[Diabetes mellitus type II: when convert to insulin?].
About 5% of patients with type II diabetes per year have to switch over to an insulin regimen because of critical metabolic disturbances. This becomes particularly urgent in catabolic states. Further situations necessitating an insulin regimen are secondary failure of oral antidiabetic therapy, painful peripheral neuropathy and late manifestations of type I diabetes (late autoimmune diabetes mellitus in adults, LADA). Today's state of knowledge suggests for the change to an insulin regimen to start with bedtime injections of depot insulin, eventually combined with oral medication over the day. This regimen allows to keep the weight increase lower than with two or more insulin injections. Exogen insulin substitution ameliorates typical abnormalities in type II diabetes, such as increased hepatic glucose production, reduced peripheral glucose utilization, reduced function of beta-cells and dyslipidemia. It carries, however, the risk for hypoglycemia and weight-increase.
Bianda
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TL
Departement für Innere Medizin, Universitätsspital Zürich.
Spinas
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GA
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004734:Energy Metabolism / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin