Medical Guides

Having confirmed the diagnosis of diabetes, the crucial clinical question is whether insulin treatment is to be started immediately. While initiating the treatment, the following guidelines should be considered:

• In younger patients. If the age is less than 35 years and presents with acute symptoms, weight loss and ketonuria, the decision to start insulin is straightforward.
• In overweight or obese middle-aged or elderly patients, a trial of dietary changes and regular exercise should be tried initially, especially if they do not have severe symptoms.
• In normal weight patients who are symptomatic, oral drugs can be used initially, in addition to appropriate dietary and exercise measures.
Useful clinical pointers at diagnosis which suggest that
insulin may be required include:
• Unintentional weight loss preceding diagnosis
• Normal body weight or underweight for height
• Presentation with osmotic symptoms, i.e. increased urine frequency, increased thirst, etc., of short duration
• Marked fasting hyperglycaemia
Insulin cannot be taken by mouth because the digestive juices in stomach and intestine breakdown the insulin. Therefore it has to be administered by injections.