Insulin treatment

I was like a dried tree, but you have given me new life.

An Ethiopian villager, after starting insulin.

The astonishing power of insulin to restore health and well-being to rapidly deteriorating newly diagnosed Type 1 diabetic patients is as remarkable now as it was in 1922. After Banting gave insulin to Elizabeth Hughes in that year, she wrote to her mother that "it is simply too wonderful for words this stuff." Insulin to this day always has this effect; the challenge now is to optimise control in order to maintain health throughout life.

Insulin is also needed to enhance well-being and control in many Type 2 diabetic patients when the natural progression of their disease has lead to loss of optimal control. The potential to reduce the development of long-term diabetic complications as demonstrated by the UKPDS (see page 42) has led to a recent explosion in conversions from tablets to insulin. The difficult decisions which surround the need for insulin in this situation, together with benefits, uses and misuses of insulin have been described in the previous chapter.

The use of insulin must be tailored to meet individual requirements. The aim is to achieve the best possible control in the circumstances, avoiding at all costs the disabling hypoglycaemia which can occur if control is excessively tight. In some elderly patients and those who lack motivation, it is therefore wise to aim only at alleviating symptoms and not to attempt very strict control.

An Ethiopian patient carrying his diabetes equipment to the clinic
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