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Roller Coaster Of Insulin Therapy
- 1. Professor P Joshi Director: Diabetes Care Centre, Pretoria Emeritus Professor of Medicine: MEDUNSA Professor P Joshi Director: Diabetes Care Centre, Pretoria Emeritus Professor of Medicine: MEDUNSA
- 2. Extrapolation from ProgressiveExtrapolation from Progressive Decline ofDecline of ββ-- cell Functioncell Function Adapted from UKPDS 16. Diabetes 1995;44:1249–58 Years from Diagnosis HOMA Beta-CellFunction(%) –10 –8 –6 –4 –2 0 2 4 6–12 100 80 60 40 20 0 DiagnosisDiagnosis DespiteDespite TherapyTherapy
- 3. InsulinInsulin ResistanceResistance Type 2Type 2 DiabetesDiabetes ββ-cell-cell DysfunctionDysfunction Insulin Sensitivity Insulin Sensitivity Hyperinsulinaemia - thenHyperinsulinaemia - then ββ--cell Failurecell Failure NormalNormal IGTIGT NEED INSULINNEED INSULIN THERAPYTHERAPY Progression oProgression off Type 2 DMType 2 DM Pathogenesis of Type 2 DiabetesPathogenesis of Type 2 Diabetes Diabetes Care 1992;15:318-68 GlycaemiaGlycaemia DMDM InsulinInsulin LevelsLevels
- 4. ATP - SensitiveATP - Sensitive KK++ ChannelChannel Voltage -Voltage - DependentDependent CaCa2+2+ ChannelChannel Ca2+ LABILE POOL OF INSULIN STORAGE POOL OF INSULIN 1 3 5 7 9 11 13 15 17 19 21 23 Minut es Phases of Insulin ReleasePhases of Insulin Release Insulin Adapted from Herchuelz A 1983
- 5. EVERY 1% REDUCTION IN HBA1C REDUCED RISK* 1%1% Deaths from diabetesDeaths from diabetes Heart attacksHeart attacks MicrovascularMicrovascular complicationscomplications Peripheral vascularPeripheral vascular disordersdisorders UKPDS 35. BMJ 2000; 321: 405-12 Lessons from UKPDS:Lessons from UKPDS: Better Control has Less ComplicationsBetter Control has Less Complications - 37% - 43% *p<0.0001 - 21% - 14%
- 6. Conclusion:Conclusion: GoodGood Control ReduceControl Reducess RiskRisk • DCCT and UKPDS • Risk reductions of >30% with intensive control • Any improvement is beneficial • Good diabetes management is essential
- 7. Conclusion:Conclusion: GoodGood Control ReduceControl Reducess RiskRisk • DCCT and UKPDS • Risk reductions of >30% with intensive control • Any improvement is beneficial • Good diabetes management is essential