Treating obese patients with poorly controlled diabetes: confessions of an insulin therapist.
How to treat the obese, poorly controlled patient with diabetes is a common and vexed question. Using insulin without giving thought to ameliorating the inevitable weight gain will cause desperation in the physician and despondency in the patient. Novel attempts at dietary manipulation before commencing insulin can be beneficial provided there is close scrutiny of short-term changes in weight and metabolic parameters. Combinations of insulin and metformin can also be helpful at an early stage. It may be helpful to use insulin as a therapeutic trial provided the goals of therapy are agreed with the patient at the outset. Above all it is important to avoid therapeutic nihilism - a minority of fat people may be jolly but few are truly happy.
Kerr
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Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK. david.kerr@rbch-tr.west.nhs.uk
Cavan
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D003920:Diabetes Mellitus / Q000178:diet therapy / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008019:Life Style; D009765:Obesity
D007004:Hypoglycemic Agents; D007328:Insulin