Indications for insulin in Type 2 diabetes
Approximately 6% of non-obese and 2% of obese Type 2
diabetic patients need to start insulin each year.
Predicting the
need for insulin is difficult: those of lean body mass, especially
in the presence of islet cell antibodies, are at greatest risk.
Whether to give insulin to Type 2 diabetic patients is one of
the most important yet difficult decisions to be made in treating
these patients. Failure to give insulin to some patients results in
protracted and needless malaise if not actual danger.
On the other hand, giving insulin inappropriately can cause needless
problems, notably from hypoglycaemia and weight gain.
I
ndications for giving insulin to Type 2 diabetic patients
who are inadequately controlled despite adherence to their
recommended diet and oral hypoglycaemic agents are as
follows:
• Continuing weight loss (even if this is insidious), and
persistent symptoms, or both. Insulin treatment in these
patients almost always results in a substantial improvement in
health.
• A non-obese patient without symptoms whose weight is stable
and who is conscientious with existing medication. Diabetic
control will usually improve, and about half of the patients
will enjoy an improvement in well-being.
• An obese patient without symptoms whose weight is stable
presents an even more difficult problem.
The correct management is to ensure that they are taking their
medication, together with intensification of diet, but
sometimes insulin may be needed simply to improve control
of diabetes in order to reduce long-term complications
during the following decade or more.
A reduction of HbA1C of approximately 2% together with weight gain of around
5-7 kg can be expected.
Unfortunately improvement in glycaemic control is not always achieved
Patient choice is important here, and some prefer not to take insulin after all
explanations have been presented. Reluctant patients can be
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