Insulin therapy multiple daily injections

Raskin P, Bode BW, Marks JB, Hirsch IB, Weinstein RL, McGill JB, Peterson GE, Mudaliar SR, Reinhardt RR. Continuous subcutaneous insulin infusion treatment and multiple daily injection therapy are equally effective in type 2 diabetes. Diabetes Care 2003 26 2598-603. 

Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens using insulin lispro in type 1 diabetic patients on intensified treatment a randomized study. The Study Group for the Development of Pump Therapy in Diabetes. Diabetes Care 2000 23(9) 1232-5. 

In Type-I diabetes, which is due to the loss of insulin-producing cells as a consequence of autoimmune disorders, substitution of insulin is the most important measure. However, merely to inject one daily dose is not an adequate therapy. Here, the objective is to mimic the daily variations in plasma insulin which are closely related to food intake. One such attempt which has improved microvascular complications is intensified insulino-therapy through multiple daily injections of insulin. Another approach is to develop techniques of islet transplantation and using a bioartificial pancreas. In the case of islet transplantation, tissues will not only respond to changes in blood glucose levels but also to hormones of the entero-insular axis. 

CSII in patients with type 2 diabetes. In a meta-analysis of the use of CSII in patients with type 2 diabetes hypoglycemia, including severe hypoglycemia, was as common as with multiple injection insulin therapy [23 ]. Another similar analysis showed similar outcomes in patients using CSII compared with multiple daily injections [24 ]. 

Fatourechi MM, Kudva YC, Murad H, Elamin MB, Tabini CC, Montori VM. Hypoglycemia with intensive insulin therapy a systematic review and metaanalyses of randomized trials of continuous subcutaneous insulin infusion versus multiple daily injections. J Clin Endocrinol Metab 2009 94 729. ... 

Insulin is a hydrophobic peptide drug for diabetes. Diabetes mellitus is a serious pathologic condition responsible for major health care problems all around the world costing billions of dollars annually. In the United States, it represents the fourth leading cause of death. Diabetes also leads to severe complications such as kidney disease, retinopathy, neuropathy, leg or foot amputations and heart disease [2G. As a consequence of poor oral bioavailabiUty and current lack of alternative delivery routes, insulin is presently administered parentally. The subcutaneous route, requiring single or multiple daily injections, is the main stay of conventional insulin therapy [27]. 

Kamoi K, Miyakoshi M, Maruyama R. A quality-of-life assessment of intensive insulin therapy using insulin lispro switched from short-acting insulin and measured by an ITR-QOL questionnaire a prospective comparison of multiple daily insulin injections and continuous insulin infusion. Diabetes Res Clin Pract 2004 64 19-25. 

Tupola S, Rajantie J. Documented symptomatic hypoglycaemia in children and adolescents using multiple daily insulin injection therapy. Diabet Med 1998 15(6) 492-6. 

As described earlier, the current advocacy of intensive insulin therapy regimens, involving multiple daily subcutaneous injections, places a heavy burden of compliance on patients and has prompted interest in... 

Conventional Intensified Insulin Therapy or Multiple Daily Insulin Injections (MDI)... 

Drug administration route There is a greater risk of developing ketoacidosis with insulin-pump therapy than with multiple daily insulin injections, because there is always a smaller subcutaneous depot of insulin at any time with the insulin pump. However, in practice, the frequency of ketoacidosis is similar with insulin pump and insulin injections. Insulin-pump therapy can lead to some localised non-serious skin infections at the infusion site. In general, current pumps are robust and reliable, but malfunctions can still occur. [15 ]... 

Ziegler R, Cavan DA, Cranston I, Barnard K, Ryder J, Vogel C, Parkin CG, Koehler W, Vesper I, Petersen B, Schweitzer MA, Wagner RS (2013) Use of an insulin bolus advisor improves glycemic control in multiple daily insulin injection (MDI) therapy patients with suboptimal glycemic control first results from the ABACUS trial. Diabetes Care 36... 

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