| Management |
| |
| Insulin Initiation – Will Make A Way |
Dr. Sailesh Lodha, DM, Jaipur.
|
| |
| Insulin is a potent anabolic peptide hormone having varied effects on carbohydrate, protein and fat metabolism. |
| |
| Its use in Type-1 diabetes is unambiguously clear. Insulin therapy in Type-2 diabetes has improved the quality of life of those patients. |
| |
| It has now become a very important tool for physicians who earlier had difficulty in treating a subset of Type-2 Diabetes with high doses of oral hypoglycemic agents. |
| |
| Insulin initiation at the right time without delay carries a number of benefits with it. But we all realize in practice that this is often more easily said than done. |
| |
| Patients are willing to take 25-30 mg Glibenclamide with 1.5-2.0 gm of Metformin only to resist insulin. Majority of such patients when explained properly would not delay insulin therapy. |
| |
| The misinformed always know too much! Being a medical professional doesn’t make one immune to the insulin slander campaign. |
| |
| In our society where qualified physicians and Endocrinologists are scarce, this becomes more relevant. |
| |
| It is the duty of the treating physician to clear the doubts regarding Insulin to the patients as well as the paramedics. |
| |
| Is there any contraindication to insulin therapy? OBVIOUSLY NO. |
| |
| Indications of insulin-in Type 2 DM |
|
|
- Acute stressful situations –
Stroke, MI, Infections
|
|
|
- Very high blood glucose with marked symptoms.
|
- Acute complications –
DKA hyperosmolar states.
|
|
|
|
| Benefits of Insulin – |
| |
- More physiologic mode of therapy
- It has a predictable action.
- Insulin is an anabolic hormone hence it counters the effect of catabolic hormones.
- This may provide a feeling of well being to the user (an effect that is independent of its glucose lowering effect.)
- Lesser cardiovascular complications, proven by DIGAMI study, which showed the beneficial effects of insulin when used as infusion in myocardial infarction and in post MI period. It improved long term survival, an absolute reduction in morality of 11%.
- It is now clear that exogenous insulin in son atherogenic.
- No hepatonephrotoxicity.
- Hardly any drug interactions
- Improves platelet function and lipoprotein profile
- Lesser arrhythmias and regional wall motion abnormalities (RWMA)
|
| Sometimes it is possible to restart oral hypoglycemics if insulin is used for a brief interval in sulphonyluria failure. |
| |
| Despite of the colossal benefits of insulin, doctors may unwittingly transfer some of their anxieties, worries and misinformation about diabetes therapy to the patients, which may influence their decision to initiate insulin. |
| |
| Tips for successful initiation of Insulin – |
| |
- Discuss about insulin option on routine visits. Inform the patient on routine visits when the patient is well controlled on OHA so that in future whenever there is a need of insulin the patient doesn’t get a bolt from the blue.
- Demonstration of pens and other devices from time to time.
- Group discussions.
- Injection with closed eyes is certainly less painful.
- First injection should be with the smallest gauge needle and with the convenient delivery devices.
- Never ask the patient to buy insulin and get injected from a paramedical. You must actually teach each patient. Dependence on others and wrong techniques are a major cause for refusing insulin.
- Every patient must be told the benefits of tight control, hypoglycemia management, management of insulin during travel.
- If a child who has Type 1 diabetes demonstrates to a group of older people how to inject Insulin, that leaves a remarkable effect.
- Glorify insulin if required by naming a few prominent public figures who are on Insulin.
- Hence a positive optimistic view, greater awareness and proper education is the only key to success in diabetes.
|
| |
|
