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Challenges in insulin therapy in diabetic patients. Dr Stanley Ngare

Challenges in insulin therapy in diabetic patients

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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 - PowerPoint PPT Presentation

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Page 1: Challenges in insulin therapy in diabetic patients

Challenges in insulin therapy in diabetic patients.

Dr Stanley Ngare

Page 2: 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 Challenges in monitoring blood

glucose Complications of insulin therapy.

Page 3: Challenges in insulin therapy in diabetic patients
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Page 5: Challenges in insulin therapy in diabetic patients
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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

Page 8: Challenges in insulin therapy in diabetic patients
Page 9: Challenges in insulin therapy in diabetic patients

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

Page 10: Challenges in insulin therapy in diabetic patients
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Fears in Initiating Insulin

Single most important “ medical” barrier to glycaemia :

▪HYPOGLYCEMIA Single most important “ Patient

&provider barrier” to glycaemia:PSYCHOLOGICAL “ INSULIN

RESISTANCE”

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Page 14: Challenges in insulin therapy in diabetic patients

Indications for Insulin use

All people with Type 1 Diabetes Many Type 2 Diabetic patients Pregnancy Inpatient care

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Page 20: Challenges in insulin therapy in diabetic patients

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

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Page 22: Challenges in insulin therapy in diabetic patients

THANK YOU

AppreciationMr Michael Brown -CDE