Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-58

• Management of Acute hyperglycemic crises: Diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar non-ketotic syndrome (HHNS). • Type 2 diabetes undergoing major surgery, requiring corticosteroid therapy or presenting with a metabolic decompensation, end organ failure, severe infection and would benefit from rapid lowering of BG levels.

Adverse effects of Insulin Hypoglycemia

• Hypoglycemia is the most common complication of insulin therapy and most feared by people affected by diabetes. It is often associated with a mismatch between insulin requirements and carbohydrate intake, missed/delay in meals, physical activity or insulin dose errors. • The DCCT showed 65% of the intensive and 35% of the conventional treatment group had at least one episode of severe hypoglycemia (139). • A meta-analysis showed the incidence of severe hypoglycemia was 4.6 and 7.9 episodes per 100 patient years in the conventional-treatment and intensive-therapy group (139). • In the UKPDS insulin treated group, the annual incidence of a severe hypoglycemia was 3%, and 40% for any hypoglycemia (3). • A prospective study found people with type 1 diabetes had 42.89 mild hypoglycemic events/person/year and 1.15 severe hypoglycemic events/person/year while people with type 2 diabetes had 16.37 mild events/person/year and 0.35 severe events/person/year (140). • A systematic review and meta-analysis reported rates of hypoglycemia for insulin users with type 2 diabetes as follows: • Mild/moderate hypoglycemia: 50%; incidence 23 events per person-year Weight gain • Insulin therapy is associated with a weight gain of 4 to 5 kg (24). Insulin stimulates glycogen, protein and lipid synthesis and increases body fat mass. • Reported mean weight gain based on the type of insulin: basal +2.1- 3.6 kg, prandial +6.4 kg and biphasic +5.7 kg (142). • Weight gain can occur with improved glycemic control due to decreased glycosuria and basal metabolic rate (142,143). • The UKPDS investigators observed a 6.5 kg weight gain during the 10-year follow-up. The o Severe hypoglycemia: 21%; incidence one event per person-year (141).