Risks of Insulin Therapy

Insulin is a life-sustaining medication for patients with type 1 diabetes. However, it does have important risks of which patients must be informed. Many of these risks increase as glycemic targets approach physiologic levels and the hemoglobin A1c is near normal.

The most feared complication of insulin treatment is hypoglycemia, because it can be potentially life threatening. Hypoglycemia results when too much insulin is given relative to the baseline glucose level, the carbohydrate intake, and the patient's level of activity. The DCCT established that the risk of hypoglycemia was directly proportional to the intensity of glucose control (2). Patients in the intensively treated arm of the study experienced a threefold frequency of severe hypoglycemia compared to the conventionally treated arm (36). However, increased hypoglycemia with intensive therapy is not due to the regimen per se, but rather to the glycemic target selected for these patients. Excessive hypoglycemia is best managed by raising the premeal and bedtime glycemic targets. Hypoglycemia is discussed in further detail in Chapter 18.

The other major risk of insulin therapy is weight gain. Insulin promotes fat storage in adipocytes and protein synthesis in muscles. It participates in many other growth and anabolic pathways. In addition, patients who experience improved control with intensive therapy eliminate glucosuria, go into positive caloric balance, and provoke further weight gain. In the DCCT, patients treated with intensive insulin therapy had a substantially higher incidence of obesity than those given conventional therapy (36).

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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