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Intensive insulin therapy: Part I. Basic principles.

I B Hirsch1, C D Herter

  • 1University of Washington School of Medicine, Seattle.

American Family Physician
|May 1, 1992
PubMed
Summary
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Intensive insulin therapy involves a comprehensive diabetes management program, not just medication. Individualized goals are key, as tight control reduces microvascular risks but increases hypoglycemia.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Intensive insulin therapy is a comprehensive diabetes management program.
  • A multicomponent insulin regimen is only one part of this approach.
  • Euglycemia is not always the goal; individualized glycemic targets are necessary.

Purpose of the Study:

  • To outline key pharmacokinetic considerations for family physicians prescribing insulin.
  • To discuss the relationship between glycemic control and diabetic complications.
  • To highlight the benefits and risks associated with intensive diabetes management.

Main Methods:

  • Review of pharmacokinetic factors influencing insulin therapy.
  • Analysis of evidence linking blood glucose control to diabetic complications.

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  • Discussion of the risks, primarily hypoglycemia, associated with improved glycemic control.

    • Main Results:

    • Insulin species, absorption, injection site, and timing significantly affect glycemia.
    • Meticulous diabetes control appears to decrease risks of microvascular complications and neuropathy.
    • No significant improvement in advanced retinopathy or nephropathy was observed with improved glycemic control.

    Conclusions:

    • Intensive insulin therapy requires understanding pharmacokinetic nuances for effective management.
    • While beneficial for microvascular health, intensive glycemic control necessitates careful monitoring to mitigate hypoglycemia risk.