Insulin Conundrums . Veronica Green. Risk reduction. Risk reduction for each 1% reduction in HbA1c in type 2 diabetes. Amputation or death due to peripheral vascular disease. Any diabetes- related endpoint. Microvascular complications. Myocardial infarction. Cataract extraction.
Risk reduction for each 1% reduction in HbA1c in type 2 diabetes
Amputation or death due to peripheral vascular disease
Any diabetes- related
Risk reduction (%) associated with a 1% lower HbA1c
*p < 0.0001
**p = 0.021
Epidemiological extrapolation showing benefit of a 1% reduction in mean HbA1c with a mean duration of diabetes of 10 years
Oral + exenatide /
Diet and Exercise
V Green Byetta workshop 2
Will I do my patient any good?
Will their complications worsen?
Will it make a difference to the blood glucose levels?
Will they put on more weight?
Can this person learn to inject?
Is it going to make a difference?
What insulin to use?
Am I able and competent to do this?
What if something goes wrong?
Will this make me a drug addict?
What about my lifestyle?
Fear of hypos
My diabetes mild, I don’t need insulin
Treat with glucose
Release of glucagon, + stress hormones
Glucogenolysis, gluconeogenesis (liver/kidney)
Raise in BG