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Challenges in insulin therapy in diabetic patients.
Dr Stanley Ngare
Its important to understand:
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.
Impact of Insulin
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
Classification of Insulin
1. Rapid acting Analogues (insulin like)2. Short acting /soluble/ regular 3. Intermediate acting
Isophane (NPH- Neutral Protamine Hegadorn)
4. Long acting (Analogues) Glargine Detemir
Fears in Initiating Insulin
Single most important “ medical” barrier to glycaemia :
▪HYPOGLYCEMIA Single most important “ Patient
&provider barrier” to glycaemia:PSYCHOLOGICAL “ INSULIN
RESISTANCE”
Indications for Insulin use
All people with Type 1 Diabetes Many Type 2 Diabetic patients Pregnancy Inpatient care
Dosing of Insulin
Calculate the TDD • Type 1 (0.6) UI kg/day• Type 0.2-0.3UI kg/day
Some conditions may require higher or less doses e.g obesity, puberty, hypoglycemia unawareness.
Progressive adjust insulin to target SMBG ( Glucometer)• Essential tool
THANK YOU
AppreciationMr Michael Brown -CDE