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Wednesday, January 03, 2007

Limits to Insulin Use in Diabetes


New forms of insulin, and the development of pumps which can be attached to or put inside our bodies, have certainly made diabetes management very close to having a normal pancreas. Indeed, there is even light at the end of the tunnel in terms of generating entirely new and healthy cells capable of producing insulin.

However, insulin dosing is always tricky business, and it is not as though taking unlimited amounts of it can return people with diabetes to the days of indulging in sweets and fats. Indeed, weight gain is common after starting insulin therapy, as the body begins to recover from the decaying effects of too much glucose circulating in blood.

Insulin is only available through prescriptions, so people with diabetes who use it know from their doctors about hypoglycemia, how to recognize it signs, and how to deal with it. Nevertheless, dangerous fluctuations in blood glucose levels are still possible when one is asleep, falls unconscious after an accident, or is even mildly unwell.

The delicate balancing act, to which one is subject with insulin, is not its only limitation. It is possible to have a surfeit of insulin circulating in blood, without glucose moving in to the cells where it is needed. A shortage of cell receptors may prevent insulin from acting. We know that losing weight is the best way to deal with insulin resistance, but excessive dosing may also reduce the receptor numbers over time.

Exercising regularly, moderation in eating carbohydrates, restricting fat and diary product intakes severely, and avoiding sugar altogether are the best ways of keeping insulin doses as low as possible, while keeping body cells full of receptors. These are things which depend on patient compliance, and there is little a doctor can do to correct matters if a patient becomes less and less responsive to insulin dose increases over time.


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