Insulin therapy regimens

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... 

Several years have passed since you have been following MF s therapy. His weight is down to 230 lb (104.6 kg), and he tries to maintain his diet and exercise. His recent HbAlc levels have increased up to 8.4% from 7.2% despite combination therapy with sulfonylureas and metformin. The physician believes that it is time to start insulin therapy for MF and asks you to initiate therapy and follow his regimen. 

Lifestyle modifications are always in order in patients who have developed or those who are at increased risk of developing NODAT.74 Insulin therapy and oral hypoglycemic agents are used often (Table 52-8) in patients in whom lifestyle modifications alone have not controlled blood glucose levels. See Chapter 40 for appropriate treatment regimens for diabetes. 

When acarbose is combined with insulin, the greatest effects are seen with regimens that involve only once- or twice-daily administration. The alpha-glucosidase inhibitors seem to be less effective when they are combined with intensive insulin therapy (35). In combination with insulin or oral hypoglycemic drugs the frequency of hypoglycemic episodes can increase sucrose or higher carbohydrates are reported to be less effective, which can be understood from the mechanism of action. 

How should insulin therapy be introduced and give examples of suitable regimens ... 

Buysschaert et al. (1983) reported a better glycaemic control of totally insulin-dependent diabetic patients under continuous insulin infusion compared with conventional insulin therapy (Lager et al., 1983). An improved metabolic control, an increased glucose-disposal rate and an inverse insulin resistance following a more physiological insulin regimen with continuous insulin infusion compared with conventional therapy was also reported (Jarret, 1986). Similar results were observed by Muhlhauser et al. (1987) where an intensified insulin injection therapy performed as routine treatment of Type-1 diabetics significantly lowered HBA) levels (Fig. 13). 

Assess adherence to the prescribed regimen, including timing of inhaled medications with respect to airway clearance therapies and timing of enzymes and insulin with regard to meals. Is the patient taking any medications not prescribed by the CF center team ... 

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