Scribd is the worlds largest social reading and publishing site. Type 2 diabetes mellitus is the most common form of the disease, affecting up to 95% of patientsan estimated 15 million americans. Comparison of metformin and insulin versus insulin alone. The treattotarget clinical trials established that the addition of basal insulin to existing oral glucoselowering therapy achieves good glycemic control in the majority of patients with type 2 diabetes 27 29. A dose of 4 units or 10% of the amount of basal insulin. Type 2 diabetes mellitus t2dm is a global epidemic and is expected to affect over 592 million people worldwide by 2035, a dramatic. Type 1 diabetes, a chronic autoimmune disease, causes destruction of insulinproducing. Ppt insulin therapy powerpoint presentation free to. Diabetes mellitus powerpoint presentation free to download id.
Insulin therapy of type 2 diabetes ppt download slideplayer. Intensive insulin therapy in type 2 diabetes patients. This was prompted by recent new evidence on the use of insulin in such people. Physicians in insulin therapy gapptm, conducted speci. Patients with type 1 diabetes, of course, need insulin immediately after diagnosis. B ecause type 2 diabetes is a progressive disease, its natural course requires initiation of insulin in a significant proportion of patients, especially when oral agents fail to achieve glycemic. A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications 1,2. The introduction of insulin in type 2 diabetes mellitus racgp.
Individualizing insulin therapy in the management of type. Insulin is the primary treatment in all patients with type 1. Free download diabetes mellitus powerpoint presentation slides. The discovery of insulin by frederick banting, charles. Type 2 diabetes is a progressive disease characterized by insulin resistance and progressive. Improving care and promoting health in populations. Initiating basal insulin therapy in type 2 diabetes. Insulin is the primary treatment in all patients with type 1 diabetes mellitus t1dm a. An exception is patients with latent autoimmune diabetes of the adult lada, whose glucose can be controlled on noninsulin medications for a while, although for a much shorter period than for patients with type 2 diabetes. Typically, patients with t1dm will require initiation with multiple daily injections at the time of diagnosis. The hormone insulin plays a major role in transferring. Insulin therapy for type 2 diabetes and how doctors help.
Treating type 2 diabetes involves dietary modification i. In selecting initial therapy, we consider patient presentation eg. Rapid acting insulin analogs insulin aspart, insulin lyspro, insulin glulisine which have an onset of action of 5 to 15 minutes, peak effect in 1 to 2 hours and duration of action that lasts 46 hours. Shortterm intensive insulin therapy in type 2 diabetes. Deterioration of beta cells over time increasing prevalence with increasing risk factors, eg, obesity hyperglycemia affects morbidity, mortality, and resources tight glycemic control with insulin may reduce costly complications. Are overweight are noncaucasian have a family history of type 2.
In the space of a few months in 1921, an acute and terminal diseasetype 1 diabetesbecame a manageable chronic condition. The group was aware of evidence that the benefits of insulin therapy are still. If you are measuring your body weight in kilograms. Type 2 diabetes most people with diabetes have type 2 most people are over age 40 when diagnosed, but type 2 is becoming more common younger adults, children and teens type 2 is more likely in people who. Although insulin therapy has traditionally been regarded as the last option in the stepwise treatment of type 2 diabetes mellitus, it should be noted that the current adaeasd position statement for the management of diabetes recommends consideration of insulin as part of a firstline combination regimen. Ppt diabetes mellitus powerpoint presentation free to.
Insulin therapy in type 2 diabetes combination oral agents plus basal insulin bbedtimeedtime nphnph glargine detemir insulin therapy conventional approach splitmixed nph plus. Use of insulin therapy in managing type 2 diabetes mellitus. Continuous insulin infusion pump therapy in patients with type 2 diabetes can be considered in those with severe insulin resistance and poor control. Typically, whereas introducing insulin therapy in a more timely fashion would significantly improve glycemic control among. Earlier initiation of insulin treatment in type 2 diabetes mellitus powerpoint ppt presentation. An estimated 382 million people are living with diabetes, half of whom are undiagnosed. Insulin therapy for type 2 diabetes mellitus clinical. With all doses, large and small, the onset of action and the time to peak effect is similar, the duration of insulin action is, however.
Therapy of type 2 diabetes mellitus, update, part 1. Insulin is a common treatment option for many patients with type 2 diabetes, and is generally used late in the natural history of the disease. Insulin is synthesized on the ribosomes of the rough endoplasmic reticulum rer as a single amino acid chain precursor molecule called preproinsulin. Deterioration of beta cells over time increasing prevalence with increasing risk. Data sources included pubmed for trials and investigations in type 2 diabetes examining insulin use from january 1998 to april 2014. Insulin therapy for type 2 diabetes pubmed central pmc. D, a 48yearold africanamerican man who was diagnosed with type 2 diabetes t2dm 4. Its injectable delivery mode, propensity for weight gain and. Excessive weight gain worsens glycaemic control and increases cardiovascular risk. Type 1 sometimes type 2 type 2 dm patient with persistent elevated fpg leves 200 300mgdl or ketonuria or ketonemia fpg.
A practical approach for primary care physicians and other health care professionals james r. Heart failure risk is significantly increased in diabetes mellitus. Patients with type 2 diabetes and insulin resistance may require high insulin doses to control hyperglycaemia. Heart failure in type 2 diabetes mellitus circulation. Unfortunately, current insulin replacement therapy can only approximate normal insulin levels.
Given the continued interest in defining the optimal management of individuals with type 2 diabetes, the editor of diabetes care convened a working party of diabetes specialists to examine this topic in the context of insulin therapy. Therapy of type 2 diabetes mellitus, update, part 3. Multiple insulin injection therapy diabetes mellitus. Sometimes, people with type 2 diabetes or gestational diabetes need insulin. Over the past 20 years, during which increasing attention in the field of type 2 diabetes mellitus t2dm has focused on atherosclerotic complications, heart failure hf has emerged as another serious complication occurring significantly more frequently in people with t2dm. Adjust only 1 insulin dose at a time correct hypoglycemia 1st. Insulin therapy for type 2 diabetes diabetes is a condition in which your pancreas fails to secrete a sufficient amount of insulin to help you maintain normal blood glucose, or sugar in the blood, which is transported to various parts of the body to supply energy. Pdf practical guide to insulin therapy in type 2 diabetes. The preferred regimen for insulin initiation in type 2 diabetes is oncedaily basal insulin. Ppt earlier initiation of insulin treatment in type 2 diabetes. Initial management of blood glucose in adults with type 2 diabetes. According to the adaeasd algorithm for the management of type 2 diabetes, insulin could be initiated with either oncedaily nph insulin or a longacting.
Many individuals with type 2 diabetes require doses of insulin before meals, in addition to basal insulin, to reach glycemic targets. Indication for insulin therapy in type 2 diabetes acute metabolic complications acute illness severe infection pregnancy and lactation fasting plasma glucose 300 mgdl failure of oral antidiabetic agent dr. Prevention and treatment of type 2 diabetes involves maintaining a healthy diet, regular physical. Insulin therapy in type 2 diabetes combination oral agents plus basal insulin bbedtimeedtime nphnph glargine detemir insulin therapy conventional approach splitmixed nph plus regular insulin mdi multidose insulin protocols basalbolus insulin therapy basal insulin therapybasal insulin therapy concept and. Type 2 diabetes t2d, formerly known as adultonset diabetes, is a form of diabetes that is characterized by high blood sugar, insulin resistance, and relative. This chart is a quick summary of recommended treatment course for patients across various bmi categories. Hypoglycemia risk is very low among type 2 diabetic patients just starting insulin therapy, making nph insulin the most costeffective drug. Edelman md 1 2 1 section of diabetes metabolism, va san diego healthcare system 2 and the department of medicine, university of california at san diego, san diego, california address reprint requests to dr.
Insulin therapy in type 2 diabetes chou chienwen md. How to use adas type 2 diabetes treatment algorithm. Current and future directions powerpoint presentation free to download id. Therapy of type 2 diabetes mellitus, update, part 2. Five simple steps to optimize bolus insulin therapy in type 2. Type 2 dm most common type comprises 90 to 95% of dm cases most type 2 dm patients are overweight, and most are diagnosed as adults. When you have type 1 diabetes, your pancreas doesnt make insulin, a hormone that moves sugar glucose from your bloodstream into your cells.
Metformin is a glucose lowering drug that, among other mechanisms, is supposed to work by enhancing insulin action mainly in the liver. Calculating insulin dose diabetes education online. A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin a. Intensification of insulin therapy in type 2 diabetes. Its injectable delivery mode, propensity for weight gain and hypoglycaemia, and the paucity of trials assessing the risktosafety ratio of early insulin use are major shortcomings associated with its use in patients with type 2 diabetes. Consensus on insulin treatment in type 2 diabetes endocrinologia. In this presentation, we will give an overview of the evidence on the various insulin regimens commonly used to treat type 2 diabetes. Heart failure considerations of antihyperglycemic medications. Ongoing controversy surrounding the mets, in terms of its predictive value for particular diseases, is a consequence of the failure of metabolic scientists and clinicians to establish. Insulin resistance and insulin hypersecretion in the. Beta cells in the pancreas generate insulin and pancreas is the organ in the body which produces the insulin. Current and future directions issues in the management of type 2 diabetes type 2. Treatment of patients with type 2 diabetes mellitus includes education.
The converted glucose is transferred to the blood and is availed by the cells for energy. Management of type 2 dm 2009 recommending earlier use of insulin therapy in pa ti en ts wit h s ub o pt im al gl yc em ic co nt ro l e ith e r at p res en ta ti on or wi th f ai lu re of or al. The hormone insulin plays a major role in transferring glucose from the blood to the cells. Insulin therapy in type 2 diabetes sunder mudaliar md 1 2 steven v. Lasalle, do rachele berria, md, phd the responsibility of diabetes management and insulin therapy has definitively moved to primary care physicians. If you have type 1 diabetes, insulin therapy is vital for replacing the insulin your body doesnt produce. Although many markers of the autoimmune process have been. Comparison of metformin and insulin versus insulin alone for. Insulin therapy is essential and lifesaving in individuals with type 1 diabetes and beneficial for those with type 2 diabetes who fail to achieve optimal glycaemic targets with other. Longacting insulin analogues versus nph human insulin in type 2 diabetes. S03 knowledge and attitudes of certified diabetes educators regarding genetic testing for type 2 diabetes mellitus. This is usually shortacting insulin or rapidacting insulin analogue. A dose of 4 units or 10% of the amount of basal insulin at the largest meal or the meal with the greatest postprandial excursion is a safe estimate for initiating therapy. Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial a1c level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy.
Approximately half of the patients are unaware of their disease 22. Other considerations american diabetes association. Insulin therapy for type 2 diabetes patients dr shahjadaselim1. D, a 48yearold africanamerican man who was diagnosed with type 2 diabetes t2dm 4 years ago, presented to his clinician for a routine followup visit. Transplantation of insulin producing cells ipcs was once thought to be the most promising strategy for treating diabetes, but the pace from the laboratory to clinical application has been obstructed due to. The conventional method adopted for the control of type 2 diabetes is an insulin therapy, which injects insulin into patients via analogue instruments such as insulin pens, pump, u500, or u100. The introduction of insulin in type 2 diabetes mellitus. In addition to timely initiation, rapid titration of the dose is indispensable for successful insulin therapy. New forms of insulin and insulin therapies for the treatment. To view this presentation, youll need to allow flash.
Basal insulins try to simulate the basal pattern to maintain patients close to normal fasting blood glucose levels. Indication for insulin therapy in type 2 diabetes acute metabolic complications acute illness severe. Weight gain is common with insulin therapy in type 1 and type 2 diabetes. The majority of these patients will require insulin replacement therapy as their disease progresses.
Edelman, md va san diego healthcare system mail code. Insulin therapy for type 1 diabetes requires multiple injections or using an insulin pump continuous subcutaneous insulin infusion csii. For the majority with type 2 diabetes mellitus t2dm, insulin therapy will be required to maintain optimal glycaemic control over time. Presentation slides american association of diabetes. Human insulin insulin is a 51amino acid peptide hormone comprising two polypeptide chains, the a and b chains,which are linked by disulphide bridge. New forms of insulin and insulin therapies for the. Type 1 diabetes must be managed with insulin injections. The ultimate goal of insulin therapy is to mimic normal insulin levels.
Mesenchymal stem cell therapy in type 2 diabetes mellitus. Obesity management for the treatment of type 2 diabetes. For these reasons, some diabetes experts advocate the initiation of insulin therapy earlier in the course of type 2 diabetes than has been common in the past. A free powerpoint ppt presentation displayed as a flash slide show on id. It can also increase diabetic morbidity and mortality if it acts as a psychological barrier to initiation or intensification of insulin therapy, or affects compliance. Insulin therapy of type 2 diabetes presentation transcript.
May 15, 2017 type 2 diabetes mellitus t2dm, which is characterized by the combination of relative insulin deficiency and insulin resistance, cannot be reversed with existing therapeutic strategies. Insulin therapy for people with type 2 diabetes should only be initiated and managed by healthcare professionals with the relevant expertise and training. The addition of glucagonlike peptide1 receptor agonists glp1 ras to basal. The benefits and risks of insulin therapy should be discussed with the person so that they can make an informed choice.90 1144 571 757 1005 1363 577 327 43 717 1090 438 22 1070 366 1002 296 1176 117 1207 457 1540 1216 1427 1417 1217 969 1547 927 1187 1469 529 893 331 1319 1087 151 1041