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Insulin: Dosing Regimen and Adverse Effects01:16

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
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Consensus on Insulin Dose Modification During Fasting in Type 2 Diabetes.

A G Unnikrishnan1, Sailesh Lodha2, S K Sharma3

  • 1Chief Endocrinologist and CEO, Chellaram Diabetes Institute, Pune, Maharashtra.

The Journal of the Association of Physicians of India
|August 24, 2017
PubMed
Summary

Fasting with type 2 diabetes mellitus (T2DM) requires careful physician consultation. This consensus provides guidelines for managing T2DM patients during fasting, focusing on insulin dose adjustments to prevent complications.

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Area of Science:

  • Endocrinology and Metabolism
  • Diabetes Management

Background:

  • Fasting poses significant risks for patients with type 2 diabetes mellitus (T2DM), necessitating informed decisions and physician guidance.
  • Current medical consensus aims to support physicians in managing T2DM patients who choose to fast.

Framework:

  • Developed six consensus-based recommendations for insulin regimens during fasting.
  • Recommendations cover diet, exercise, risk categorization, breaking fast, and dose modifications for basal, premix, and prandial insulins.
  • Guidelines integrate established literature with Indian clinical practice for optimal glucose control.

Implementation:

  • Emphasizes patient hydration and consumption of low-glycemic, high-fiber foods.
  • Advises avoidance of sugary, caffeinated, and fried foods during fasting periods.
  • Primary goals are preventing post-meal hyperglycemia and hypoglycemia during fasts.

Implications:

  • Provides healthcare practitioners with a reference tool for initiating and intensifying insulin therapy.
  • Aims to enable T2DM patients to complete fasting periods with reduced complications.
  • Facilitates safer fasting practices for individuals with type 2 diabetes mellitus.