Diabetes mellitus: general aspects of insulin treatment, types of insulin

1. Big picture

Insulin treatment is replacement therapy. The examiner wants you to understand one central idea:

Normal pancreas = continuous basal insulin + meal-related insulin peaks. Insulin therapy tries to imitate this with basal insulin + prandial/bolus insulin.

This is essential in type 1 diabetes mellitus (T1DM) because there is absolute insulin deficiency. In type 2 diabetes mellitus (T2DM), insulin is used when endogenous insulin secretion is no longer enough, during severe hyperglycemia, acute illness, pregnancy, perioperative periods, or when other therapies fail or are contraindicated. Current standards still describe type 1 insulin therapy as a combination of premeal prandial insulin with a longer-acting basal insulin, and typical total daily insulin requirements are often estimated by body weight with basal insulin forming a substantial part of the daily dose. ([Diabetes Journals][1])

The most dangerous insulin complication is hypoglycemia. The most dangerous mistake is withholding insulin from a patient with absolute insulin deficiency, especially in T1DM or diabetic ketoacidosis (DKA).

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