Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-59 intensive-therapy group treated with insulin had an average weight gain of 4.0 kg more than the conventional group (p<0.001) (3,144). • In the DCCT, the intensive insulin therapy group had significantly more weight gain (4.75 kg, p<0.001) than the conventional-therapy group (144). Severe hypoglycemia was associated with an additional increased weight gain of 2.2 kg (p<0.005) (145). • Weight gain associated with insulin therapy can be minimized in the following ways (143, 146): o Ensuring sufficient insulin doses without overdosing (over-insulinization). o Minimizing the frequency of hypoglycemia and the need to treat. o Reinforcing the importance of decreasing caloric intake, healthier dietary choices (low-fat/low-calorie) and exercise to minimize weight gain. o Reinforcing food choices with lower carbohydrate-content, thus reducing the post prandial glucose rise, requiring less bolus insulin to cover the post-prandial glucose rise. This technique minimizes the percent error of carbohydrate-to-insulin dose calculation and therefore minimizes over-insulinization. o Addressing individual fears of hypoglycemia and encouraging the individual to minimize the frequency of unnecessary eating to prevent hypoglycemia or over treating a low blood sugar (excess caloric intake). Allergic react ion (147,148) Allergic reactions, such as urticaria, angioedema, rashes and local erythema, are rare with human insulin. The incidence of allergic reaction is only 0.1-3% with human insulin/insulin analogues . The incidence of an allergic reaction to insulin additives (protamine or zinc), is also low. • Reactions, though rare, can range from a local hypersensitivity (cutaneous weal) to a more severe systemic allergic reaction. • Changing to a different insulin manufacturer can often alleviate the problem. Lipohypertrophy (149) Localized fat hypertrophy (lipohypertrophy) is most often the result of frequent use of the same injection site. The estimated prevalence of lipohypertrophy is 49% to 64% in study participants. The most common cause of lipohypertrophy is the failure to rotate injection sites. • Lipohypertrophy is associated with a decreased rate and erratic insulin absorption, a subsequent deterioration in BG control, unexplained hypoglycemia and, in some cases, disfigurement (150-152). • Routine assessment of injection sites by the individual with diabetes and the DHC team is