Intensive insulin therapy: Part II. Multicomponent insulin regimens

Area of Science:

• Endocrinology and Metabolism
• Pharmacology of Diabetes Treatment

Background:

• Insulin is essential for survival in insulin-dependent diabetes mellitus (IDDM).
• Physiologic insulin delivery requires more than once-daily administration.
• Non-insulin-dependent diabetes mellitus (NIDDM) patients may require insulin therapy.

Purpose of the Study:

• To review insulin administration regimens for different diabetes types.
• To discuss insulin delivery methods for achieving glycemic control.
• To explore controversial treatment options in NIDDM.

Main Methods:

• Review of established and emerging insulin delivery strategies.
• Analysis of insulin regimens for IDDM and NIDDM patients.
• Discussion of treatment approaches for varying degrees of hyperglycemia.

Main Results:

• IDDM necessitates complex insulin regimens, including multiple daily injections or continuous subcutaneous insulin infusion (CSII).
• NIDDM patients with moderate hyperglycemia may benefit from bedtime intermediate-acting insulin (NPH or ultralente).
• Severe hyperglycemia in NIDDM requires insulin strategies similar to those for IDDM.

Conclusions:

• Optimal insulin therapy is tailored to diabetes type and severity.
• Lifestyle flexibility can be a consideration in choosing insulin regimens.
• The combination of insulin and sulfonylurea for NIDDM remains a subject of debate.