Reasons for Delay in Insulin Therapy

Reasons for Delay in Insulin Therapy Although the reasons for poor glucose control amongst diabetics is complex, one concerning issue remains the reluctance of physicians and patients to begin insulin therapy. This has been widely documented, despite awareness amongst both caregivers and Type 2 diabetics of the increased health risks caused by inadequate glucose control. Diabetes, and the complications caused by poor management of the disease, are rapidly becoming a health concern of epidemic proportion in Europe and the United States. According to Celafu (2004), normal glucose levels are seldom maintained over time in Type 2 diabetics. â€Å"Even with early intervention and education, many patients with type 2 diabetes are unable to achieve treatment goals through lifestyle changes alone† (Anon 2005, 4). Oral antidiabetic drugs, the initial treatment for Type 2, â€Å"eventually fail to provide adequate glycemic control† (Anon 2005, 4). Targets are missed both due to the progressive nature of the disease and to a reluctance to initiate insulin therapy (Davies 2004). Davies (2004, S15), citing an unpublished study by the British Diabetic Association, reports that â€Å"in the UK a large dataset of over 600, 000 from across the country in the year 2000 reported a mean HbA1c of 8.6 in type I patients and 7.8 in type II patients.† This is significantly above the 6.5 recommended (Davies 2004). Funnell and Kruger (2004) similarly report that over half the Type 2 diabetics in the United States regularly exceed recommended glycemic goals, such as an A1C of less than 7%. However, they cite three large independent trials which all show significant A1C improvement with the introduction of insulin therapy (Funnell and Kruger 2004). Results from the 1998 UK Prospective Diabetes Study suggests that even a 1% Hb reduction can lead to a 21% reduction in diabetes-related death (Stratton et al 2000). Similar reductions also result in a 14% reduction in myocardial infarction, and up to a 37% reduction in microvascular complications (Stratton et al 2000). Reductions in peripheral vascular disease by over 40% are also cited (Stratton et al 2000). According to Davies (2004, S14), a number of studies show â€Å"unequivocally that reducing hyperglycemia reduces both the incident risk and progression of diabetic complications, with no threshold level of HbA1c beneath which further prognostic advantage cannot be achieved.† â€Å"Given the scope of the problem, clinicians need to identify type 2 diabetes early and initiate aggressive intervention to positively influence patients at risk for the disease and help prevent disease progression and associated complications† (Anon 2005, 3). â€Å"In order to achieve the suggested targets for glycemic control necessary to reduce the incidence of diabetic complications, it has been established that a more intensive insulin regimen† and earlier use of insulin is often called for (Cefalu 2004, 1149). Unfortunately, such early insulin use is uncommon (Cefalu 2004). Literature reviewed cites a number of barriers responsible for the slow introduction of insulin regimens to Type 2 diabetic treatment. Barriers on the part of patients typically include fear of injections, feelings of failure, misconceptions regarding the effects of insulin, and concern that the disease is worsening. Cefalu (2004) found that fear of pain and inconvenience of having to inject insulin greatly increases patient anxiety regarding initiating insulin. He concludes â€Å"a major limitation for advancing to intensive insulin therapy is that the only viable way to administer insulin is through injection† (Cefalu 2004, 1149). Davies (2004, S18) similarly found that in Type 2 diabetics, â€Å"needle phobia presents as a common additional barrier to good control.† Patients may also view moving to an insulin regimen as a indicator they have failed at other therapies, such as lifestyle management (Cefalu 2004). This can produce guilt over even minor incompliance in previous treatment, and cause the patient to want to â€Å"try harder† on their existing treatment plan rather than move to insulin (Cefalu 2004). In a recent survey, nearly forty percent of patients agreed that ‘Starting insulin would mean that I have not followed my treatment recommendations properly’ (Davies 2004, S16). Kuritzky and Nelson (2004, S11) additionally found that â€Å"well-intended practitioners may have inadvertently set the stage for patient nonreceptivity by portraying insulin as appropriate therapy for patients who have failed with oral agents.† Davies (2004) goes further, offering anecdotal evidence of practitioners who attempt to coerce non-compliant Type 2 diabetics into lifestyle and oral medication compliance by the threat of beginning insulin therapy. This can result in strong patient resistance to insulin when it is eventually called for (Davies 2004). This can even lead to belief that insulin indicates inevitable complications or death to the patient. â€Å"The perception is that use of insulin signifies progression to a more serious phase of their disease; some patients view insulin use as a ‘prelude to death’ (Cefalu 2004, 1152). Some patients also â€Å"mistakenly believe that insulin intensifies insulin resistance† (Kuritzky and Nelson 2004, S11). Others claim considerations of weight gain outweigh their desire for tight glucose control (Anon 2005). Physicians and caregivers more often cite hypoglycemia, obesity, and patients lack of coping skills as reasons to delay insulin initiation. Davies (2004, S16) found â€Å"concerns about causing hypoglycemic episodes or increasing patients’ obesity means that physicians may permit poor control to continue unduly by delaying the initiation or intensification of insulin therapy† and â€Å"regard insulin as treatment of last resort.† Instead, Kuritzky and Nelson (2004, S11) recommend â€Å"patients should be taught that insulin therapy is appropriate at any time during the course of diabetes to achieve glycemic goals.† Finally, those diabetics on insulin therapy are often on less than optimal dosages. Mayfield and White (2004, 489) conclude from their study of Type 2 diabetics that â€Å"statistics suggest that suboptimal insulin therapy is too common.† Nearly thirty percent of Type 2 diabetics use insulin therapy, â€Å"but less than one half achieve the recommended A1C level of 7 percent or less† because even physicians who are willing to intiate insulin therapy are hesitant to aggressively use insulin (Mayfield and White 2004, 489). REFERENCES Anon 2005. The Role of Basal Insulin in Type 2 Diabetes Management. Supplement to The Journal of Family Practice, October 2005, 2-8. Cefalu, W. 2004. Evolving Strategies for Insulin Delivery and Therapy. Drugs 2004, 64(11): 1149-1161. Davies, M. 2004. The reality of glycaemic control in insulin treated diabetes: defining the clinical challenges. International Journal of Obesity, 28(Suppl 2): S14–S22. Funnell, M. and Kruger, D. 2004. Type 2 Diabetes: Treat to Target. The Nurse Practitioner , January 2004, 29(1):11-23. Kuritzky, L. and Nelson, S. 2004. Insulin therapy in primary care: Practical issues for clinicians. Supplement to The Journal of Family Practice, June 2005, S10-S11. Mayfield, J. and White, R. 2004. Insulin Therapy for Type 2 Diabetes: Rescue, Augmentation, and Replacement of Beta-Cell Function. American Family Physician, August 1, 2004, 70(3): 489-500. Rizvi, A. 2004. Type 2 Diabetes: Epidemiologic Trends,Evolving Pathogenic Concepts, and Recent Changes in Therapeutic Approach. Southern Medical Journal, November 2004, 97(11): 1079-1087. Stratton et al 2000. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes. British Medical Journal, 321: 405–412. UKPDS 1998. UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998, 352: 837-853.

Avicenna (Ibn Sina) Essay

Abu ‘Ali al-Husayn ibn Sina is better known in Europe by the Latinized name â€Å"Avicenna. † He is probably the most significant philosopher in the Islamic tradition and arguably the most influential philosopher of the pre-modern era. Born in Afshana near Bukhara in Central Asia in about 980, he is best known as a polymath, as a physician whose major work the Canon (al-Qanun fi’l-Tibb) continued to be taught as a medical textbook in Europe and in the Islamic world until the early modern period, and as a philosopher whose major summa the Cure (al-Shifa’) had a decisive impact upon European scholasticism and especially upon Thomas Aquinas (d. 274). Primarily a metaphysical philosopher of being who was concerned with understanding the self’s existence in this world in relation to its contingency, Ibn Sina’s philosophy is an attempt to construct a coherent and comprehensive system that accords with the religious exigencies of Muslim culture. As such, he may be considered to be the first major Islamic philosopher. The philosophical space that he articulates for God as the Necessary Existence lays the foundation for his theories of the soul, intellect and cosmos. Furthermore, he articulated a development in the philosophical enterprise in classical Islam away from the apologetic concerns for establishing the relationship between religion and philosophy towards an attempt to make philosophical sense of key religious doctrines and even analyse and interpret the Qur’an. Recent studies have attempted to locate him within the Aristotelian and Neoplatonic traditions. His relationship with the latter is ambivalent: although accepting some keys aspects such as an emanationist cosmology, he rejected Neoplatonic epistemology and the theory of the pre-existent soul. However, his metaphysics owes much to the â€Å"Amonnian† synthesis of the later commentators on Aristotle and discussions in legal theory and kalamon meaning, signification and being. Apart from philosophy, Avicenna’s other contributions lie in the fields of medicine, the natural sciences, musical theory, and mathematics. In the Islamic sciences (‘ulum), he wrote a series of short commentaries on selected Qur’anic verses and chapters that reveal a trained philosopher’s hermeneutical method and attempt to come to terms with revelation. He also wrote some literary allegories about whose philosophical value recent cholarship is vehemently at odds. His influence in medieval Europe spread through the translations of his works first undertaken in Spain. In the Islamic world, his impact was immediate and led to what Michot has called â€Å"la pandemie avicennienne. † When al-Ghazali led the theological attack upon the heresies of the philosophers, he singled out Avicenna, and a generation later when the Shahrastani gave an account of the doctrines of the philosophers of Islam, he relied upon the work of Avicenna, whose metaphysics he later attempted to refute in his Struggling against the Philosophers (Musari‘at al-falasifa). Avicennan metaphysics became the foundation for discussions of Islamic philosophy and philosophical theology. In the early modern period in Iran, his metaphysical positions began to be displayed by a creative modification that they underwent due to the thinkers of the school of Isfahan, in particular Mulla Sadra (d. 1641).

Magazines articles Essay

I enjoyed multiple stories in this film. The first story that stood out for me the most was the mother who had cancer. This story was extremely sad for me because I could not picture my mother in that position. I believe they are communicating through filming because the mother wants to put her story out there. By watching this film the mother seems like she is a strong person who does not mind putting her story out there because she does not want anyone to feel like they are the only ones going through this experience. My reaction was surprised when I saw her marks on her back from the cancer. I did not think she would show that on camera to the world. In her case I believe that verbal communication was the most affective especially when she was talking to her son. The next story that stood out for me was the older couple who wrote their vows for each other. I found that clip humorous. I believe for them communicating verbally is special for them to share what they want for each oth er. Just from watching their clip I could get an insight of their life just by the way they jokes with each other in their vows. It is easy to tell that they have a strong marriage and are not afraid to joke around with each other. The next story that made me think was the story of the women from Afghanistan. This story was interesting to me because for Americans it is portrayed that the women in Afghanistan have no freedom and are controlled by the men in their life. Showing the women doing karate was an eye opener because it showed me we do not know everything that is going on in Afghanistan. Just because one part of Afghanistan may be a certain way does not mean it is all like that. Non verbal communication made the most impact because just seeing the women doing something they enjoy meant a lot. No words can describe that better than seeing the looks on the women’s faces when they are enjoying themselves. Being in different countries sometimes you can’t believe everything you see in politics or see on the news and media. This clip was a perfect example of that. This whole video made an impact on me because it showed me that when I am laying in my bed with all my blankets and pillows there are many people out there my age sleeping on the streets with no food or even shelter. When I am riding the bus to class somewhere around the world a young man or woman is carrying all of their belongings on their back.

The Current State Of Renewable Energy Consumption Between...

Target 7.1: Dimensions can be created to track the progress of this target however, they are difficult to quantify. This is due to the fact that the metrics which can be created to measure this target depend on what the key elements of the target (such as universal, affordable, reliable, and modern) are agreed to be defined as. What is considered to be affordable/reliable/modern can be subjective especially in a global context. Therefore, the dimensions can be measured, however the target itself is not truly measurable. Target 7.2: The global energy mix is the breakdown of the consumption of primary energy sources. The breakdown is based on the geographical regions of the world (Planà ¨te Énergies, 2015). If the different types of energy in regions all around the world can be measured as a percentage, then they can be tracked and measured over time. This will allow for the comparison of the current state of renewable energy consumption between today and 2030. Target 7.3: Improvement is difficult to measure because it is very subjective and relies heavily on the context that it is placed in. However, the use of a global rate and energy efficiency as measures of this target allow for easily quantifiable dimensions since they rely on mathematical equations. So long as the standards for â€Å"improvement† are set, this is a measurable target. Target 7.a is a broad and general target with many components. Its separate components (such as access to clean energy research and technologyShow MoreRelatedThe Global Trend Of The European Union1260 Words   |  6 Pagesscarce resources energy efficiency and renewable energy become increasingly important. It is also well-known that the climate-change as a result of high CO2-emissions, among others, can only be stopped or at least slowed down by reducing these emissions. 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