“100 Years of Insulin Shots: Evolution, Efficacy, and Empowerment in Diabetes Management”
For over a century, insulin shots have revolutionized diabetes management. Originating in 1922 at the University of Toronto by Banting, Best, and colleagues, insulin therapy became pivotal. Its evolution has transformed the landscape of diabetes care, offering hope, efficacy, and empowerment to millions worldwide.
Insulin shots for T2D
Initiating insulin therapy in type 2 diabetes is a critical decision influenced by various factors. Despite the absence of a definitive answer, timely action is essential. Traditional stepwise approaches may delay insulin initiation, risking prolonged hyperglycemia.
Swift response is warranted when glycemic goals remain unmet after 2-3 months of maximally dosed dual oral therapy. For patients intolerant to oral agents or expressing a preference for insulin, earlier initiation is advisable.
High A1C levels serve as a cue for timely intervention, optimizing management and improving quality of life. This approach aligns with evidence supporting the rapid addition of insulin to enhance treatment satisfaction and outcomes.
How
Basal insulin therapy in type 2 diabetes begins with the addition of once-daily NPH insulin or long-acting analogs, guided by “treat-to-target” trials. Despite options like insulin detemir, NPH insulin remains preferred for its cost-effectiveness. Clinical trials are needed to clarify detemir’s efficacy and optimal dosage for glycemic control.
Clinicians must balance glucose control with the risk of hypoglycemia, especially after findings from the ACCORD study. Rapid basal insulin titration is crucial for efficacy. For once-daily injections, evening NPH insulin is favored. Timing for long-acting analogs varies, with morning administration potentially beneficial for detemir or glargine if nocturnal hypoglycemia is problematic.