Free Health Dissertations - Some Patients Also Mistakenly Believe That Insulin Intensifies Insulin
Some patients also mistakenly believe that insulin intensifies insulin resistance (Kuritzky and Nelson 2004, S11). Others claim considerations of weight gain outweigh their desire for tight glucose control (Anon 2005).
Physicians and caregivers more often cite hypoglycemia, obesity, and patients lack of coping skills as reasons to delay insulin initiation. Davies (2004, S16) found concerns about causing hypoglycemic episodes or increasing patients’ obesity means that physicians may permit poor control to continue unduly by delaying the initiation or intensification of insulin therapy and regard insulin as treatment of last resort.Instead, Kuritzky and Nelson (2004, S11) recommend patients should be taught that insulin therapy is appropriate at any time during the course of diabetes to achieve glycemic goals.
Finally, those diabetics on insulin therapy are often on less than optimal dosages. Mayfield and White (2004, 489) conclude from their study of Type 2 diabetics that statistics suggest that suboptimal insulin therapy is too common. Nearly thirty percent of Type 2 diabetics use insulin therapy, but less than one half achieve the recommended A1C level of 7 percent or less because even physicians who are willing to intiate insulin therapy are hesitant to aggressively use insulin (Mayfield and White 2004, 489).
REFERENCES
Anon 2005. The Role of Basal Insulin in Type 2 Diabetes Management. Supplement to The Journal of Family Practice, October 2005, 2-8.
Cefalu, W. 2004. Evolving Strategies for Insulin Delivery and Therapy. Drugs 2004, 64(11): 1149-1161.
Davies, M. 2004. The reality of glycaemic control in insulin treated diabetes: defining the clinical challenges. International Journal of Obesity, 28(Suppl 2): S14S22.
Funnell, M. and Kruger, D. 2004. Type 2 Diabetes: Treat to Target. The Nurse Practitioner , January 2004, 29(1):11-23.
Kuritzky, L. and Nelson, S. 2004. Insulin therapy in primary care: Practical issues for clinicians. Supplement to The Journal of Family Practice, June 2005, S10-S11.
Mayfield, J. and White, R. 2004. Insulin Therapy for Type 2 Diabetes: Rescue, Augmentation, and Replacement of Beta-Cell Function.American Family Physician, August 1, 2004, 70(3): 489-500.
RIZVI, A. 2004. TYPE 2 DIABETES: EPIDEMIOLOGIC TRENDS,EVOLVING PATHOGENIC CONCEPTS, AND RECENT CHANGES IN THERAPEUTIC APPROACH. SOUTHERN MEDICAL JOURNAL, NOVEMBER 2004, 97(11): 1079-1087.
Stratton et al 2000. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes. British Medical Journal, 321: 405412.
UKPDS 1998. UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998, 352: 837-853.
