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adding insulin in type 2 diabetes

Posted by: felicians on 10/12/2015 9:37 AM

After some time of treating type 2 diabetes with oral medication it is quite common to see that glucose levels and glycosylated hemoglobin (HbA1C) levels are stubbornly high. Causes are multiple (from patient compliance to lower insulin levels from pancreas) and if the pancreatic insulin secretion and reserve function is low, then adding oral meds will not normalize labs nor restore patient's physiological status.
Some newly diagnosed type 2 patients require insulin very soon after diagnosis and starting oral meds due to the fact that their insulin-resistant state was detected late, after years in which the pancreas was over-secreting insulin to compensate for insulin resistance.
How do we decide on adding insulin? Taking an insulin level alongside with glucose levels is enough to have a clinically useful estimate on the exogenous need for insulin (insulin is added if its levels are inadequate in relation to glucose levels); the drawback being that this lab cannot be done at many sites and it does not offer information on the dynamic of insulin secretion. Both these inconvenients can be successfully addressed by using an OGTT test (oral glucose tolerance) and a simple estimate (GMI - Glucose Metabolic Index) calculated with the three values from this test (fasting, 1 and 2 hrs). GMI = F + 2xH1 + H2
Details are in the article below:
http://article.aascit.org/file/html/9720735.html

Topic: Example Topic 1