Better control of the diabetic metabolic state will prevent the diabetes complications. However in current clinical
practice, it is sometimes difficult to achieve this goal. Additionally, physicians find themselves in an equivocal position
to initiate insulin therapy, its selection, combining with Oral agents and further management. The current article was
written to focus on diabetes pathogenesis at molecular level, its classification and management by insulin injections.
Knowledge of basic biochemistry, pharmacology with kinetics of Insulin is essential for diabetes management. Nonetheless,
it should be a priority to search for evidence based clinical methodologies for selecting the patients for initiating,
modifying or combining the insulin therapy. Type-1 diabetic patients are best controlled on basal bolus insulin regimens.
However in type-2 diabetes, metformin with lifestyle modifications should be the first line therapy, thereafter combined
with oral hypoglycemic agents or shifting to insulin gradually if diabetes remains uncontrolled. Metformin is recommended
to be prescribed with insulin as compared to oral hypoglycemic agents which should be discontinued while starting
insulin. Monitoring the insulin therapy on regular visits to diabetologist and diabetes multidisciplinary team remains
the integral part of diabetes management. The review also outlines relevant and recent insulin analogue patents for the
management of Diabetes.
Keywords: DKA, HbA1c, insulin resistance, MDI, OHA, SMBG, Type-1 DM, Type-2 DM, islands of clear cells, Endocrinopathies
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Published on: 09 May, 2012
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