Some patients are not easily controlled with medication alone and these patients will need insulin injections (treatment of diabetes with insulin), some once per day, but difficult to control diabetics might need up to three injections per day.
As explained under the syndrome of insulin resistance, we know that diabetes insulin resistance needs to be under control first with type 2 diabetes mellitus and medication is useful for this (metformin). Once this is under control, all of the insulin that is given will be utilized.
In the past, when patients with type 2 diabetes were treated with insulin first, often the excess non-utilized insulin would cause severe reactive hypoglycemia (= low blood sugar) at night during the sleep.
However, as doctors learnt more about this condition, and dosing has become more cautious, this is rare now.
One of the rules that has emerged is that if the insulin dosage in a 24 hour period exceeds 1 unit per kilogram of body weight (70 units in a 70Kg or 154 lbs. person), insulin resistance is present. Otherwise insulin is given exactly as described under type 1 diabetes . Often type 2 diabetics need twice as much or more insulin because of insulin resistance. As the oral medication often takes two or three months for a full effect to show, the blood sugars have to be particularly closely followed to avoid a hypoglycemic reaction (from over treating diabetes).
The newest developments with insulin is a long acting insulin glargine. What is new about it is that insulin glargine (Lantus, thanks to www.lantus.com for this link) can be given only once a day in the morning and can also be combined with oral medications, which will stabilize diabetes more than each treatment modality alone. Insulin treats high blood sugar more effectively, the oral diabetes medication has anti-inflammatory and anti-arteriosclerotic effects. Between both treatment modalities the hemoglobin A1C can be easier controlled.
It is important to stress again that in an overweight or obese patient the first priority of the patient and physician is to address this weight problem and have a dietician involved in a sensible weight loss program. Simply swallowing pills is not good enough. The same is true when diabetes is treatet with insulin, which should always be a part of a holistic approach where weight loss is also an integral part of. If you have any questions about your diabetes and its treatment, consult with your physician.
Note that your blood sugars need to be followed closely with weight loss as you may need less insulin to keep your blood sugars within the normal range. Discuss this with your treating physician.
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