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