Insulin is NOT a first choice medicine in type 2 diabetes mellitus (T2DM).
Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash
1.
Exceptions:
- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)
@sambit_dash
1.
The guideline chart attached above is very clear - lifestyle modifications should be the first choice ± #metformin. Metformin is cheap.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.
2.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.
2.
Those <5% are at a secondary level care hospital, and not at primary care. In primary care, that number will be even lower.
For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.
3.
For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.
3.
Lifestyle modifications are more easily suggested than followed.
Only a few will forego their chance to eat "unhealthy", even when they know they shouldn't. While this is unfortunate, it is a reality - in the guise of "personal choice". More should be done about that. How?
4.
Only a few will forego their chance to eat "unhealthy", even when they know they shouldn't. While this is unfortunate, it is a reality - in the guise of "personal choice". More should be done about that. How?
4.
The statement from @fgodlee on insulin is a broad generalization, a 30,000 feet view, and from that point, she is right.
However, insulin is lifesaving for those who NEED it. Projecting all insulin use as unnecessary may be harmful to those who really need it.
5.
However, insulin is lifesaving for those who NEED it. Projecting all insulin use as unnecessary may be harmful to those who really need it.
5.
Her own words in the context of Cesarian sections in the article you quoted - "in some cases, it may be true but not in all cases" - is also true for insulin.
It's also very difficult to convince patients for insulin, even when needed.
@fgodlee @sambit_dash @ashwani_mahajan
6.
It's also very difficult to convince patients for insulin, even when needed.
@fgodlee @sambit_dash @ashwani_mahajan
6.
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