Type 2 Diabetes: A Case Study

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Type 2 diabetes (T2DM) is the most common form of diabetes accounting for 90-95% of all cases (American Diabetes Association [ADA], 2016b). T2DM is characterized by insulin resistance and progressive β-cell failure. This combination frequently warrants the eventual addition of exogenous insulin along with upward insulin titration to achieve glycemic targets (ADA, 2016; Lamos, Younk, & Davis, 2016; Ovalle, 2010). For many highly insulin resistant individuals, this may include doses in excess of 200 units per day. The intent of this paper is to share criteria used to assess a patient’s degree of insulin resistance and identify potential barriers to standard insulin therapy. Potential options for matching high insulin requirements with currently available insulin therapies will be explored and the impact of such therapies on healthcare costs will be examined.
For patients with T2DM the ADA (2016a) recommends initiating insulin with either 10 units per day or 0.1 – 0.2 units/kg per day as a safe starting …show more content…
However, it is important to consider the factors that may further exacerbate the underlying insulin resistance that is inherent inT2DM. Similar to adolescence, insulin resistance develops or is further exacerbated by pregnancy. Several drugs can also contribute to insulin resistance. These include and may not be limited to glucocorticoids, niacin, HIV-1 protease inhibitors, and antipsychotics. Insulin resistance can also be further amplified when other disorders coexist. Such disorders include acromegaly, thyrotoxicosis, insulinoma, glucagonoma, Cushing’s syndrome, ketoacidosis, and pheochromocytoma. Patients also typically experience insulin resistance following severe stress, which could be the result of surgery, trauma, or sepsis. Additionally, insulin resistance is known to increase with age (Ovalle,
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