he says. And genetics can play a role, too. Additionally, people with type 2 diabetes tend to make less and less insulin over time and that causes a rise in blood sugar after meals. The role of eating right and exercising Many people with type 2 diabetes aren’t put on medication right away. Your doctor will likely suggest changes in your eating and exercise habits first. “Once someone is put on medication, they may need it for the rest of their life. But, they also can treat diabetes with a healthy lifestyle and exercise,” says Dr. Shewbridge. Healthier eating habits are a good place to start. “Cut out simple sugars. Eat less starchy bread, pasta, noodles and cereal. These foods don’t necessarily taste sweet, but they break down Continue reading >>

Patient Education: Diabetes Mellitus Type 2: Insulin Treatment (beyond The Basics)

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 >>

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 >>

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 >>

Insulin Therapy For Type 2 Diabetes 'may Do More Harm Than Good'

Insulin Therapy For Type 2 Diabetes 'may Do More Harm Than Good'

A new study published in the journal JAMA Internal Medicine suggests that for older patients with type 2 diabetes, medications to lower blood sugar levels may "do more harm than good." Approximately 25.8 million people in the US have diabetes, with type 2 diabetes accounting for 90-95% of all cases. Type 2 diabetes is characterized by insulin resistance - the inability of the body to produce enough insulin or use the hormone effectively, which causes high blood sugar levels. Over time, high blood sugar levels can cause kidney, eye or heart diseases, nerve damage or stroke. Diagnosis of type 2 diabetes is usually determined through a blood test that measures hemoglobin A1c levels in the blood. This test reveals the average level of glucose the patient has had in their blood over the past 3 months. In the US, type 2 diabetes is diagnosed when hemoglobin A1c levels reach 6.5% or higher. The higher A1c levels are, the greater the risk of other health problems. Sometimes the condition can be managed through changes in diet, but other patients with type 2 diabetes may need medication - such as insulin or metformin - to help lower their blood sugar levels, and ultimately, reduce the risk of diabetes complications. But the researchers of this latest study, from University College London (UCL) in the UK, the University of Michigan Medical School and the Ann Arbor Veterans Affairs Hospital, MI, claim that the benefits of such treatment - particularly for people over the age of 50 - may not always outweigh the negatives. "In many cases, insulin treatment may not do anything to add to the person's quality life expectancy," says study co-author John S. Yudkin, emeritus professor of medicine at UCL. "If people feel that insulin therapy reduces their quality of life by anything more t Continue reading >>

Type 2 Diabetes Faqs

Type 2 Diabetes Faqs

Common questions about type 2 diabetes: How do you treat type 2 diabetes? When you have type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin. Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. “Diet and exercise“ is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels. If you cannot normalize or control the blood sugars with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection. Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the blood stream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin in the circulation. Don’t be surprised if you have to use multiple medications to control the blood sugar. Multiple medications, also known as combination therapy is common in the treatment of diabetes! If one medication is not enough, you medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy. Many people with type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problem Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

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