Perception of insulin therapy among patients with type 2 diabetes mellitus in Jos, North Central Nigeria

Background -The implementation of insulin in the management of type 2 diabetes mellitus is often necessary for better glycaemic control. However, many still consider insulin therapy as the last resort. Several factors come to play in the acceptance of insulin as a form of therapy by patients. This study evaluated the perception of insulin therapy among patients with type 2 diabetes mellitus. Methods- This was a descriptive cross-sectional study carried out at the Jos University Teaching Hospital (JUTH) Jos, North Central Nigeria. One hundred and eighty five persons (100 insulin naïve persons and 85 persons on insulin) were recruited consecutively. The insulin treatment appraisal scale (ITAS) was used to evaluate the perception of insulin therapy among these patients. Results- fifty five (64.7%) females were on insulin while 64 (64%) were insulin naïve. The mean age was 52 ± 11 years and 59 ± 10 years in those on insulin and insulin naïve persons respectively. Twenty one (24.7%) persons on insulin and 33 (33%) insulin naïve persons had tertiary level of education. Insulin naïve persons had higher mean total score of the 20 items, total score of the 16 negative items and total score of the 4 positive items compared with persons on insulin. Among persons on insulin, those with less than one year of education had a better perception of insulin therapy compared with persons who had six years or more of education; Duration of insulin use, gender and age had no impact on perception of insulin therapy. Conclusion- The perception of insulin therapy among persons with type 2 diabetes mellitus is poor

SKINNY - SKIN Thickness and Needles in the Young

Background. Intensive diabetes management requires the use of multiple daily injections. Inappropriate insulin injection technique; inadvertent intramuscular (IM) injections; needle phobia and insulin omission negatively affect glucose control.Objectives. To document skin and skin plus subcutaneous skin thickness using high resolution ultrasound (US) in a group of children and adolescents with type 1 diabetes. In addition; injection technique; needle re-use and injection site analysis was performed.Methods. Commonly recommended injection sites were examined using high-resolution US. Patient characteristics such as age; body mass index; frequency of injections and favoured sites were analysed. Results. A total of 40 paediatric and adolescent children aged 4 years 3 months to 18 years were examined. The maximum skin thickness at any site was 2.93 mm. A high rate of IM injection was predicted with the standard 8 mm needle and was reduced but not eliminated with the use of the shortest available 4 mm needle. As the subcutaneous skin thickness increased across injection sites in the following order: arm; thigh; abdomen and buttocks; the risk of IM injection declined.Conclusion. Choice of needle length; injection site and injection technique are important considerations in diabetes management in the paediatric population and are likely to affect quality of glycaemic control. Shorter needles are more acceptable and reduce the risk of IM injections

Pattern of diabetic retinopathy in Kano, Nigeria

BACKGROUND:The aim of the study is to determine the pattern of retinopathy seen in diabetic patients attending the outpatient clinic in Aminu Kano Teaching Hospital, Kano, Nigeria. MATERIALS AND METHODS: Consecutive patients who were attending the diabetic clinic and who consented were examined over a three-month period. Information obtained includes patient's bio data, type and duration of disease, and findings on eye examination. The fundus was examined with direct and indirect ophthalmoscopes, +90 D with slit lamp and fundal photography. Retinopathy was graded using the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDRDSS). RESULTS: A total of 214 patients were examined during the study period. There were 88 males and 126 females (M: F = 1: 1.43). The mean age of the study population was 52.14 ± 13.23 years. The mean age of patients without diabetic retinopathy (DR) was 49.14 ± 13.17 years and the mean age of patients with DR was 58.51 ± 10.94 years. Forty nine patients (23%) had insulin-dependent diabetes mellitus (IDDM) while 165 patients (77%) had non insulin dependent diabetes mellitus (NIDDM). There was statistically significant difference in presence of retinopathy in patients with IDDM compared to those with NIDDM [X(2) =29.77 {95% CI}, P=0.000]. DR was significantly more common in patients with disease duration of 15 years or more compared with those with disease duration of 14 years or less [X(2) = 65.85, {95% CI} P= 0.000]. Based on ICDRDSS scale, 136 patients (64%) had no retinopathy and 78 patients (36%) had retinopathy. Some patients were visually impaired and the cause of blindness was DR in 6 patients (2.8%). Cataract and glaucoma were the cause in 6 patients (2.8%).CONCLUSION:Diabetic retinopathy is common in our environment and is more frequent in IDDM and those with long disease duration. DR is a cause of visual disability although diabetic patients are not exempted from blindness from other eye diseases such as cataract and glaucoma. A screening program needs to be developed to facilitate early detection and prompt treatment

Patients with Type 2 Diabetes and Difficulties Associated With Initiation of Insulin Therapy in a Public Health Clinic in Durban

Objectives: Many patients with type 2 diabetes are uncontrolled on maximum oral treatment. The early introduction of insulin can lower diabetes-related complications. The purpose of this study was to explore the reasons behind a perceived reluctance of patients with type 2 diabetes to commence insulin therapy despite objective evidence for the augmentation of oral treatment with insulin. Secondary objectives were to review the demographic data of these patients; to review the patients' knowledge of their disease and of insulin and to compare the knowledge and difficulties of those who agreed to be initiated on insulin with that of those who refused.Design: The study used an observational analytical design. All uncontrolled patients with type 2 diabetes on maximum oral therapy were interviewed using face-to-face interviews with open- and closed-ended questions.Setting and subjects: The study was conducted over a three-month period at the Phoenix Community Health Centre; a state-run institution; in Durban; KwaZulu-Natal.Outcome measures: The education level of the patients; their knowledge of the disease; understanding of insulin; family support and fear of needles and pain were notable outcome measures.Results: Fifty-nine patients were enrolled in the study. The mean haemoglobin A1c was 9.6. Level of academic education was not associated with a willingness to start insulin therapy (p-value = 0.426). Forty-seven per cent of the patients had no understanding of insulin. Forty-four per cent of the patients were willing to initiate insulin therapy and 55 refused. There was no significant difference in knowledge score between those who accepted and refused insulin therapy (p-value = 0.554). Seventy-nine per cent of patients were afraid of the pain associated with injections.Conclusion: As a fear of injections and needles was the only significant factor that was associated with the refusal to initiate insulin therapy (p-value 0.001); health professionals need to address this during patient education; so as to initiate insulin treatment successfully and timeously

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE

Insulin Resistance: Causes and Metabolic Implications

Insulin is an anabolic hormone that plays key roles in glucose metabolism. Insulin resistance is a decreased biological response to normal concentration of circulating insulin. In insulin resistance; normal amounts of insulin are inadequate to produce a normal insulin response from fat; muscle and liver cells. Insulin resistance in fat cells results in hydrolysis of stored triglycerides; which elevates free fatty acids in the blood plasma. In muscles; it reduces glucose uptake; whereas in the liver; it reduces glucose storage with both effects serving to elevate blood glucose. High plasma levels of Insulin and glucose due to Insulin resistance often lead to metabolic syndrome and type 2 diabetes mellitus. The cause of the vast majority of cases of insulin resistance remains unknown. However; it is claimed that insulin resistance might be caused by a high carbohydrate diet. Studies have shown that glucosamine (often prescribed for joint problems) may cause Insulin resistance. It is also reported that insulin resistance occurrence in a population increased as sugar consumption and addition of high fructose corn syrup to diets increased. Physical inactivity and obesity have been implicated as factors; which aggravate insulin resistance. The presumption that a defect in specific gene may cause insulin resistance is still under investigation

Diabetes Mellitus in Pregnancy

Before the discovery of insulin in 1921 by Banting and Best in Toronto; the life expectancy of diabetes was short. The few diabetic women who conceived and those who developed diabetes in pregnancy (nearly 30) died in diabetic coma as a direct result of pregnancy; while many more died within 2-3 years of confinement from concurrent tuberculosis (Williams 1909). The perinatal mortality ranged from 40-60

Pharmacologie de l'Insuline

La structure de l'insuline est connue et decrite. Les principes de la fabrication sont rappeles brievement. Le dosage immunologique est indispensable a toute etude in vitro. Il valut le prix Nobel a ses savants. Nous rappelons egalement la composition des differents types d'insuline; rapide ou retardee. L'insuline humaine est fabriquee d'une part par genie genetique et de l'autre par genie chimique. Diverses insulines sont mises dernierement sur le marche pour mimer de plus pres la secretion physiologique. L'insuline peut causer la presence d'anticorps de type divers

Pharmacologie de l'insuline

La structure de l'insuline est connue et decrite. Les principes de la fabrication sont rappeles brievement. Le dosage immunologique est indispensable a toute etude in vitro. L'article rappelle egalement la composition des differents type d'insuline; rapide ou retardee

L'insulinotherapie conventionnelle optimisee en Cote d'Ivoire : resultats preliminaires

"L'insulinotherapie de ""survie""; basee sur l'injection quotidienne unique d'une insuline d'action retard; est certes commode mais peu efficace en general. De ce fait; en depit des difficultes reelles liees aussi bien aux ressources materielles qu'humaines; les auteurs ont entrepris ce travail sur l'insulinotherapie conventionnelle optimisee. Le desequilibre glycemique principalement du a l'injection; represente la principale indication du traitement intensif. Celui-ci n'est efficace que dans 51 pour cent des cas au prix d'une hospitalisation longue (de duree superieure a 30 jours 28 pour cent des cas) et couteuse (119171;70 F CFA) en moyenne). Par ailleurs les effets collateraux et notamment l'hypoglycemie (30 pour cent de cas) sont nombreux et constituent l'ineluctable rancon du traitement"