Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-13

have indicated that the use of either long-acting analogue has improved A1C (1). The use of newer basal insulins: glargine U300 and degludec U100 or U200 all have been found to have less overall hypoglycemia and nocturnal hypoglycemia (1) when compared to glargine U100. For people using CSII, the use of rapid-acting insulin analogues is preferred over short-acting insulin, as people experience improved postprandial glycemic control with less hypoglycemia (1). Weight gain Depending on the level of dysglycemia, weight gain can occur as a result of reduced urinary excretion of glucose and the lowering of metabolic rate due to decreased hepatic glucose output (31). Using IT does not automatically lead to weight gain, but the potential does exist. In the DCCT, intensively managed participants were distinguished from conventionally managed participants by a greater observed weight gain (approximately 5.1 kg or 11 lb) (32). However, short-acting and intermediate-acting insulins were used in the DCCT; in today’s clinical setting, there seems to be less weight gain associated with the use of rapid-acting insulin. This may be related to the more physiologic profile of the mealtime analogues that result in a reduced need to snack. The basal analogue insulin detemir is associated with either weight loss, no weight change or less weight gain when compared to NPH/N or glargine in both people with type 1 and 2 diabetes (31,33,34). Glargine U300 when compared to glargine U100 may result in less weight gain (1). Potential weight gain can be controlled with appropriate energy intake (see Nutrition, below) and fine-tuning of insulin doses. The “cost” of weight gain may represent a significant psychological barrier to IT for individuals. Several studies of women and female teenagers have indicated the underuse of insulin as a method cited to control weight (31). Personal failure An important principle underlying IT is that patients are “the key partners in the day-to-day management of their own diabetes” (35) and assume the responsibilities. There exists a possible perception of personal failure if goals are not met all the time. The DHC teammust ensure that people are prepared for the day-to-day challenges (35) by being proactive in helping people set realistic, achievable goals.

Transient worsening of ret inopathy for people with type 1 diabetes Several studies have noted that rapid improvement of BG control in people with type 1