In general, all of them diabetics can use insulin. The choice of treatment depends on the type diabetes melitus they represent.
For patients with diabetes mellitus type 1 insulin therapy It is necessary to replace the insulin that is produced in minimal or no amount by the patient’s pancreas.
On the other hand, patients with type 2 diabetes mellitus they may also need insulin as part of your treatment plan adjunctively if target blood glucose levels cannot be achieved with oral therapy.
Likewise, therapy with insulin It benefits patients with gestational diabetes, which can affect 3-10% of pregnancies, and patients with latent autoimmune diabetes of adults (LADA), an autoimmune form of diabetes that usually appears in the 30s.
Thus, glucose variability can be reduced by appropriate diabetes treatment.
IN Type 2 diabetesthe patient must take control of their blood glucosebased on changes in their eating habits and physical activity.
Initiation of insulin
He starting insulin it enables greater glycemic control and even greater awareness of the relationship with their habits, strengthening self-care. This is reflected in more stable results of self-measurement of glycemia in capillary blood and in control analyzes in the doctor’s office.
In fact, lower glycemic variability can be achieved with use insulin compared to oral antidiabetic agents.
The basal insulin it was reserved as a second choice in type 2 diabetics after poor control with oral antidiabetics. It is now known that it is better not to wait for exhaustion insulin pancreas insulinization. Early initiation together with metformin is more beneficial to reduce its resistance in tissues. In patients who are not excessively overweight, it is therefore in many cases the treatment of first choice, delaying the early depletion of beta cells and the progression of the disease.
Combined agenda
Combined use insulin glargine with other OADs, it provides synergy of the effects of different pharmacological groups, the common goal of which is to improve metabolic control in type 2 diabetes.
On the one hand, insulin glargine offers a prolonged and constant supply of insulin practically throughout the day. It could be combined with metformin, which facilitates the reduction of gluconeogenesis at the liver level, increases glucose uptake at the muscle level, and reduces glucose absorption at the level of the gastrointestinal tract.
It can also be combined with a GLP-1 analog that stimulates endogenous secretion insulinwhich facilitates improved sensitivity to it along with lower appetite and subsequent restriction of intake and weight loss.
Another option is to use together with ISGLT2, which is a good ally of insulin with its glycosuric effect and cardiovascular and nephroprotective benefits.
patient profile
So, depending on the patient profile, the ADO that works best for you can be used to improve metabolic control in patients with type 2 diabetes insulin con insulin glargine.
Barriers that exist to begin with basal insulin They focus on lack of time and physician mistrust regarding adherence, concerns about hypoglycemia, and weight gain. And on the patient side, injection pain, social stigma, disease progression, fear of hypoglycemia, and weight gain would all help delay it.
diabetes education
Actually, insulin prescribed late in most patients with Type 2 diabetes. It is essential to receive adequate instruction, to educate the patient. treatment with insulin should be addressed by promoting a positive attitude if presented insulin as an effective and flexible alternative to achieve therapeutic goals, useful for each patient and at any time during the course of their illness.
Negative attitudes towards insulin They are very common. They are afraid to start treatment and are uncomfortable with the prospect of daily injections. Some patients think that by injection insulin it can be complicated and limit your activities. Overcoming psychological barriers is essential. Both the doctor and the nurse must encourage the patient to accept the recommendation insulin.
This article was prepared using the collaboration of primary care physicians Ramón Noguera Rodríguez, Ana Guarch Ibañez, Oriol Peña Rodríguez, Antonio Navas Robles, Zisimos Antonio Charmpalis and José Miguel Stefanoni David from Barcelona and Arianna González. Fuentes, Alba María Moreno Fortes and Fernando Frank Loredo Rodríguez from Orihuela.
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