Fulbright Scholar, Consultant in Nephrology, Putnam Community Medical Center, Palatka, FL, USA; Courtesy Clinical Professor of Medicine, University of Florida at Gainesville, FL, USA; Mandal Diabetes Research Foundation, 665 State Road 207, Suite 102, Saint Augustine, FL 32084, USAUnited States
Also available as PDF (figures and tables appear in the PDF).
Although Diabetes Mellitus (DM) or sugar diabetes was identified centuries ago, it was not known why this metabolic disorder develops until JR Macleod and Frederick Banting made the discovery. DM is due to deficiency of insulin produced by beta cells of the pancreas. Prior to this discovery and its application around 1921, many people with this disorder died from diabetic coma. Thus insulin made a milestone in the treatment of DM, in early part of the 20th century and it is the same today. However, commercialism prevails in the care of DM with too much twist in the therapy. It is now the norm to prescribe oral anti-diabetic agents in all adults with diabetes called Type 2 DM. Oral anti-diabetic drugs lower fasting blood glucose and HbA1c but not 2h postprandial blood glucose. The latter is related to diabetic complications. Thus, although patients are not dying from diabetic coma because of insulin but they are developing whole gamut of complications which have increased the morbidity and mortality in patients with DM. Thus the emphasis of this article is to resurge the use of insulin as a gift of life for patients with DM and a therapy which permits a healthy and active life for them.
Keywords: Diabetes Diabetes Mellitus; Insulin Pancreatic beta cells; Postprandial blood glucose; Fasting blood glucose; Glycosylated haemoglobin; Gift of life Diabetic complications; Diabetes; Diabetes Mellitus; Insulin; Pancreatic beta cells; Gift of life; Diabetic complica- tions
1) Define diabetes or diabetes mellitus by obtaining fasting and 2h Postprandial (PP) metabolic panel. 2hPP glucose greater than 200 mg per dL establishes diabetes.
2) Insulin is the cornerstone of therapy in established diabetes. Insulin is a gift of life for diabetes, it prevents complications and allows subjects to live a healthy life except a few needle pricks a day 3) Blood pressure control is an integral part of diabetes therapy which reduces the risk of complications. Blood pressure control can be achieved with safe antihypertensive drugs 4) Use of ACEI/ARB drugs should be avoided. These drugs have no place in diabetes care.
5) Adequate glycemic control with insulin reduces proteinuria. Manipulation of proteinuria with ACEI/ARB invariably results in acute renal failure or chronic renal failure with progression to end stage renal disease.