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insulin treatment in Type 2 diabetes - Part 2

Insulin Type


Manufactured insulin can be either synthetic (human) or animal in origin, and falls into five main categories

• rapid-acting
• short-acting
• intermediate acting (also called isophane insulin)
• fixed mixtures (of rapid - or short-acting and intermediate-acting insulin)
• long-acting

Indications for insulin treatment

Strong indications for insulin therapy include:

• symptoms of hyperglycaemia such as polyuria, thirst, 
  recurrent fungal infections (especially genital thrush) or bacterial infections (especially urine infections
• pregnancy or planning pregnancy
• oral hypoglycaemic treatments not tolerated/ contra-indicated
• weight loss without dieting in someone of low or normal weight.

Possible indications for insulin therapy include:

•  unsatisfactory glycaemic control, even with the maximum tolerated dose of oral hypoglycaemic agents (OHAs) (HbA1c higher than 7 per cent, self blood glucose monitoring results higher than 7 mmols/litre before meals or 9 mmols/litre two hours after meals) 
• personal preference
• painful neuropathy
• foot ulceration and infection.

insulin treatment in Type 2 diabetes - Part 1

How Insulin Works

Put simply, insulin unlocks the ‘doors’ of cells to let the glucose in and it also suppresses liver glucose production. People with Type 2 diabetes may need supplementary injected insulin if they are insulin deficient and/or insulin resistant as a result of obesity or taking certain drugs, such as steroids, and where diet, physical activity and oral hypoglycaemic agents (OHAs) are no longer sufficiently effective in lowering blood glucose

Normal basal insulin secretion

The liver releases glucose at a relatively constant rate all the time, with a slight dip during the night and a surge before dawn.A steady release of insulin is therefore

needed to maintain normal blood glucose levels.

Normal meal-time insulin


As well as this 24-hour background insulin secretion, there is a burst of insulin at every meal -often called the meal-time bolus.Whenever glucose is released into the bloodstream from food, a matching release of insulin is required for up to two hours in order to move the
glucose into the cells. How long this increased insulin level is needed depends on the type of carbohydrate, its glycaemic index, and the fat content of the meal.

mechanism of insulin secretion

                          Normal Basal and Meal time insulin produced by pancreas

WOUND CARE GUIDELINES

The wound care guidelines have been developed by clinicians who are treating patients with wounds. They reflect current research and evidence based expert opinion.

The guidelines are intended for use as a resource for wound management and should be available to all medical,nursing and therapist caring for patients with wounds in Bolton Primary Care NHS Trust and Bolton Hospitals NHS Trust,Bolton Hospice and The Beaumont Hospital. Evidence based recommendations are included and a formulary of wound care products is included to promote rational prescribing.
These guidelines have been produced for use by any member of the healthcare team.

They are not intended as a substitute for professional judgement but are in support of the practitioner making an informed decision relating to the management of the patient,in accordance with individual professional competence.

Click at the book to download

Android Insulin Dose Calculator

Insulin Dose Calculator

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Ceftobiprole medocaril (Ortho-McNeil)

                         Fifth-Generation Cephalosporin

Another drug in development is ceftobiprole, which is in the midst of phase III trials for cSSSIs. Ceftobiprole is the first fifth-generation cephalosporin and also the first cephalosporin with activity against methicillin resistant Staph aureus (MRSA), according to Mark Kosinski, DPM, a Professor in the Department of Medicine at the New York College of Podiatric Medicine. Unlike other cephalosporins, ceftobiprole is designed to have a high affinity for PBP2a and therefore will be active against MRSA, adds Dr.Kosinski. As far as advantages go, he says the antibiotic offers gram-positive and gram-negative coverage, and also has a low potential to spur in vitro resistance.


The drug is parenteral only at this point, has good tissue penetration and has been shown to be active against Pseudomonas aeruginosa, according to Dr. Kosinski, a member of the Infectious Diseases Society of America.


Read More at Drugs development-technology

Versatile Wound Care Option - Dermacyn

Dermacyn™ Wound Care (Oculus Innovative Sciences). One newly developed modality may prove to be a worthwhile adjunct in facilitating good wound care. According to the
company, clinicians may employ Dermacyn, a super-oxidized and non-toxic water product, to help debride and clean acute and chronic dermal lesions, such as stage I to IV pressure ulcers, diabetic ulcers and post-surgical wounds.


Matthew Regulski, DPM, the Director of the Wound Center of Ocean County, N.J., uses Dermacyn for “any type of wound” at his facility. Those wounds include arterial wounds, venous wounds, immunopathic wounds and inflammatory wounds. Dr. Regulski’s staff pre-treats the wound with a Dermacyn soak for 10 minutes prior to debridement. He notes he will also use the product in conjunction with grafts, human growth factors and autologous platelet gels. In addition, Dr. Regulski uses the product in pulse lavage and with products like Versajet (Smith and Nephew) and VAC Therapy (KCI).


Calling Dermacyn “quite revolutionary,” Dr. Regulski cites a number of advantages. He notes it destroys bacteria, resistant strains, viruses, fungi and spores, and also can inhibit the release of histamine from mast cells and pro-inflammatory cytokines like TNF-alpha, IFN-gamma and interleukins. With Dermacyn, one can sterilize a wound in as few as three applications and Dr. Regulski adds that its sterilization properties are so effective that he now uses very little silver or cadexomer dressings. Dr. Regulski adds that Dermacyn is non-cytotoxic and non-genotoxic, and his patients have not had oral, ocular or skin irritations.