The Effect of Type and Daily Doses of Insulin to Treatment Success in Type 2 Diabetes Patients who are Receiving Basal-bolus Insulin Therapy

Abstract

Objectives: The present study aims to compare different types of insulin concerning treatment success and insulin dose requirement in type 2 diabetes patients who were receiving basal-bolus insulin therapy and to evaluate the causes of treatment failure despite high doses of insulin. Methods: In our retrospective study, 198 type 2 diabetes patients who were receiving basal-bolus insulin therapy included. Patients were divided into three groups according to the insulin types (Group 1: short and long-acting analogue insulin users (n=83), Group 2: short and long-acting human regular insulin users (n=58), Group 3: human regular insulin + long-acting analogue insulin users (57)). Demographic data and daily insulin doses were recorded from the patient follow-up files. These data and the rates of achievement of the target HbA1c levels were also compared between groups. In addition, insulin doses of the patients whose glycemic targets could and could not be achieved were compared. Results: In this study, 123 (62.1%) of the 198 patients were female and 65 (47.9 %) were male. The mean age of the three groups was 55.81±8.1, 58.3±8.9, 58.3±8.8, respectively. HbA1C values were 8.72±1.65% in group 1, 9.0±1.98% in group 2 and 9.05±2.24% in group 3. The rates of achievement HbA1c value below 7% were 27.7% in analogue insulin group, 25.9% human regular insulin group and 31.6% in regular + analogue insulin group (p >0.05). There were no significant differences in daily basal and bolus insulin doses, total daily and per kg insulin doses and basal-bolus rates between groups. Higher total daily insulin doses were determined in patients who could not achieve target glycemic values than achieved it in group 1 and 2. Higher basal insulin doses were determined in patients who could not achieve target glycemic values than could achieved it in group 3. Conclusion: In our study, in which we did not find any significant difference in the dose analysis between analogue and regular insulin, the findings showed that high insulin doses might not be sufficient for glycemic control. The underlying causes should be investigated and correctible reasons should be eliminated in these patients.

Implementation of Buerger Allen exercise in patients with diabetes mellitus type II to improve lower extremity circulation

“…The procedure consists of 3 stages: (1) the lower extremity is lifted up at an angle of 45°-90° and supported by a pillow or chair for 2-3 minutes or until the skin looks pale (pale white or tingling). (2) The patient sits at the side of the bed with the legs hanging down. The patient systematically flexes and extends the foot, then pronates and supinates and flexes and extends the toes.…”

“…Diabetes is a complex, chronic disease that requires continuous medical care with multifactorial, risk-reducing strategies beyond glycemic control [1,2]. Diabetes self-management education and support are critical to preventing acute complications that reduce the risk of long-term complications [3].…”