Roller Coaster of Insulin Therapy Rationale for insulin therapy in type 2 diabetes

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The South African Diabetes & Vascular Disease Journal

The South African Journal of Diabetes & Vascular Disease presents: Problems and challenges in patients with type 1 diabetes. Larry A Distiller Centre for Diabetes and Endocrinology Johannesburg http://www.diabetesjournal.co.za

Health & Medicine

Problems and challenges in patients with type 1 diabetes. Larry A Distiller Centre for Diabetes and Endocrinology Johannesburg

Type 1 Diabetes ,[object Object],[object Object],[object Object],Replace this missing hormone In concept, no different from hypothyroidism, HRT etc.! So what’s the problem?

Redefining the “problem” of diabetes Diabetes the “Illness” : Patient has symptoms of hyperglycemia Symptoms treated Patient no longer ill! Able to continue “normal” lifestyle with minimum disruptions. Achieved with blood glucose <15mmol/l

Redefining the “problem” of diabetes ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

THEORETICAL BARRIERS TO CONTROL Patient Barriers Age Gender Educational level Past experience with diabetes Race Ethnicity Socioeconomic status Attitudes Personality Energy Level Physical Health Mental Health Religion Emotional State Past Experience with diabetes education Stress Education Barriers Vision Profession Values Knowledge Skills Attitude Personality Gender Energy Level Experience Flexibility Ethnicity Religion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Treatment of the Patient with type 1 diabetes changed forever following the DCCT. ,[object Object]

The foundation of modern diabetes management SHGM Pen Devices/CSII Diabetes Nurse Educator Intensive management of type 1 diabetes

Allows for ,[object Object],[object Object],[object Object]

Goals of Insulin Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Know & Understand your Insulins ,[object Object],[object Object],[object Object],[object Object]

Know Your Patient ! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Your Client Must Also Understand the Insulin ,[object Object],[object Object],[object Object],[object Object]

Decide ,[object Object],[object Object],[object Object],[object Object],[object Object]

Helping Your Patient Choose a Regimen ,[object Object],[object Object],[object Object],[object Object],[object Object],But in the end the PATIENT must make the choice. It is he/she, not you, who has to live with it!

And how low to go? ,[object Object],[object Object],[object Object],[object Object]

Should the Risk of Hypoglycaemia modify our Treatment? Yes Age (<8yrs: >60yrs CVD Advanced Complications Hypo Unawareness Job-Risk Sleeping alone Etc. No Young Healthy Aware Fit Compliant Most patients in the middle !

And what about SHGM ,[object Object],[object Object],[object Object],[object Object],[object Object]

There are four kinds of ‘testers” ,[object Object],[object Object],[object Object],[object Object]

Those who won’t ,[object Object],[object Object],[object Object],[object Object],[object Object]

Those who don’t ,[object Object],[object Object],[object Object]

Those who do – by “rote” ,[object Object],[object Object],[object Object],[object Object]

Those who do with purpose ,[object Object],[object Object],[object Object]

Fixed dose insulin therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Functional Insulin therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Rules of Testing ,[object Object],[object Object],[object Object],[object Object]

Rules of Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Don’t Try to Change History ! ,[object Object],[object Object],[object Object]

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Roller Coaster of Insulin Therapy Rationale for insulin therapy in type 2 diabetes

1. Problems and challenges in patients with type 1 diabetes. Larry A Distiller Centre for Diabetes and Endocrinology Johannesburg

3. Redefining the “problem” of diabetes Diabetes the “Illness” : Patient has symptoms of hyperglycemia Symptoms treated Patient no longer ill! Able to continue “normal” lifestyle with minimum disruptions. Achieved with blood glucose <15mmol/l

8. The foundation of modern diabetes management SHGM Pen Devices/CSII Diabetes Nurse Educator Intensive management of type 1 diabetes

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Roller Coaster of Insulin Therapy Rationale for insulin therapy in type 2 diabetes

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