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Israel Hodish - One of the best experts on this subject based on the ideXlab platform.
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Insulin Therapy, weight gain and prognosis.
Diabetes obesity & metabolism, 2018Co-Authors: Israel HodishAbstract:Insulin Therapy is mainly used by people with type 2 diabetes who have failed other therapies and have become Insulin-deficient. This group represents about a quarter of all people with type 2 diabetes. Almost all those with type 2 diabetes who start Insulin Therapy or intensify it gain weight, which may potentially diminish the prognostic advantage of improved glycaemia. To date, all available guidelines emphasize both the attainment of glycated haemoglobin (HbA1c) goals and weight control, without directing the clinician as to which element is of a higher priority. The following review attempts to clarify the issue using the available literature. The body of evidence presented in this review indicates that glycaemic management with exogenous Insulin replacement is of a much higher priority than weight gain. Lower weight or weight loss do not show prognostic benefit in advanced stages of diabetes; therefore, weight gain should not discourage providers from achieving and maintaining HbA1c goals with Insulin Therapy, regardless of Insulin dosage or other medications.
Peter J. Campbell - One of the best experts on this subject based on the ideXlab platform.
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Intensive Insulin Therapy and weight gain in IDDM.
Diabetes, 1993Co-Authors: Michael G. Carlson, Peter J. CampbellAbstract:Intensive Insulin Therapy is frequently complicated by excessive weight gain. The purpose of this study was to determine the cause and composition of this weight gain. Therefore, changes in body composition, energy expenditure, glycosuria, and substrate kinetics were evaluated in patients with IDDM who transferred from conventional Insulin Therapy to intensive Insulin Therapy. Six adult patients with IDDM were studied on conventional Insulin Therapy and after 2 mo of intensive Insulin Therapy while maintaining constant caloric intake and were compared with a group of 6 matched nondiabetic volunteers. Body composition was determined by underwater weighing. Energy expenditure was measured during 24-h stays in a whole-room calorimeter. Whole-body turnover rates of glucose, glycerol, palmitate, and leucine were determined by isotope dilution methods. Intensive Insulin Therapy lowered the mean daily blood glucose concentration and HbA1 (14.8 ± 1.6 to 7.7 ± 0.6 mM and 12.9 ± 0.9 to 9.6 ± 0.6%, both P P P P P
Jessica R. Castle - One of the best experts on this subject based on the ideXlab platform.
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Recent Advances in Insulin Therapy.
Diabetes technology & therapeutics, 2020Co-Authors: Leah M. Wilson, Jessica R. CastleAbstract:Insulin Therapy has advanced remarkably over the past few decades. Ultra-rapid-acting and ultra-long-acting Insulin analogs are now commercially available. Many additional Insulin formulations are in development. This review outlines recent advances in Insulin Therapy and novel therapies in development.
Martha M. Funnell - One of the best experts on this subject based on the ideXlab platform.
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Lessons from DAWN: Implementing Effective Insulin Therapy
The Internet Journal of Advanced Nursing Practice, 2008Co-Authors: Martha M. FunnellAbstract:Negative attitudes to Insulin Therapy are common. Results from the Diabetes Attitudes, Wishes and Needs (DAWN) study show that barriers to achieving adequate glycemic control include misconceptions and concerns of patients and providers regarding the use of Insulin. Data from DAWN highlight the importance of addressing psychosocial factors as an integral component of care for patients with diabetes. Strategies to deal with the initiation of Insulin Therapy can provide ways to overcome barriers to effective Therapy and bridge the gap between diabetes targets and clinical practice. By identifying and addressing patient and provider concerns regarding initiation of Insulin Therapy, providers can facilitate effective self-management of diabetes and help patients achieve current targets for glycemic control.
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Overcoming Barriers to the Initiation of Insulin Therapy
Clinical Diabetes, 2007Co-Authors: Martha M. FunnellAbstract:N ew recommendations for the management of type 2 diabetes call for more rapid initiation of both oral medications and Insulin Therapy.1 Although most providers agree that Insulin is an efficacious approach to the management of type 2 diabetes, many still consider Insulin Therapy as the last resort and indicate that their patients are hesitant to take Insulin.2 In addition, the initiation of Insulin Therapy is difficult in the confines of a 10-minute office visit. The first step is to determine the patient's view of Insulin Therapy and correctly identify barriers from the patient's perspective. The discussion about the need for Insulin Therapy affects people differently. Some may feel angry or betrayed, others fear that Insulin will add to the burden and stress of managing diabetes, and still others may feel overwhelmed or frightened.3 To determine a patient's concerns, ask questions such as: 1. What do you need to know to consider Insulin Therapy? 2. What problems do you think you will encounter? 3. What do you see as the biggest negative of Insulin? The greatest benefit? 4. What would help you overcome your concerns? 5. Are you willing to try Insulin? If not, what would cause you to consider Insulin? The first response to such questions is very rarely a full accounting of the patients' true concerns. Continuing to ask questions, such as “Why do you think that is?” or “Can you tell me more about that?” will help both you and the patient better understand the existing barriers so that you can best support patients in the decision-making process. The decision to initiate Insulin Therapy ultimately belongs to the patient with type 2 diabetes. Common barriers among patients include beliefs that Insulin is a personal failure, that Insulin is not effective, that Insulin causes complications or even death, or that …
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Self-Management Support for Insulin Therapy in Type 2 Diabetes
The Diabetes educator, 2004Co-Authors: Martha M. Funnell, Davida F. Kruger, Mary SpencerAbstract:PURPOSE the purpose of this article is to describe the self-management support that can be provided by diabetes educators for type 2 diabetes patients who are transitioning from Therapy with oral hypoglycemic agents to Insulin. METHODS The role of the diabetes educator in patient education and self-management support during all aspects of Insulin Therapy is discussed. Phases during which support may be especially important include the decision-making process, initiation, and maintenance. RESULTS Although some patients make the decision fairly easily, the introduction of Insulin Therapy is likely to raise many issues and questions for many type 2 diabetes patients. The more reluctant patients may experience psychological Insulin resistance, a syndrome where Insulin Therapy is viewed as a threat or failure, which can affect health professionals as well. The diabetes educator can provide support and approaches to help diminish this resistance and make the transition to Insulin Therapy easier and more effective for patients with type 2 diabetes. CONCLUSIONS Education and ongoing self-management support are needed for informed decision making and the initiation and maintenance of Insulin Therapy. Therefore, diabetes educators have a critical role to play during both the decision-making process and the safe transition to Insulin Therapy.
Craig Nielsen - One of the best experts on this subject based on the ideXlab platform.
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In Reply: Starting Insulin Therapy.
Cleveland Clinic journal of medicine, 2015Co-Authors: Andrei Brateanu, Giavanna Russo-alvarez, Craig NielsenAbstract:Readers comment on resuming anticoagulation after hemorrhage (April 2015) and on starting Insulin Therapy in patients with type 2 diabetes (August 2015).