Canadian Diabetes
Published quarterly, Canadian Diabetes provides practical, current information to family physicians on diagnosis and treatment issues associated with diabetes.
Canadian Diabetes Autumn 2011 - Full Issue Read issue.
Recent Articles
Moving Up a Level
Diabetes is characterized by insulin deficiency. In type 1 diabetes, loss of insulin production may be rapid and profound with life-threatening consequences. In type 2 diabetes, loss of insulin production is slower, but progressive and relentless (1). In type 1 diabetes with almost total loss of insulin production, intensive management with basal-bolus insulin or insulin pump therapy is recommended by the Canadian Diabetes Association clinical practice guidelines (2). At the time of diagnosis of type 2 diabetes, about 50% of maximal insulin-producing ability has been lost, and this loss continues at a rate of approximately 5% per year. When insulin production declines to approximately 20% of maximum (±6 years from diagnosis), the individual with diabetes becomes metabolically unstable, glucose levels and glycated hemoglobin (A1C) start to rise into double digits, and insulin is required to restore control.
De l’intensification de l’insulinothérapie
Le diabète est caractérisé par une carence insulinique. En présence de diabète de type 1, la baisse de la production d’insuline peut être rapide et marquée, ce qui peut menacer le pronostic vital. En présence de diabète de type 2, la baisse de la production d’insuline est plus lente, mais progressive et implacable1. Contre le diabète de type 1, dans lequel la perte de la production d’insuline est presque totale, les lignes directrices de pratique clinique de l’Association canadienne du diabète préconisent un traitement intensif, soit une insulinothérapie basale-bolus ou l’utilisation d’une pompe à insuline2. Au moment du diagnostic de diabète de type 2, la production d’insuline correspond à environ 50 % de la production maximale; la production d’insuline continue par la suite de baisser au rythme d’environ 5 % par année. Quand la production d’insuline n’est plus que d’environ 20 % de la production maximale (environ 6 ans après le diagnostic), le métabolisme de la personne diabétique devient instable, la glycémie et le taux d’hémoglobine glycosylée (HbA1c) épassent le cap des 10 % et une insulinothérapie s’impose pour rétablir l’équilibre.
Insulin Therapy: Taking Care to the Next Level
Why bother? Why bother, indeed. As the decision to intensify management is being made, it must be remembered that diabetes is a progressive disease that can be managed by achieving well-established glucose targets. Recent major clinical trials have emphasized the importance of reaching these targets to help prevent the long-term vascular complications of diabetes. The United Kingdom Prospective Diabetes Study (UKPDS) (1) examined the benefit of intensive glucose management from the moment of diagnosis and provided some of the most valuable information we have on the long-term management of type 2 diabetes. Similarly, the Diabetes Control and Complications Trial (DCCT) (2) in type 1 diabetes emphasized the value of reaching glucose targets in preventing vascular complications. The subsequent long-term follow-up of these studies, the UKPDS legacy study (3) and the Epidemiology of Diabetes Interventions and Complications (EDIC) trial (4), both emphasized the benefit of early, aggressive management of both type 1 and type 2 diabetes in preventing or delaying vascular complications.
A Practical Guide to Insulin Pump Management in
Insulin pumps have become increasingly more prevalent in the management of diabetes in recent years. Currently in North America, about 20% to 30% of patients with type 1 diabetes mellitus are pump users (1). As a result, non-diabetes specialists are encountering these patients throughout the healthcare system, including the inpatient setting. Ideally, hospital personnel knowledgeable in insulin pump therapy should be available to assist patients, and medical and nursing staff (2). However, many institutions currently lack this resource. This article is designed to help non-diabetes specialists manage patients on pump therapy in and around hospital.
Diabetes Is Worth Sweating For
The prevalence and healthcare costs associated with type 2 diabetes are increasing worldwide. The main reason for the increase is changes in lifestyles in our society—specifically, less exercise being performed and excessive calories being consumed. Although there have been many improvements in the therapeutic options available, studies continue to show that half of people with diabetes fail to achieve the glycemic target of glycated hemoglobin (A1C) <7% (1).
Production of materials has been made possible through a financial contribution from the Public Health Agency of Canada.
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