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CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Insulin Stabilisation"Prof. Trisha Dunning (biography)
English - 2006-04-07 - 62 minutes
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Summary :
In this presentation Prof. Dunning discusses insulin action and the types of insulin available, factors concerning insulin use, education issues and commencing insulin in type 2 diabetes.
Insulin stabilisation needs to be maintained over time. In the context of diabetes this refers to replacing endogenous insulin in type 1 diabetes, augmenting endogenous insulin in type 2 diabetes, and rescue therapy in acute illness in type 1 and type 2 diabetes.
Insulin has a number of metabolic effects and there are various factors that affect its absorption. There are four main types of insulin available: rapid-acting, short-acting, intermediate-acting and long-acting insulins. These can be used in different regimens such as once a day insulin, twice a day, three times a day or a basal-bolus regimen. Insulin has some side effects, including hypoglycemia and weight gain. Also discussed are managing insulin, mixing insulins and administering insulin.
Insulin should be used to achieve blood glucose levels as close to the normal range as possible without causing too much hypoglycemia. Also, treatment goals and strategies to achieve the target range of blood glucose must be tailored to account for co-morbidities, the patient's fear of hypoglycemia and his/her ability to perceive and manage it.
Insulin regimens and doses need to be adjusted regularly to accommodate metabolic and lifestyle changes. It is important to watch the pattern of blood glucose levels (as well as the patient's activities and any intercurrent illnesses) over 2-3 days then pick out the problem areas, addressing hypoglycemia first. Education of the patient regarding insulin use also needs to be individualised.
Regarding insulin use in type 2 diabetes, the speaker discusses a few aspects such as what would be the purpose and criteria for commencing insulin treatment in these patients, how to manage glucose lowering agents when changing to insulin, and possible insulin regimes.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Insulin action and types of insulin
- Insulin regimens and administration
- Factors affecting insulin absorption
- Adjusting insulin doses
- Insulin-related fears
- Patient education about insulin
- Commencing insulin in type 2 diabetes
Bibliographic references :
H Ilkova, B Glaser, A Tunckale, N Bagriacik, and E Cerasi Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care, Vol 20, Issue 9 1353-1356.
Cavaghan, MK. The Beta Cell and First-Phase Insulin Secretion. Medscape Diabetes and Endocrinology, 2004 6(2): 1-5.
Dunning P., Martin M. Beliefs About Diabetes and Diabetic Complications. Professional Nurse, 1998 13(7): 429-434.
Gerich, J. Physiology and Pathophysiology of Postprandial Glucose Regulation. Medscape Diabetes and Endocrinology. 2004 6(2): 1-6.
Nathan, D. Initial Management of Glycemia in Type 2 Diabetes Mellitus New England Journal of Medicine. 2002 347(17): 1342-1349.
Olsson, P., Hans, A., Henning, V. Miscibility of Human Semisynthetic Regular and Lente Insulin and Human Biosynthetic Regular and NPH insulin. Diabetes Care. 1987 10(4): 473-477.
UK Prospective Diabetes Study Group. UK Prospective Diabetes Study (UKPDS) VIII. Study Design, Progress and Performance. Diabetologia. 1991 34(12): 877-890.
Zinman, B. Glucose Control in Type 1 Diabetes: From Conventional to Intensive Therapy. Clinical Cornerstone. 1998 1(3): 29-38.
UK Prospective Diabetes Study 7: Response of Fasting Plasma Glucose to Diet Therapy in Newly Presenting Type II Diabetic Patients Metabolism. 1990 39(9): 905-912
American Diabetes Association. Insulin Administration. Diabetes Care. 2004 27 (Supp): 106S – 107S
Boyages S., When and How to Start Insulin Therapy in Type 2 Diabetes. Medicine Today. September (Supp): 10-16
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003. Clinical Practice Guidelines For the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. 2003 27(2) (Supp): 128-140.
Rutherford, A., Wright, E., Hussaine, Z., Colagiuri, R. On Behalf of the DAWN Advisory Committee. DAWN: Diabetes Attitudes, Wishes and Needs, the Australian Experience. 2004
Zinman, B. Translating the Diabetes Control and Complications Trial (DCCT) Into Clinical Practice: Overcoming the Barriers. Diabetologia. 1997 40(Supp 2): S88 – S90.
Dunning T., Martin M., 1998 Type 2 Diabetes: Is It Serious? Journal of Diabetes Nursing 2(3): 70-76.
BOOKS:
Colwell, J. Diabetes – Hot Topics. Philadelphia: Hanley & Belfus. 2003. ISBN 1560535628
Davidson, M. Diabetes Mellitus Diagnosis and Treatment. 4th ed. Philadelphia: W.B. Saunders Company. 1998. ISBN 0721664032
Klingensmith, GJ. Intensive Diabetes Management, 3rd ed. Virginia: American Diabetes Association. 2003. ISBN 1580401643
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