Multiple daily injections

Fisehman, M.W., and Sehuster, CR. Long-term behavioral changes in the rhesus monkey after multiple daily injections of [Pg.156]

In 132 patients with type 2 diabetes using insulin randomly assigned to continuous subcutaneous insulin infusion (with insulin aspart) or multiple daily injections of insulin aspart and NPH insulin) for 16 weeks, after 8 weeks training to establish optimal dosages (191) there were more episodes of hyperglycemia (blood glucose over 19.4 mmol/1) with multiple daily injections. HbAic was identical. Most of the patients who expressed a view (93%) wanted to stay on the pump. 

A 56-year-old man was given a continuous subcutaneous insulin infusion because of frequent episodes of hypoglycemia of which he was unaware and he had four separate episodes of profound ketoacidosis (194). Multiple daily injections produced less flexibility in his mealtimes, more episodes of hypoglycemia, and the need for more injections. However, injecting 60% of his basal needs as insulin glargine once daily in combination with continuous subcutaneous infusion prevented further episodes of diabetic ketoacidosis. 

Continuous subcutaneous insulin infusion (CSII) has been compared with multiple daily injections of insulin in a randomized study in 32 patients, mean age 13 years, over 16 weeks (195). Of the 16 patients who used CSII one returned the pump twice and one returned the pump once, in both cases for pump software errors. Medtronic MiniMed 508 or Paradigm 511 pumps were used in the study. 

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. 

L, Fayman G, Lilos P, Dickerman Z, Phillip M. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes a randomized open crossover trial. Pediatrics 2003 112 559-64. 

M, Tamborlane WV. A randomised prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 2004 27 1554-8. 

Zinman B, Ross S, Campos RV, Strack TThe Canadian Lispro Study Group. Effectiveness of human ultralente versus NPH insulin in providing basal insulin replacement for an insulin lispro multiple daily injection regimen. A doubleblind randomized prospective trial. Diabetes Care 1999 22(4) 603-8. 

Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. Comparison of continuous subcutaueous iusuhu infusion and multiple daily injection regimens using insulin hspro 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. 

Long-term UFH therapy has been linked to significant bone loss and osteoporosis, requires multiple daily injections, and mnst be monitored frequently (every 1 to 2 weeks) throughout pregnancy. Becanse of these limitations, many experts recommend the use of LMWHs over UFH throughout pregnancy... 

This was a randomized, single-dose, two-way, crossover and comparative study which involved 23 middle-aged subjects (12 males, 11 females age range 35-70 years) with type 2 diabetes. Before randomization, the two treatment groups were similar in terms of baseline clinical features, including lipid parameters. All subjects were currently receiving multiple daily injections to control their diabetes. 

Simulation of basal secretion of insulin using an infusion pump or multiple daily injections can result in decreased vascular complications in patients of all ages. In addition, a more consistent administration of insulin can result in a lower risk of brain damage in pediatric patients. 

The noncommunicable disease of diabetes mellitus has reached epidanic proportions, and it knows no geographic boundaries (Turner 2014). Diabetes, a chronic disorder characterized by elevations in both basal and postprandial (post-meal) glucose levels, is associated with a two- to fourfold increased risk of cardiovascular disease and a threefold increased risk of mortality (Meigs 2003). There are two major forms of diabetes, type 1 and type 2. The typical age of onset of type 1 diabetes is in childhood. This form is also known as insulin-dependent diabetes since patients do not produce enough insulin for healthy function multiple daily injections of insulin (i.e., exogenous insulin) are required to maintain life, and strict dietary rules, planned physical activity, and daily home glucose tests are also necessary. 

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 ]. 

Chase HP, Arslanian S, White NH, Tamborlane WV. Insulin glargine versus intermediate-acting insulin as the basal component of multiple daily injection regimens for adolescents with type 1 diabetes mellitus. J Pediatr 2008 153 547-53. 

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