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Challenges in insulin therapy in diabetic patients.

Dr Stanley Ngare. Challenges in insulin therapy in diabetic patients. 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

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Challenges in insulin therapy in diabetic patients.

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  1. Dr Stanley Ngare Challenges in insulin therapy in diabetic patients.

  2. 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.

  3. 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

  4. Classification of Insulin • Rapid acting Analogues (insulin like) • Short acting /soluble/ regular • Intermediate acting • Isophane (NPH- Neutral ProtamineHegadorn) • Long acting (Analogues) • Glargine • Detemir

  5. Fears in Initiating Insulin • Single most important “ medical” barrier to glycaemia : • HYPOGLYCEMIA • Single most important “ Patient &provider barrier” to glycaemia: PSYCHOLOGICAL “ INSULIN RESISTANCE”

  6. Indications for Insulin use • All people with Type 1 Diabetes • Many Type 2 Diabetic patients • Pregnancy • Inpatient care

  7. 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

  8. THANK YOU • Appreciation Mr Michael Brown -CDE

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