Insulin is a pancreatic hormone, regulating metabolism and lowering blood glucose levels. First used in 1922 to treat diabetes, insulin is still prescribed mostly for patients with type 1 diabetes, but the number of type 2 diabetes patients using insulin is predicted to see a two-fold increase globally by 2030.
An estimated 3.8 million people in the UK have a diagnosis of diabetes. Type 2 diabetes, where the body becomes resistant to insulin or does not make enough insulin, accounts for around 90 per cent of cases and type 1 diabetes, where the pancreas produces little or no insulin, accounts for around eight per cent of cases.
Poor diabetes control can lead to damage to the heart, blood vessels, eyes, kidneys and nerves. Access to safe and effective treatment, including insulin, is critical to managing diabetes.
Type 1 diabetes is managed using daily insulin delivered by injection or a pump. The National Institute for Health and Care Excellence (NICE) recommends a multiple daily injection basal bolus regimen for all adults with type 1 diabetes. A twice-daily mixed insulin regimen can be considered for patients if multiple daily basal bolus is not possible.
Patients with type 2 diabetes have a variable combination of increased insulin resistance and a gradual loss of pancreatic beta-cell function. Treatment will therefore change over time. Initiating insulin at the right time in type 2 diabetes and ensuring good glycaemic control improves patient outcomes and reduces the development of complications.
Annual checks such as HbA1c for long-term glycaemic control, blood pressure, cholesterol, eyes, feet and kidney function help to identify complications. Diabetes UK has produced a document – 15 Healthcare Essentials – explaining the package of care for patients.