Endocrine » Diabetes

Managing Hyperglycaemia

Treatment of type 2 diabetes is aimed at lowering insulin resistance and increasing function of beta cells. In many patients, beta-cell dysfunction worsens over time, necessitating exogenous insulin. Because patients with type 2 diabetes have both insulin resistance and beta-cell dysfunction, oral medication to increase insulin sensitivity (e.g., metformin, a thiazolidinedione [TZD]) is often given with an intermediate-acting insulin (e.g., neutral protamine [NPH]) at bedtime or a long-acting insulin (e.g., glargine insulin, given in the morning or evening. Insulin secretagogues, such as a sulphonylurea agent, can also be given to increase pre-prandial insulin secretion. The goal of these combined daytime oral agent plus once-a-day insulin is to lower the fasting glucose level to 100 mg/dL by using the insulin. When this target is achieved, the oral agents are effective in maintaining pre-prandial and postprandial blood glucose levels throughout the day. If a regimen combining oral agents and insulin fails to lower glucose levels into the normal range, patients should be switched to a daily multiple-injection schedule with premeal rapid-acting insulin and longer-acting basal insulin.

In order to proceed further, you need to have an account on IDG.
Create a new account now

Registered users, you can login below to access this page.