Overview of Insulin Therapy in Diabetes

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Dr Stanley Ngare
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Pharmacology of Types of insulin available
Various routes of delivery & factors that
affect absorption
Patient and provider barriers
Treatment should be individualised
Challenges in monitoring blood glucose
Complications of insulin therapy.
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Pre 1922- Type 1 DM:
Was an acute terminal illness
Insulin changed this:
Saved lives = chronic illness
Now:
Helps achieve glycemic control hence delay or
prevent microvascular complications
?prevent macrovascular complications
Rapid acting Analogues (insulin like)
Short acting /soluble/ regular
Intermediate acting
1.
2.
3.
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Isophane (NPH- Neutral Protamine Hegadorn)
Long acting (Analogues)
4.
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Glargine
Detemir
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Single most important “ medical” barrier to
glycaemia :
▪HYPOGLYCEMIA
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Single most important “ Patient &provider
barrier” to glycaemia:
PSYCHOLOGICAL “ INSULIN RESISTANCE”
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All people with Type 1 Diabetes
Many Type 2 Diabetic patients
Pregnancy
Inpatient care
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Calculate the TDD
• Type 1 (0.6) UI kg/day
• Type 0.2-0.3UI kg/day
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Some conditions may require higher or less
doses e.g obesity, puberty, hypoglycemia
unawareness.
Progressive adjust insulin to target
SMBG ( Glucometer)
• Essential tool
Appreciation
Mr Michael Brown -CDE
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