Talk:Intensive insulin therapy

The

The article suggests that intensive treatment reduces macrovascular disease. This has only been confirmed in the DCCT trial in 2005 (PMID 16371630). JFW | T@lk 14:39, 22 December 2005 (UTC)

• Your pmid link doesn't seem to work. I assume you are referring to this weeks NEJM article on the EDIC f/u study. You can decide whether the mention last year in this article was (a) prescient or (b) based on weaker evidence. Get it in Wikipedia first! alteripse 22:21, 22 December 2005 (UTC)

Heh. It seems the NLM assigned a PMID but the abstract was not entered into Medline in time. You're correct that I'm referring to this week's NEJM. It must make your life a bit more meaningful, Alteripse. JFW | T@lk 23:00, 22 December 2005 (UTC)

"insulinotherapy" vs Insulin Therapy

Finally, the word "insulinotherapy" strikes this reviser's North American ears as an unfamiliar and unnecessarily sesquipedalian Europeanism. Could we change the phrase to the more familiar Insulin Therapy? (User:Alteripse, moved from page Andreas 00:37, 8 February 2006 (UTC))

• Well, this was the first article I expanded and worked on nearly 2 years ago so you will have to excuse the newbie awkwardness. alteripse 21:43, 8 February 2006 (UTC)

reasons for recent reversion

Hello, as you reverted my contribution because my English wasn't that good could you please help me (I am not a native Speaker): Fast acting insulinanlaloga are preferred by "Diabetics" in contrast to the "Doctors". (It is the case, that you just have to wait half of the time between injection and eating, which is usually 45-50 minutes with the older insulin in the morging - and just 25min with Humalog - a great advantage). For archeiving the thearpy goals there is no difference.

Insulin pump: The freedom of syringes and injection is a good thing - but it is not the main adavantage (as long as you don't have a phobia) The main advantage is, that you can freely "edit" the Basal rate -profile to your exactly needs. In some cases (not to say most cases) this cannot be archieved with long acting Insulin. No Insurance would pay the about 2000$/year that pump-therapy costs more if it was just for freedom of syringes. NOM 83.164.14.106 02:10, 10 February 2007 (UTC)

Your correct statements: An advantage of fast analogs over regular insulin is that the insulin can be take closer to the beginning of the meal instead of long before. The ability to program a changed basal rate is one of the most important advantages over multiple injections.

Your incorrect statements: First, diabetes doctors do not prefer regular insulin to faster analogs. The medical journals and medical textbooks have proclaimed the advantages of analogs for nearly a decade. Second, if your glucose is normal you should take Humalog as you begin to eat, not 25 minutes before eating or you will risk hypoglycemia. Third, it is easier to achieve therapy goals with analogs than with regular insulin. Numerous studies have shown better glycemic control with intensive regimens. Fourth, while I agree that the ability to program a changed basal rate is one of the most important advantages over multiple injections, when you ask people with diabetes why they prefer a pump over multiple injections, nearly all will say it is to avoid all the shots. Finally, as a style issue "people with diabetes" is preferred over "diabetics". I do not mean to be discouraging by reverting your contribution, but your information should be accurate. alteripse 11:21, 10 February 2007 (UTC)

The sad thing about it is: Most of the studies are sponsored by the companies offering fast acting insulin analoga. It is just a good marketing campagne. It ist the same thing as it was just a marketing lie, that you don't nee to wait between injection and eating anymore. On good glucose (90mg% / 5mmol/l) most have to wait about 25 min in the morning/ 5 min at noon / 15 min afternoon that their level will not raise to 150mg% (8.3 mmol/l). Without a higher risk of hypogycemia! I do think a lot of people do have a better HbA1c with the analoga. But it is the case as most don't want to wait the 45min in the morning before eating. Because of this a lot of people (knowing about the pharmacokinetic) change their insulin. For example regular "human" insulin on holydays and weekends - humalog on weekdays.

Because of this, diabetes doctors who know more than the advertisements, do not preferre one to the other. If you have the time to wait (or use it for showering in the morning), they would even recommend "human" insulin because of the uncleared issue that analoga might cause or promote cancer. 83.164.14.106 01:44, 13 February 2007 (UTC)

Sorry, but you are simply wrong. If you have to take an analog 25 minutes before breakfast with a normal sugar, you have an inadequate basal rate or an inadequate carb ratio. And name me a single diabetes doctor who has published even an opinion, let alone evidence, that the rapid analogs have no advantage over regular insulin. And where is the evidence of "cancer risk" from analogs? alteripse 03:33, 13 February 2007 (UTC)

First: Everyone should try our for himserlf/herself if he needs to wait (measure 1.5h after meal - withour physical work - if your glucose level is over 150mg% you have to wait a little bit longer.). Most Do have to wait about 25 min. If I eat marmelade or sweet muffins I even have to wait loger! Second: Please read before writing! I didn't say there are no advantages - there are just no for reaching the therapy goals - but a lot for the convenience to do so for some people. Third: cancer: just google "insulin analogs carcinoma" or "insulin-like growth factor". 83.164.14.106 15:32, 16 February 2007 (UTC)

Obviously if your glucose is high before you start a meal, you can take the insulin sooner. Please re-read what I actually said: if you are usually above 150 before a meal you have not optimized your basal insulin, and that is a better solution than taking the analog early. Second: if you think you did not claim analogs had no advantages what did you mean when you said: "For archeiving the thearpy goals there is no difference."? Achieving a lower HbA1c is certainly a therapy goal, and analogs have been proven repeatedly to do that. Third, all those google hits for "insulin analog carcinoma" consist of exactly one letter to the editor when analogs were first being used in 1996 asking if there might be a risk. If that is the strongest evidence after millions of patient-years of use over the last decade, insulin analogs are apparently less likely to cause cancer than the water you drink! Every other citation has nothing to do with injected insulin analogs. Do you not understand that insulin-like growth factor 1 is a human hormone we all make that has nothing to do with insulin injections? alteripse 21:14, 16 February 2007 (UTC)

If you have 150 AFTER meal! Come on, read before you write...! 83.164.14.106 14:27, 19 February 2007 (UTC)

Requested move

I think Flexible insulin therapy is a better title, especially since this topic might be confused with intensive glucose lowering targets. --Steven Fruitsmaak (Reply) 21:03, 8 June 2008 (UTC)

I agree. David spector (talk) 17:55, 14 October 2009 (UTC)

Spam Link Removal

I noticed that many diabetes-related pages have traffic generating links to pages that are of very questionable value. I'm removing these as I encounter them. Are there clear guidelines about what 3rd-party sites can be added as External References? Bernfarr (talk) 10:14, 14 July 2010 (UTC)