What are the indications for insulin administration in Type DM

Patients with Type 2 DM manifest a disturbance both in the action of insulin (insulin resistance) and in its secretion, which is decreased. During the natural course of the disease, the disturbance of insulin secretion progressively worsens. Ultimately, most Type 2 diabetics will need exogenous insulin administration. In the UKPDS study, 80 percent of the patients who were initially treated with a sulfonylurea, needed insulin after nine years.

The main indication for insulin administration in Type 2 DM is the secondary failure of treatment with oral antidiabetic medicines: that is, when a patient is receiving the optimal treatment with tablets and the HbAlc is at levels approaching 8 percent, the administration of insulin is rendered necessary. Several experts recommend beginning insulin therapy even earlier (when HbAlc steadily exceeds 7 percent). Other indications for insulin administration in individuals with Type 2 DM are reported in Table 28.4.

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